Mr. Tony O'Brien:

I will ask Mr. Woods to respond to Deputy Durkan's question on the issue of demand and capacity and to Deputy O'Connell's question regarding the definition of a portable solution.

On private health insurance, the issue raised by Deputy Kelleher is an important one. However, it is important to bear in mind that although the level of utilisation of private health insurance has fluctuated little over the last decade, it currently stands at around 50% of the population. The private health care sector in Ireland is not big enough to meet the demands for services of that proportion of a population. In addition, there are a wide range of services that are best provided currently from the multidisciplinary university level teaching hospitals that are in the public sector, particularly trauma and some major interventions. In the context of what is happening now, patients who present with private health insurance and who consent to so do generate a bill to their private health insurer.

In the past, whether a bill could be raised was entirely dependent on the fairly antiquated and out-of-date designated beds process. This meant that in many instances the public health system was not recouping any income for patients who were being treated privately. We have gone from one clearly unsatisfactory situation to another. The notion that all privately-insured patients could and should be directed to private hospitals is not a realistic option at present. The private hospital system is simply too small.