The success of VHI in producing record profits is unlikely to provide much solace for some of its customers.

Profits soared from £2.8 million to £11.2 million but the company's reserves are still well short of the 40 per cent of premium income level which the group requires to maintain its solvency requirements. As such, the health insurer is looking for yet another rise in premiums after cumulative rises of 72 per cent over the last five years.

It seems likely that fees will rise by about 9 per cent, the same as last year. The trouble for the VHI is that, despite community rating, it runs the risk of pricing some of its less well off members out of benefit.

There is no doubt that the rate of medical inflation is higher than consumer prices in general. It is also true that advances in medicine mean that newer, more effective, but also more expensive, treatments are available for a greater range of illnesses and conditions.

What is more worrying is the insurer's assertion self-evident assertion that the age profile of the population and, consequently, its membership is rising and that we are using more medical services.

It is essential that the forthcoming White Paper clearly shows how a group which represents 1.46 million people in this State can expect to provide affordable medical coverage in the medium to long term.