Free GP care for under six year olds and over seventy year olds
Between May and September 2013, Prof Steve Thomas provided advice and costed a strategy for Minister of State for Primary Care, Alex White, on the design and implementation of roll-out of free GP care. Previously, between October 2011 and February 2012, Prof Thomas led a TCD team to develop a workforce planning model for the Department of Health to support the roll-out of free GP care and presented the work to minister of State for Primary Care, Roisin Shortall.
The 2016 Programme for Government committed to the introduction of free GP care for all under 18 year olds.
Resilience of the Irish Health System during crisis
The Resilience Project was a four year research programme (2011-2015) assessing the resilience of the Irish health system during the economic crisis. Funded by the Health Research Board, PI, Professor Steve Thomas and researchers Dr Sara Burke, Dr Sarah Barry and Conor Keegan provided ground breaking research demonstrating the catastrophic impact of austerity on people who use health services and the health system itself.
With numerous peer reviewed publications and conference and seminar presentations, the project is credited with making the case for the reversal of cuts to the health budget in 2015 and the reduction of some of the increased healthcare costs to families and individuals introduced during the economic crisis.
The team collaborated with the European Observatory for Health Systems and Policies, the WHO Barcelona Office for Health Systems Strengthening, the World Bank and the Countries in Crisis network (Portugal, Greece and Spain) comparing the resilience of systems across countries.
Removal of private care from public hospitals
The Centre’s Pathways to Universal Healthcare research team led by Prof Steve Thomas provided technical assistance to the Oireachtas Committee on the Future of Healthcare which drafted the Sláintecare report.
A key recommendation of the Report is the removal of private practice from public hospitals during the first seven years of the plan: ‘the phased elimination of private care from public hospitals. Everyone will have entitlement to access public care in public hospitals – those who have private health insurance will still be able to purchase care from private healthcare providers. The Committee also recommends an independent impact analysis of the separation of private practice from the public system in order to identify any adverse and unintended consequences on the public system’. An Independent review group examining the removal of private practice from public hospitals was established by Minister Harris in December 2017 and made a public call for submissions.
Centre researchers led by Dr Sara Burke subsequently produced a submission (link to PDF of Pathways submission) to the Review Group providing evidence and findings from research projects Resilience of the Irish Health System and Pathways to Universal Healthcare to inform their work. Dr Sara Burke and Prof Steve Thomas also wrote an op ed on this topic published on 26 February 2018 in the Irish Times.
Oireachtas Committee on the Future of Healthcare
From November 2016 to May 2017, a team of researchers - Prof Steve Thomas, Dr Sara Burke, Dr Sarah Barry, Dr Bridget Johnston, and Rikke Siersbaek - from the Centre provided technical support for the Oireachtas Committee on the Future of Healthcare. Initially, the team hosted three workshops with the Committee and then assisted the Committee with its remit ‘to devise cross-party agreement on a single long-term vision for health care and direction of health policy in Ireland’.
On the 30 May 2017, the Committee published its final report. According to the Committee’s chairperson, Roisin Shortall TD, ‘the formation of the Oireachtas Committee on the Future of Healthcare provided a unique and historic opportunity for TDs from across the political spectrum to come together to develop consensus on a long-term policy direction for Ireland’s healthcare system. Our task has been to consider how best to ensure that, in future, everyone has access to an affordable, universal, single-tier healthcare system, in which patients are treated promptly on the basis of need, rather than ability to pay’.
An overview of the Committee’s work process and the report’s recommendations can be found in the Oireachtas News press release. View full video of report launch here.
Supporting the HSE Clinical Programme in Palliative Care - What is known about the effectiveness and cost-effectiveness of palliative care?
Palliative care involves a wide range of services to assess better the needs of people with life limiting conditions and those near the end of life, to support these needs and focus on managing symptoms and improving quality of life, and to help people to achieve their goals in this period. Staff in the Centre and the ESRI worked closely with the HSE Clinical Programme in Palliative Care to review and present the evidence on the effectiveness and cost-effectiveness of different palliative care services, as part of an Atlantic Philanthropies funded study on the economic evaluation of palliative care. The clinical programme was able to draw on the latest evidence in setting targets and priorities in the development of palliative care in Ireland. Staff in the Centre continue to carry out policy relevant work on palliative and end of life care, and to work with policy makers and service providers.
