Profit is one thing. What about value for money? Do they care about that.
To an extent yes. The non profit part doesn't necessarily drive efficiency within VHI but it can within the industry as the other providers now have to match VHI's value proposition and make a profit on top, whilst still competing on price.
VHI do sometimes target a "profit" or surplus, so that they can reinvest it into capital, such as the VHI 360 centres for example. Or so they can make their balance sheet healthier. It also helps offset years where they make an unexpected loss.
When it comes to costs of medical procedures they did/do a lot of work negotiating these. The reason fixed price procedures exist in the first place is so that in "normal" cases the price of the medical procedure is known. This gives some certainty. The alternative to this would be to have all procedure charges on an a la carte basis. So one knee replacement could cost x amount and another patients very similar knee replacement could cost more because the doctor gave them an extra test or deemed and charged for an extra night. Fixed price procedures removed this uncertainty by removing the incentive for hospitals to look for ways to enlarge the bill. If there are complications and additional surgeries or ICU etc are needed the scope of fixed price procedures end and these become billable.
Post recession the private hospitals where looking for ways to drive up demand and be profitable so they cut the prices of procedures. Fast forward to today, the private hospitals are overwhelmed with patients. They can negotiate price increases with the insurers easily in this environment and they do. The insurers have little way to reduce these costs, without simply cutting ties with hospitals which wouldn't help customers. The increase in demand in the hospitals is driving increased claims and this drives increased premiums by insurers.
During COVID VHI gave premium refunds more times than any of the other insurers at the time. As the claims fell more than they forecasted they refunded the difference. The other insurers were forced to follow VHI but they didn't do it as often and wanted to pocket the difference in profit.
I reckon we could open multiple new private hospitals in Ireland tomorrow and they would still all be nearly full such is the demand. Some of this is blame for the pause in care during COVID. Another factor is rapidly growing population. Until this gets met with supply and levels out I would expect prices to continue to rise.