BUSI­NESS LESSONS

Sunday Independent (Ireland) - Business & Appointments - - FRONT PAGE -

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.

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