Mr. John Armstrong:

There are a couple of questions left, namely, those on the mid-year moves in terms of the double levy and the advanced and non-advanced plans. The issue Deputy Naughten raised on the Finance Bill has emerged in recent days. We have already started talking to the Department about it. I subscribe very much to what Mr. Clancy said. It is one of the unforeseen consequences of moving and the changes we made. I urge the members of the committee to examine this carefully as the Finance Bill moves through the Oireachtas. We have been engaging with the Department on it. We will need to continue doing so. It is a technical change but it will have quite significant implications.

With regard to the advanced and non-advanced plans, there is obviously much discussion. Having a standard plan, which we proposed originally, could largely get around the problem. The difficulty in wanting to have an advanced-plan and non-advanced plan structure is that it involves a move to making choices and to choices having to be made. Obviously, the interpretation of the legislation was regrettable from our side in terms of the advanced aspect. It raises issues associated with the procedure in respect of lower-level plans. We have been considering moving to a standard plan. We would advocate it.

Let me address a couple of points that Senator Crown raised. His first question was a quick one but it raised quite profound issues over incentives we want to build into the system. Having the stopping of smoking as a public policy objective needs to be considered carefully. We have tools within the regulations to create incentives, and the incentive in question is a good one that we may want to act upon. I would certainly be keen on examining the modification of community rating to allow for it.

There is a range of issues associated with universal health insurance. The process will be very complicated. I have worked in a number of countries and noted they all have quite serious issues with the implementation of universal health insurance. Many of the issues we have addressed today will need to be solved in some way in terms of bringing in effective universal health insurance. They will need to be considered.

The experiences of the VHI regarding public and private beds are similar. This raises the issue of the inability of insurers to negotiate contracts with public facilities. It hampers their ability to create the right incentives in connection with shorter lengths of stay, trying to discharge patients earlier and getting people into day-care services, etc. The ability of insurers to negotiate contracts individually, perhaps as part of the new groups, would be an important and significant step in that regard.