Mr. Dónal Clancy:

The risk equalisation system in this market should start by saying that there is a standard, core set of benefits to which everyone is entitled. After that, if a person wants additional services, they can be risk-rated and the customer must pay for them. That can differ from facility to facility or by geography. A person may want cover for a particularly active life, for travel abroad and so forth, while another person may never move outside the parish. These are all elements that can be added in, but fundamentally, the core standard set of benefits should provide the essential cover that a person needs as a citizen and must be community-rated across the board. If we are going to arrive at a meaningful universal health insurance system, we must have this in place. We must be in a position to say there is a standard product, that is where the future lies and the entire market will operate on that basis and that is the basis on which subsidies in the fund should cross over. We must protect the elderly and the sick but we must do so on an equalised basis on a standard product, and not on the range of products that are available right now. As Mr. Dowdall pointed out, there are people who are barely hanging on and who will be paying €350 from 1 April, compared with €150 only two or three years ago. That is a substantial difference. At the same time, there are people on the high-value options, paying between €3,000 and €4,000 for cover. While we welcome such customers because they are going into the pool, they are paying the same levy as everyone else.

The subsidisation across those products, even within our plans, is the same as it is throughout the market. It is simply not right. It is an inequity and it should not be there. The roadmap of the future of universal health care and reaching the needs of everyone is set out and this gives us a good option of having a standard core set of benefits.

Reference was made to the levy as it is set now and the way it has jumped. The intention was to have an advanced and a non-advanced level, as Deputy Kelleher suggested, with apportioning of the products. Unfortunately, it is set at a level which deems no one to be in that category and no one will qualify either because no one can afford 66% coverage of private facilities. With the majority of operations, the average person will be stretched to cover the balance of 34%. That is a fundamental issue. The point has been highlighted here already but private cover in a public hospital at the moment is €1,046, semi-private cover is €933 and day-case cover is €753. We can discuss efficiencies and so on but many procedures are carried out in the wrong settings in public hospitals. People are being charged for day-case procedures - that is, €753 for procedures that take place in public hospitals - but such procedures should be carried out not in a consultant's surgery but in a general practitioner surgery.