Mr. Declan Moran:

In the context of hip replacement, there is a prosthesis cost involved on the private side. Quite often, this would make the procedure as expensive as that carried out in a public hospital. In public hospitals, one pays a flat charge and one does not pay for the prosthesis. It is much cheaper to have a procedure which does not involve a prosthesis in a private hospital. There is no definitive answer in this regard. It depends on the procedure involved and the additional costs that will be incurred. As a result of the fact that we pay package procedure prices in private hospitals, one generally finds that turnaround tends to be faster, admissions tend to be quicker, they ensure the correct person is being treated and so on.

We have more influence in respect of the settings. This goes back to Deputy Conway's question with regard to impediments to making things happen. In the private system, because we have a contract, we can explicitly state that we will only pay for a particular procedure if it happens on a side room basis. If it is done on a day care or inpatient basis, we will only pay the side room rate regardless. That is not the position when it comes to public hospitals. We would, however, absolutely like it to be the position. I suspect that once the contracts to which I refer are put in place, insurers gain influence and can drive behaviours in private hospitals. If we could do the same in public hospitals, we would also be able to drive behaviours there and not just to be benefit of ourselves but also to that of the public hospital system.