It is hard to say, but what has really worked for me in my career has been having people who have believed in me and supported me. The single biggest support for me in my career has been my family. While there were different risks involved at different stages, it was a team effort in a huge way. My career has been really important to me, but it is still only a small part of my life. What is most important and most rewarding for me is how my family has grown up. That is what I am most proud of. the night to continuously try to get them to sign forms. People are being sent forms after they’ve been discharged looking for a signature so that the hospital can actually charge for services that weren’t provided.”
Dowdall believes that some of the country’s public hospitals see it as a revenue-raising measure.
Insurers had been told at the time that the measure would raise an extra €30m to €45m of revenue for the government: “It quickly went up to being an opportunity for a cash grab for some hospitals and it is now raising around €150m. The commitment from the minister was that if it raised more than that it would be changed and it hasn’t been changed.
“The HSE, in my view, see this as an opportunity to raise money and doesn’t consider the implications for people and doesn’t consider whether this is right. The challenge is to put some integrity back in the system.”
Dowdall believes the health system in Ireland is too politicised and that sometimes decisions are made on the basis of the next election cycle: “We can’t make decisions that are localised and short-term. We need 10- or 20-year views and start responding to the challenges of increased population and growing obesity. The obvious example of this that has worked is a decision to develop centres of excellence rather than having too many hospitals trying to be all things to all men,” he says.
When Dowdall first became involved in the health insurance market the key focus for new incumbents was just how to survive alongside the monolithic VHI in a system that he and others vociferously argued was weighted heavily in its favour. With Laya and Irish Life now controlling half the market, the previous rows about community rating and risk equalisation — a mechanism to allow people pay the same for health insurance regardless of age — are no longer quite as pressing. But, he says, in reality not much has changed.
“The current system that we have is not sustainable into the future at a time when we have a significantly ageing population. We are so dependent on bringing in younger people to the system to subsidise the costs of older people and we don’t do that today. We have a health insurance levy scheme that is a very significant cost and is completely inequitable.”
That scheme means adults are charged a government levy of €444 regardless of their level of cover. So a young person on a basic plan that costs €1,000 a year includes the same levy as someone who is paying for the most expensive €6,000 plan.
“So one person is paying a levy of over 40pc while another is paying as low as 7pc. That has to change and a percentage model has to be introduced.”
So why are such seemingly obvious and equitable changes not being introduced into the market? Dowdall believes that it does not help that the regulator reports into the Department of Health and the same department sets the charges for access to the public health by insurers, not to mention that it also owns the largest health insurer in the market.
“People are slow to change and slow to recognise that there is a better system and we need to evolve towards it.”
As he sits back and enjoys the brand new innovation hub built by a parent company looking to make a big splash in health insurance, it is hard not to get the sense that Dowdall will be staying at the cutting edge of the sector, wherever that will take it next.