Mr. Jim Dowdall:

It is really refreshing to hear hard questions being asked by the committee. These are above all the questions that we need to focus on. We need to maintain that focus in future because there are serious issues in the health insurance industry at the moment that are significantly affecting all health insurance consumers and, by extension, people who depend on the public health system. We see a significant number of people falling out of the health insurance market and into an overburdened public health system.

Deputy Naughten specifically asked about the hospital bed utilisation charge and what efforts are being made to move away from it. GloHealth had full cover for day case procedures and treatment in our plans. The irony is that under the new health insurance levy there are two tiers and we can no longer provide full cover for day-case procedures on the lower tier. We have to strip it back to 66%. Let us consider the type of people who are forced to buy lower level plans: they are people who cannot afford a higher level of cover. Therefore, we are penalising those people more. They will have a lower level of cover and a significant shortfall in the cost of procedures that are being carried out. We should find a way to encourage and facilitate insurers to provide full day-case cover on lower level plans.

Deputy Naughten asked about the gold-plated subsidy and whether it was the case that people on lower level plans were subsidising people on higher level plans. That is absolutely the case. Let us consider the numbers. From the end of March people on lower level plans will pay 53% of the cost of health insurance towards the scale of the levy. That is vast and absolutely not acceptable. Their costs are going up by 10% at the end of March simply to facilitate the increase in the health insurance levy. The Minister could change this. This relates to the 330,000 people referred to by the Department and the Minister who are on lower level plans. This could be corrected and the scale of increase does not need to be passed through to them.

There was some debate about the costs from health insurers and their ability to negotiate on costs. Some 40% of the premium cost of a typical health insurance plan is now due to the health insurance levy, and up to 40% of our claims typically relate to the public health system. We have no ability to negotiate in either of these areas. We have no ability to intervene or negotiate on the most significant part of the costs health insurers pick up, and that needs to change.

With regard to some of the comments of our colleagues in the VHI and other insurers, I agree absolutely that the model needs to change. Deputy Kelleher made some remarks in this regard as well. He asked about discussions with the Department and broader discussions, and asked how open the conversations are. My view is that there is a need to develop this area and make it more meaningful. For example, GloHealth asked at the most recent health insurance forum meeting for a detailed analysis to be carried out on the affordability challenge. What will happen to the market when the increased charges come through for the levy and the public hospital costs? This call was supported by all the other insurers, but unfortunately the Health Insurance Authority did not agree that the analysis needed to be carried out.