Dr. Fergal Lynch:

It is a series of issues. In particular, it is related to rising costs generally in the health sector throughout the last number of years, which have been very significant. The Minister has made his concerns at rising costs very clear. He is concerned to restrict the increase in costs and to address costs in different areas. There have been particular concerns, for example, about payments to individual health professionals and payment by procedure. We are back to the earlier examples of the per diem versus procedures-based charges. We are doing a number of things to eliminate costs. We have been working with the consultative forum to identify ways to reduce costs. It is very important to ensure that in doing so we do not offend against competition law. We are addressing other market issues by examining areas in which costs can be reduced. In particular, we are encouraging the VHI and others to address clinical audit, etc. We are pushing a series of things through the consultative forum and elsewhere. The clinical programmes which have been rolled out over the last while have considerable potential to address costs. We must acknowledge, however, that we have an aging population and it is increasingly difficult to hold costs down.