Supporting health care reforms in Portugal
Portugal shares much of the experience of the financial crisis in Ireland, and the associated reductions in health care resources. Prof Charles Normand led a set of studies for the WHO, the European Observatory on Health Systems and Policies and the Government of Portugal to support the reform programme. The reforms are now strengthening provision of primary and community health services, merging the delivery of primary and secondary care and improving access to medicines and other chronic disease priorities.
Financing work in Central Asia and Ukraine
Prof Charles Normand is part of teams from the WHO European Office to support financing reforms for the health services in Georgia, Kazakhstan, Tajikistan and Ukraine. An ongoing programme of work continues to help improve the sustainability of services and improve access to care.
James O'Mahony and fellow health economist Diarmuid Coughlan of the University of Newcastle critically examined the current Irish cost-effectiveness threshold of €45,000/quality-adjusted life year (QALY) in an article published in the journal PharmacoEconomics. The analysis explained that the current Irish threshold is not based on any evidence and risks causing damage to the Irish health system, as it leads to the adoption of healthcare interventions that are unlikely to provide good value for money given the funding needs of other services within the health system. This research has been presented at seminars hosted by the Economic and Social Research Institute and the Department of Public Expenditure and Reform. While Ireland’s cost-effectiveness threshold remained effectively unchanged in the most recent renegotiations between the health service and the pharmaceutical industry, this research questioning the threshold has already been cited in a number of academic and Irish government reports including the Irish Fiscal Council, indicating that it has successfully initiated reconsideration of this important element of health policy.
Dr James O’Mahony, Ella Tyrrell and Prof Charles Normand conducted research in conjunction with clinical colleagues Dr Fionnuala Mone and Prof Fionnuala McAuliffe at the National Maternity Hospital into the cost-effectiveness of preventing pre-eclampsia during pregnancy using aspirin. The approach advocated currently by the Fetal Medical Foundation (FMF) is only to provide aspirin to women that are found to be at elevated risk of pre-eclampsia, while an alternative is simply to provide aspirin to all pregnant women. The research found that universal aspirin is more cost-effective than risk testing, partly because risk testing is inaccurate and aspirin is highly affordable and has little side-effects. An anticipated policy impact of this research is the avoidance of expenditure on expensive and largely ineffective testing for pre-eclampsia in Irish maternity care services and the adoption of universal prophylactic aspirin that will reduce the incidence of pre-eclampsia in a cost-effective manner.
Ageing work with the European Observatory on Health Systems and Policies
Population ageing is a major success for public health and health services, but brings challenges for provision of incomes in older age, health and social care. Prof Charles Normand is leading on the European Observatory study on the impact of ageing in Europe. This work questions some of the common assumptions about how ageing will affect costs and service needs, and identifies some of the important contributions by older people. The study is now linked to the WHO worldwide study on the impact of ageing.
Dr James O'Mahony and Prof Charles Normand are part of the CERVIVA cancer prevention research consortium. CERVIVA’s initial role was to investigate ways to enhance cervical cancer prevention in Ireland through cervical screening, but its research focus has now expanded to consider the role of other diseases associated with the human papillomavirus, such as head and neck cancer. Dr O’Mahony’s role within CERVIVA is to conduct cost-effectiveness modelling of alternative cancer prevention strategies. The cost-effectiveness research within CERVIVA is to complement work by other agencies such as HIQA and the National Cancer Screening Service in identifying service improvements to Irish cervical screening technology with the adoption of HPV testing in primary screening and other novel techniques for detecting pre-clinical disease. Published research from the cost-effectiveness component of CERVIVA has already provided a critique of how such evidence is generated in the academic literature and by agencies in Ireland and how it is appropriately interpreted to identify optimal screening services.
Despite the general focus on over-nutrition and obesity, the problem of under-nutrition imposes serious costs and leads to poor outcomes for older people in hospital. Studies in association with Dr Niamh Rice in Ireland and with leading nutrition researchers in England, Germany and Italy have estimated the extra costs of care for people who are under-nourished and have reviewed the cost-effectiveness of nutritional supplements. The Health Information and Quality Authority has now set standards for ensuring better nutrition and hydration in hospitals and has started to carry out inspections.
Screening for Atrial Fibrilation
HIQA has recently carried out a study on the feasibility and desirability of screening for atrial fibrillation. Prof Charles Normand was involved in the design of this work, and in dissemination of the findings.