Professor Sean Tierney:

I presume Deputy Humphreys is referring to universal primary care and the reluctance of GPs to get involved. That is far from the case. Over the years, our organisation has consistently shown that we are committed to universal primary care as the first step in universalising access to health care.

We need to be careful how we do this, however. Everyone in the country is entitled to free hospital care, with some charges, and yet we have a large private secondary health care sector. We need to plan carefully the introduction of universal primary care to ensure it provides an adequate level of service to everyone. We want to see the kinds of benefits we heard about in the earlier session, where people who feel there is proper health care available to them when they need it and good education available to their children when they need it will be happier to pay for those kinds of services.

We are not opposed to universal primary care. We are anxious to introduce it. On a number of occasions, we have endeavoured to open negotiations on the issue with the Department of Health, the HSE and the Minister, with limited success to date.

Our organisation does not have information on individual GP's costs, nor do we provide them with any guidance or have any role in what they charge. That is, obviously, due to competition legislation. What Deputy Humphreys describes may simply be an effect of the market. The cost of providing services has gone up rather than down. For example, compliance with the new requirements of the Medical Council to ensure professional competence has added a significant additional cost to GPs each year. We have all seen our insurance policies go up. The cost of transport has gone up. As in other industries, costs have gone up.

I cannot answer the Deputy's question about what individual GPs are charging, because we do not have any information on that. This might, however, indicate that market-based reform may not be the solution to all our problems in health care. In our submission, we highlighted this fact, and we have produced position papers in the past on the marketplace as a solution to health care provision. We need to be careful in how we reform how health care is funded. A system based on competing insurers and competing for-profit providers, particularly when insurers are also for-profit, is likely to lead to increased costs and reduced access to health care.

We would warmly welcome discussion on that issue. It is, perhaps, not a matter for today, but a very useful paper was published yesterday by IMPACT on this issue and a number of other studies have been done. I raise the matter today because there has not been much debate about it in the Oireachtas or in public. We are anxious to enter into it and we have produced several policy papers on the matter which are available on our website.