Mr. John O'Dwyer:

Of course. The most recent OECD analysis on length of stay was conducted a few years ago. It showed the average length of stay was over seven days, and ranged from four days in Mexico to 15 days in Japan. Ireland came in at just over seven days and the VHI is 6.1 days. Therefore, any comparisons, internationally or otherwise, on length of stay clearly stack up. We are obsessed with ensuring people have their treatment carried out in the lowest setting.

On cost, we negotiate a package price with the private hospitals, based on length of stay. Therefore, it is the same price for a hip replacement whether the person is in for five or eight days and there is no incentive to keep people in a private hospital. These kinds of remuneration arrangements are very acceptable internationally and drive down costs. We do not have the same privilege of negotiation in public hospitals. Where somebody stays in a public hospital, we do not have a package price and the patient's bill is on a per day basis. We would welcome the facility to negotiate with public hospitals in the same way we negotiate with private hospitals.