Mr. Dónal Clancy:

It varies. Consultants receive the same amount of money regardless of whether they perform the procedures in their surgeries or in their rooms. The hospital obtains the additional benefit of the day case rate. In some cases it results from the fact that a surgeon will have his rooms in the hospital out of which he normally operates. In such circumstances, he or she will state that the charge applies because he or she is obtaining consumables from the hospital involved. I do not believe this is correct and we do challenge it. In some instances, people have put their hands up in respect of this matter. However, there are particular institutions which state that if we do not facilitate their particular way of operating, they will not do business with us. That is extremely difficult for insurers to deal with, particularly if they are not game players. Progress is being made but it remains a problem. Perhaps Mr. Jaggy might provide examples of what happens elsewhere in the context of the public-private mix.