Ms Cliona Loughnane:

Yes, I apologise, that was just an example.

A number of questions related to private health insurance and the reason we are talking about a tax-funded model. In the Health Reform Alliance, as Deputy Naughton mentioned, we are focused on the outcome. All we really care about in this process is that the quality of care for patients is maintained and then improved and that the outcomes for patients are better. We would not claim to be the experts as to how we get to that system, we are really focused on patient outcomes. As for the reason we are talking about the tax-funded system, it is based on not developing a system from nothing. We must work with the historical system we have inherited and the evidence shows that our system is really a tax-funded system. Moreover, until we can show that disrupting this system or moving to a completely different model would be more effective, it seems that the pragmatic approach is to work with the system we have and see how we can improve it. In its recent report, the ESRI also made the point that it is pragmatic, particularly in primary care, to consider how one can extend out tax-funded access to universal access to primary care, because that is how it is going at present in the increased provision of medical cards for different ages and medical needs and so on. Consequently, the reason we are talking about the tax-funded system is it seems that we have inherited a certain system within which we should work. In addition, I am sure members have heard evidence from health economists that tax-funded systems tend to be much more efficient. They tend to be less costly because of their nature. One is pooling together all the funds and there are economies of scale. One is not obliged to account for the cost of competition, for marketing between different health insurers and so on. The evidence appears to lead us towards a taxation-funded model or a social health insurance model if we are talking about an efficient, affordable system.

As for private health insurance, we all accept there always is a role for private health insurance and probably always will be. I do not believe there is any system in the world that does not have some level of private health insurance. The Irish system is particularly unusual because upwards of 40% of people hold private health insurance at present but as I stated, its actual contribution in paying into the system is quite limited. When one looks at how a person benefits from private health insurance, one really is getting early access to a consultant, as well as access to diagnostics, that then allow one to access the public health system. Again, this is a unique aspect of the Irish system. In other systems, if one had private health insurance, one more than likely would be treated by a private consultant in a private hospital. However, within the system we have, one has private health insurance but actually is treated by somebody in a public hospital on a public contract who is using the portion of his or her contract that is for private health insurance. It is an agreed part of our system but it is highly unusual. The Health Reform Alliance certainly would not state that we do not envisage any role for private health insurance. It is a choice that people will make. It simply appears that in Ireland, a great number of people seem to be making that choice because they have difficulty accessing the public hospital system.

There was a question on whether, as one moves towards universal provision, a move away from private health insurance can be discerned and that certainly is the case. As I stated, the level of private health insurance in Ireland is highly unusual. I am not entirely sure of the figures in the United Kingdom but I think fewer than 10% of people hold private health insurance, which indicates that because they can get access to the service, there is not the same level of requirement. Again, within the NHS it is split into two systems, whereas in Ireland we have a layering together of the two systems. There was another question about the HSE, its structure and whether that is capable of providing a universal service. That is a very broad question. We were talking outside earlier about some of the real gains that have been made by the HSE in recent years, particularly in the clinical care programmes and in respect of models of care.

The Irish Heart Foundation is particularly interested in stroke. There have been real developments in how stroke patients are being cared for, particularly in the acute service. The HSE definitely has the potential to provide care of a good quality. It is a question of how we can improve the structure we have in Ireland. There are different types of tax-funded systems. We have a single provider of care - the HSE - in Ireland. There are multiple providers in the UK as a result of the system that was introduced there in the 1990s. Even if we decide to focus on a tax-funded system, we will have to consider the various ways of providing for that. As has been said, a number of decisions have to be made along the way.