Mr. John O'Dwyer:

Elderly customers do shop around but clearly young people shop around more. That happens in all businesses, not just in health insurance.

I will try to cover a couple of questions. Somebody asked about what we are doing to drive down costs. As part of my presentation, I gave some examples. We have moved many procedures from overnight settings to day case or indeed side room settings. Over the past number of years, in excess of 150 of these were moved. We have also significantly reduced lengths of stay. For example, hip replacements a few years ago used to be 14 days in hospital. Now they are seven days. I think hysterectomies were ten days and are now five days. Knee replacements were ten days and are now five days. To do this, we have a team that consistently looks at best practice throughout the world. Other examples in costs include cardiac stents, which was reduced from approximately €1,000 to just over €200 within a new years. One with which we are probably more familiar with is an MRI. A few years ago, an MRI was €600 or €700. The VHI ran a very competitive tendering process and our average price for an MRI including the consultant's fee is now approximately €160. Our information shows that this is the second lowest in Europe. I am not trying to claim in any way that the VHI or the industry is perfect but we consistently make every effort to drive down costs.

Somebody asked what the Minister should do. As insurers, we negotiate with private hospitals separately. Each one of us has its own separate contract and pricing arrangements with private hospitals. I understand that the same applies with consultants. Regarding public hospitals, it is a stated price with no negotiation. As an industry, we would be very pleased to enter negotiations with public hospitals to make sure we get the efficiencies and drive down costs. They are the key points.