Mr. John Armstrong:

We would be happy to respond to any queries members have on it in the short term.

On objectives, quality is a key issue in my mind, as well as equity and efficiency that Senator Crown mentioned. Everything in the system should be structured to encourage that as an objective. That brings in issues of competition, package design, etc. The risk equalisation system can be done to encourage quality. The German system encourages insurers to provide disease management programmes. That will attract younger people into the system. It is something that can be done.

One of the issues we raise in our submission is our capacity as a country to introduce UHI. I have worked in many different countries on UHI projects and all the countries tend to be significantly larger than our country. It is a challenge that, because of our size, there will be much change within the hospital system and within the public policy area.

Those issues will need to be addressed in some way. It is very important to get some international expertise and collaboration in that regard.

I agree there will be at least a significant change in the way the cost cake will be split between various groups in society and it is something we need to particularly watch out for in the introduction of UHI. That can be addressed in some of the policy decisions that need to be made in terms of tapering levels of subsidies. In terms of whom the State pays for, it should not be a "Yes" or "No" but should be tapered in some way based on one's income levels, etc. There are mechanisms that can be introduced to address those.

Deputy Naughten asked about the public hospital issue. Obviously there are some ways to do it. It is a very significant part of our budget system. Procurement is regularly mentioned as an area that can be done obviously. When the UHI system is introduced we will have to find ways of integrating the public and private systems in some way, which will be a big challenge as will be developing competition between the two parts of the system. Management of costs within the public system will be key to that. It will make it quite difficult to-----