This time it is with Level Health,<\/a> a joint venture with insurer Aviva Insurance Ireland<\/a>, which celebrated its first anniversary this month.<\/p>\n \u201cWe may be the newest brand in the market, with a fresh and innovative approach, but we\u2019ve actually got over 200 years of health insurance market experience between us,\u201d says Jim Dowdall, chief executive of Level Health, of the reformed four-piece that includes chairman Oliver Tattan, chief financial officer Stephen Loughman and chief commercial officer Ruth Bailey. <\/p>\n [\u00a0Level Health files complaint in Brussels about subsidy scheme that helps Vhi mostOpens in new window<\/a>\u00a0]<\/p>\n \u201cOur view is that there is unfinished business in the health insurance market.\u201d <\/p>\n The number of private health insurers is now double the two \u2013 VHI <\/a>and Bupa Ireland \u2013 that were in the market when the veterans launched Vivas Health 21 years ago. Covered people have risen 20 per cent to 2.52 million, while industry premiums have almost quadrupled to \u20ac3.6 billion. Yet, some things, Dowdall notes, haven\u2019t changed.<\/p>\n The most frustrating, he says, is the ongoing subsidy model for older and higher-risk citizens with health coverage \u2013 of which State-owned VHI, which still has a grip on almost half of the market, remains the main beneficiary. <\/p>\n Under the risk equalisation scheme (RES), in existence in Ireland for decades and in its current form since 2013, health insurers whose customers have a higher risk profile than the market average, obtain payments from a risk equalisation fund. This is part of the Irish \u201ccommunity rating\u201d health insurance system, where everyone pays the same premium for a given policy, regardless of age or health.<\/p>\n \u201cWe\u2019re not against risk equalisation,\u201d says Dowdall. \u201cThere\u2019s a need for it in the market. But the nature of it is completely flawed.\u201d<\/p>\n The main problem is the fixed rate levies that apply to policies, which, he argues, penalises younger people, in particular, looking to take out health insurance. <\/p>\n Our intention is that we\u2019ll be at over \u20ac100 million in premium in the next two years and that we\u2019ll reach \u20ac350 million in premium three years after that<\/p>\n \u2014 \u00a0Jim Dowdall<\/p><\/blockquote>\n The stamp duty levy on the vast majority of adult policies stands at \u20ac469, and is set to rise to \u20ac517 next April. <\/p>\n \u201cYounger people, who typically opt for lower levels of cover, might pay \u20ac900 or \u20ac1,000 for a health insurance plan. But about 50 per cent of that is levy-related,\u201d says Dowdall. <\/p>\n By contrast, the levy accounts for about 25 per cent of the \u20ac1,830 average premium in the market and under 5 per cent of the most expensive, bells-and-whistles plan, which costs about \u20ac10,150 a year. <\/p>\n \u201cWe should be encouraging more young people to take out health insurance,\u201d he says. \u201cThat would reduce the cost of providing coverage across the board.\u201d <\/p>\n CV<\/b><\/p>\n Name:<\/b> Jim Dowdall<\/p>\n Position:<\/b> CEO of Level Health<\/p>\n Lives:<\/b> Castleknock <\/p>\n Family:<\/b> Married to Jeanne, has three adult children \u2013 Cian, Aoibhinn and Caomihe \u2013 and a two-month old grandchild, Scott <\/p>\n Hobbies: <\/b>He has been an active long-distance runner all his life, having completed marathons, ultra marathons and ironman triathlons. <\/p>\n Something about Jim that might surprise:<\/b> He developed his love for long-distance running when he ran the first two Dublin Marathons as a teenager in 1980 and 1981<\/p>\n Something that you might expect:<\/b> \u201cI believe the Government needs to do much more to support entrepreneurial risk-taking in Ireland.\u201d<\/p>\n Level Health filed a detailed complaint last month to the European Commission on the operation of the scheme, with the Department of Health known to be eyeing a 10-year extension of the plan when the current scheme expires in 2027.<\/p>\n \u201cVHI\u2019s position is artificially augmented and strengthened by the RES, to the detriment of the few other businesses willing to compete in the Irish market,\u201d Level Health said in a statement on the complaint. \u201cUnlike other economic sectors which were liberalised [in the 1990s], health insurance has never delivered to the consumer the full benefits of competition because of the way in which the RES has been designed and operated.\u201d <\/p>\n The complaint outlines a series of alleged breaches of European Union (EU) law, including abuse of dominance and the granting of special and exclusive rights, the granting of unlawful state aid, and infringement of the freedom to provide services. All would defy the Treaty on the Functioning of the European Union, the rule book for how the union operates. <\/p>\n Dowdall argues that there should be more than four players in the market. \u201cThere should be six or seven,\u201d he says. <\/p>\n \u201cBut I would argue that the Health Insurance Authority<\/a> and Department of Health<\/a> are not concerned about this. And the three large incumbents in the market seem to be quite happy with their relative market shares, and are reliant on the fact that people don\u2019t tend to switch providers a lot. That\u2019s not in customers\u2019 interests. They should be awake at night trying to work out how to fight for customers.