SaraBurke.com

ESRI evidence on health

Posted in Blog by saraburke on October 25, 2010

ESRI CEO Frances Ruane chaired an expert group on Resource Allocation in the health sector set up by Mary Harney in April 2008. They have published two volumes of research as well as the report of the working group. Here are some interesting findings from the 800 pages…

The ESRI evidence volume produced new figures on Ireland’s health spend compared to other countries. They looked across countries and across time and their findings show a significant increase in Ireland’s allocation to health as a proportion of national income. It increased from 7% in 2000 to about 12% in 2010 but in fact, their figures show that increases in Ireland were in line with other EU and OECD countries which increased their proportion spent on health in a very similar way.

It also showed that the increase was directly related to increases in national income. So as national income rises, countries tend to spend more on health and we are the same as most other similar countries. Also the rise to 12% can be explained by the decrease in overall income rather actual rise in health spending. And they found that we still spend comparatively less on health than many other EU and OECD countries.

Frances Ruane opened the conference on Tuesday last (19th October) with an analysis of the health system we have – and it was really pretty damning. They found a health system totally disconnected eg between hospitals and community care, an unfair, unclear, unplanned weak health system with poor governance and a very limited relationship between money allocation and population need.

The key recommendation of the Resource Allocation Working Group is to change the way we allocate the health budget. Currently, te vast majority of health budget is allocated by a lump sum year on year. THey recommend moving to a system where money is allocated on the basis of population health need eg age, gender, health need. And the HSE will begin to do this in 2011 as recommended by Anthony Staines of DCU previously.

The ESRI work highlights some of the contradictions in the system. It is very strong on the perverse incentives in the current system eg the official policy is to shift care from hospital to the community but in fact currently you might get a lot of care for free if in the hospital but you have to pay for it in the community. So it recommends taking those measures that don’t make sense out of the system.. Also it has strong recommendations in relation to chronic disease management and if you manage chronic diseases better, its much better for patient and costs less.

Interestingly the ESRI is critical of the new prescription charges and also the NTFP. They ESRI have published some very strong analysis on the nonsensical nature of the prescription charge introduced for medical card holders – that it does not make economic sense or health sense as it puts people off taking necessary medicine without raising much cash and could cost the system more in the long term.

This specific point was put to Michael Scanlon Sec Gen in health and he said we knew the evidence about prescription charges but we are faced with hard choices. That does not stand up as the measure does not make sense and in my opinion it is purely an ideological choice of the Minister. And Michael Scanlon should have said that.

The Resource Allocation Working Group established by the Minister recommended the phasing out of the National Treatment Purchase Fund. The NTPF buys private care for long waiters in the public system. But at the ESRI conference last week, Arnie Hill a breast cancer specialist, speaking at the conference on Tuesday in a personal capacity, described it as the ‘biggest marker of inefficiency in the system”, that the NTPF had all the wrong incentives. He said the group said it should be phased out but in fact you should punish the people who supported the NTPF and abolish it immediately.

Lots more to read in it at

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