From ‘more with less’ to ‘less with less’ - The Performance of the Irish Health System during the Economic Crisis
Apr 01, 2014
Final analysis of Resilience Project by academics in Trinity College Dublin reveals diminishing returns from crude cuts to healthcare system budgets.
The final seminar of a three year Health Research Board funded research project by academics in the in the Centre for Health Policy in Trinity College Dublin which took place on March 31st 2014 has revealed:
- A transferring of cost from the State on to people, e.g. prescription charges, hospital charges this affects the oldest and sickest most.
- Increased efficiencies in the health system between 2008 and 2012.
- A health system that now has to do less with less
Significantly, from 2013, the indicators show a system that has no choice but ‘to do less with less’. They indicate diminishing returns from crude cuts, evident in declining hospital cases, increased wait-times, as well as cuts to home care hours and increasing costs of agency staffing. A final paper from the Resilience Project, Measuring, Mapping and Making Sense of Irish Health System Performance in the Recession, is available in full here: http://www.medicine.tcd.ie/resilience4health/publications-links/
Key Figures about the Irish Health System:
- Approximately €2.7 billion has been cut from the Irish health system since 2009.
- There are over 12,000 fewer Health Service Executive (HSE) staff in December 2013 than there were at the height of public health sector employment in 2007.
- By December 2013 there were 1,890,465 with medical cards, the highest number in the history of the state, (over 600,000 more now than in pre crisis 2007) reflecting lower incomes and higher levels of unemployment.
- Despite a declining budget and staff numbers, during the period 2008 to 2012 public hospitals managed to do more with less evidenced by increased numbers of inpatient, day case, outpatient appointments and emergency admissions.
- Inpatients cases increased by 10,000 between 2010 and 2012, day cases increased by 193,000 between 2008 and 2012
- However, from the end of 2012 and through 2013 and 2014, there was a decrease in inpatient activity, a levelling off of day cases despite increased demand and an increase in Emergency Admissions.
- Inpatient admissions declined by 21,000 between 2012 and 2014; day cases 30,000 between 2012 and 2014.
- While these are only a fraction of all hospital cases they demonstrate the change in the trend. Similarly, Emergency Admissions are due to increase by 45,000 between 2012 and 2014.
- The cost of drugs in the demand led, publicly funded health schemes decreased by €434 million between 2009 and 2014, due in part to increased efficiencies around costs of medicines and changed prescribing practices.
- The cost of the Drugs Payment Scheme more than halved from €311 million in 2008 to €127 million in 2012, driven by declining numbers using the scheme due to hefty increases on the reimbursement threshold (from €85 per month in 2008 to €144 per month in 2013), in effect a direct transfer of costs from the State onto patients.
- Some progress has been made on the most persistent problems in the Irish health system – very long waiting times in Emergency Departments, for elective treatment and for out-patient appointments with a specialist. Specifically:
- The numbers of people waiting on trolleys in Emergency Departments has been reduced by 36% between 2011 and 2013. However, when figures from 2008 are compared to 2013, a 3.6% reduction is counted.
- There has been progress on the numbers of people waiting for inpatient and day-case hospital treatment, specifically, in eliminating those waiting over two years (a key 2011 Programme for Government Commitment).
- However, between November 2012 and November 2013, there has been a trebling of those waiting over six and twelve months for treatment.
- These hospital wait times indicate increased demand on the public health system resulting from fewer people with private health insurance alongside an increasing, ageing population with a greater burden of chronic diseases.
- Despite there being 941 fewer public hospital beds in 2012 compared to 2008, the numbers of delayed discharges remained chronically high, with the most recent figures showing 718 delayed discharges (people in hospital beds who do not clinically need to be there).
- There has been a steady decline in home care hours (designed to support people to live independently) since 2008. In 2013, there were under nine million home care hours provided, compared to over 11 million hours in 2006.
- The priorities for HSE Service Managers and decision makers in the HSE relate to running the health care system more effectively in the current constrained resource environment rather than headline priorities in the Programme for Government. One quarter of their time is taken up with living within the budget and managing change.
Reflecting on the value and impact of the research Graham Love, Chief Executive at the Health Research Board said: 'Providing high-quality, affordable, health services is a challenge - especially in a recession. This project provides insight and understanding about how the Irish health system has dealt with the recent financial crises and outlines solutions to help the service be resilient, or become stronger, in face of future crises. The national benefit and international reach of this project reinforces the importance and impact of HRB investments for Health Services Research.”
For media queries please contact:
Yolanda Kennedy, Press Officer for the Faculty of Health Sciences, Trinity College Dublin at firstname.lastname@example.org or Tel: + 353 1 8963551.
The Resilience Project is a three year research programme (2012-2014)
assessing the resilience of the Irish health system during the economic crisis.
Dr Stephen Thomas of the Centre for Health Policy in Trinity College Dublin is
the principal investigator (PI) and it is funded by the Irish Health Research
Board. From the work, guidelines will be developed to suggest how health
systems can withstand and be strengthened during times of significant cuts and
disturbances to the health system.