\u201d <\/p>\n The VHI has a 48.3 per cent share of the health insurance market, according to HIA data, while Laya is the second largest player, with a 28.1 per cent slice of activity. Irish Life Health is behind with 20.3 per cent of policies in Ireland.<\/p>\n Dowdall says that Level Health accounts for about 1 per cent of the market. The remaining 2 per cent or so is with restricted membership undertakings, which provide coverage to members of common occupational groups such as An Garda S\u00edoch\u00e1na or ESB staff. <\/p>\n [\u00a0Numbers paying for private health insurance climb despite price hikesOpens in new window<\/a>\u00a0]<\/p>\n \u201cThere\u2019s no strategy in the department for private health care. People who take out health insurance are effectively using their money to alleviate the burden on the public system. Over half of cardiac procedures in the country are carried out by the private system \u2013 and about 65 per cent of spinal and orthopaedic surgeries,\u201d he says. <\/p>\n \u201cEvery euro that is spent on private health is alleviating the burden on the public system. And does the State really recognise that? No, it doesn\u2019t.\u201d <\/p>\n Dowdall estimates that companies in Ireland are paying about \u20ac1 billion a year in health insurance premiums for employees. He argues that employees should not be paying benefit-in-kind tax on this. \u201cThey should be incentivised to alleviate the burden on the public health system,\u201d he says. \u201cThink about how achievable Sl\u00e1intecare<\/a> would be if we have a more vibrant private healthcare market.\u201d <\/p>\n One of the aims of Sl\u00e1intecare, launched in 2017, is to remove private care from public hospitals, to provide a single-tier public system. <\/p>\n Dowdall says he is met with \u201ca lot of silence\u201d when he seeks to discuss the role of private healthcare with officials. <\/p>\n \u201cPrivate healthcare is not a peripheral part of the health system. It\u2019s a hugely important part of it,\u201d he says. \u201cThe area of the Department of Health that is responsible for health insurance policy has no strategy for it \u2013 and how it can contribute even more to the overall health system.\u201d<\/p>\n He says there are \u201chuge conflicts of interest\u201d with the same unit ultimately being responsible for the VHI and the new RES scheme. <\/p>\n \u201cI have huge admiration for people working in the public system, but it isn\u2019t sufficient to cater for the country\u2019s needs,\u201d he says. <\/p>\n That\u2019s even though the Government\u2019s allocated health budget will reach a record \u20ac27.4 billion next year \u2013 almost double the \u20ac14.6 billion spent in 2016, including overruns. <\/p>\n \u201cThe increase in the cost we\u2019ve seen to the State over the past decade is not sustainable. But the challenge is that, with a growing and ageing population, demand is going to be even higher into the future,\u201d he says. \u201cPeople need to recognise the public system is not sufficient to cater for their health needs.\u201d <\/p>\n Dowdall\u2019s more than two decades in health insurance stems from his original career in technology. <\/p>\n The native of Glasnevin in north Dublin joined the IT department of Irish Life straight from secondary school in 1981. \u201cIt was very exciting at the time. You\u2019re talking about a big mainframe of computers in a room. They probably had less memory than a smartwatch today,\u201d he says. <\/p>\n Dowdall worked for US IT group Amdahl between 1996 and 2000. During this time he undertook a master\u2019s in management practice with the Irish Management Institute, having previously studied finance and information systems at night with Trinity College Dublin. <\/p>\n He joined Marrakech, the Dublin online platform for firms to manage their buying and selling processes, in 2001. It was founded in 1998, counted businessman Denis O\u2019Brien as a backer as it went on to raise tens of millions of euros of venture capital funding, and had ambitions of an initial public offering (IPO) \u2013 but never lived up to its promise. <\/p>\n\n
![\"Level](\"https:\/\/www.europesays.com\/ie\/wp-content\/uploads\/2025\/12\/HEK5RPLZCRDBPDT42AVTZ73DPY.jpg\")
Level Health’s Jim Dowdall. Photograph: Dara Mac D\u00f3naill<\/p>\n![\"\"](\"https:\/\/www.europesays.com\/ie\/wp-content\/uploads\/2025\/08\/1754647931518-c07d65db-55b5-463e-ae51-976300c5837e.jpeg\"\/)
If Irish households are so rich, why does it feel like an illusion?<\/p>\n