The devil without the details
See below my column from Medical Independent, written before HSE Service Plan was published today but all still appliesThe absence of detail in the health aspects of Budget 2013 expose one of two things, either the Minister and the Department of Health purposefully withheld information on how they are going to achieve €781 million in savings in 2013, or they just don’t know it. It is hard to tell which is worse.
Media reports the weekend after budget day indicated that the health budget was the last one to be signed off, that the Department of Public Expenditure and Reform kept sending the health estimates back, saying they were not credible, and that signing off the health budget went down to the wire. These media reports – and they are only that – go some way to explaining the insulting absence of specifics given in the health budget.
While Budget 2013 actually gives a small overall increase of €150 million to the health budget, Government outlined how €781 million in ‘savings’ will have to be achieved just to stand still. The main reason for this is a growing, ageing population with a greater burden of chronic disease, alongside high medical inflation. These ‘savings’ also include the budgetary overrun from 2012 and other costs such as paying staff increments which, irrationally, are not included in budget planning.
Taking three quarters of a billion out of the health system, on top of the €2.5 billion that has already come out over the past four years, is no easy task. It is particularly hard because James Reilly has failed to deliver on his own commitment of bringing down the cost of care. His budget for this year was dependent on achieving €250 million in ‘savings’ through reducing the drugs budget and charging for private patients in public hospital beds. By its own admission, the Government has saved €16 million in drugs costs, not the €125 million planned. And while the Government claims to have gotten some money upfront from private insurance companies, it failed to legislate for charging for private beds in public hospitals and therefore did not achieve the €143 million planned for 2012.
Not only has this directly contributed to the budget overrun for 2012, but it renders this year’s budget a wish list, which most people doubt the Minister and the Department will be able to achieve.
The Government mantra that this budget was devised so as to protect the most vulnerable is nonsense. Looking at the health provisions, the very fact that there has to be cuts in the public health budget by at least €781 million as well as reducing staff in 2013 by another 3,000 plus, means those most dependent on the public system will be hit most.
Increases in prescription charges are contrary to all international evidence that charges, no matter how small, put people off taking essential treatment. The trebling of prescription charges from 50 cents to €1.50 for medical card holders and from €132 to €144 for the 60 per cent of the population who do not have medical cards, is a clear way of increasing co-payments on those who are poorest and sickest.
The explanations given for these increases are that we have a very high drugs budget (we do) and that multiple items are prescribed which are not necessary. But if they are the problems, then reduce the drugs budget by getting a better deal with pharmaceutical companies, increase the use of generics, and penalise or incentivise doctors and pharmacists to prevent multiple, unnecessary prescribing.
The Government also plans to restrict access to medical cards but again failed to name how, except for over 70 year olds. The threshold for access to a full medical card will be €600 per week (down from €700), as compared to a threshold of €186 per week for anyone under 70. Call that fair?
Not only that, but Minister Reilly reluctantly admitted at the Budget 2013 press briefing, that it was intended to tighten rules to include current income and spending not currently taken into account i.e. they intend to make it harder for people on low incomes to get a medical card in 2013.
Government Ministers keep on telling us to look at the cumulative impact of Budget 2013. Taking three-quarters of a billion euro and 3,000-plus staff out of health, on top of increased charges for drugs, hospital beds and nursing home care, taxing maternity benefit, cutting child benefit and respite care allowances for carers, quite clearly, Budget 2013 will not be good for people’s health, particularly the health of the sickest and poorest.