New research by Trinity College Dublin healthcare experts has suggested that the full introduction of the Sláintecare model of universal healthcare would fundamentally change the funding of healthcare in Ireland with the share of household out of pocket payments falling from 15.4% currently to 8.5% in 2027. The data was presented in the context of new evidence supporting the case for the introduction of universal healthcare in Ireland.
According to their research, the contribution of private health insurance payments to overall health spending may decrease from 12.7% to 7.5% over the same period. Conversely, the share of solidarity funding by the state will increase from 69% to almost 82%, a figure similar to Sweden and the Netherlands and higher than the UK.
Speaking at a seminar in Trinity today, the research group from the Centre for Health Policy and Management at Trinity, who have been examining the pathways to universal healthcare since 2015, also indicated a significant change in the way people in Ireland are currently spending their own money on healthcare.
Using the latest CSO Household Budget Survey, they estimated that in 2015/16 households used up a bigger proportion of their healthcare spending on private health insurance (from 40% to 54%), prescriptions charges (increasing by 80%) and hospital in-patient fees (increasing by 21%), compared to 2009/10. The researchers believe that all of these changes can be related to cost-shifting policies introduced by government over the austerity period.
At the same time households have reduced the share of their health spending going towards GPs (down by 38%) and dentists (down by 62%).
Speaking about the change in public healthcare spending trends, Dr Steve Thomas, Director of Centre for Health Policy and Management, Principal Investigator on the Mapping the Pathways to Universal Healthcare project said: “A key concern is that households are reducing their consumption of healthcare services in order to afford private health insurance cover. This risks worsening their ill health and delaying access to needed care causing more pressure on hospitals and necessitating more expensive health care. Spending on nursing homes in 2015/16 may also be a significant issue for many households in the poorest 20%.”
Dr Thomas continued: “Fundamental reform of the Irish health system is urgently required, given current inequities and hardships. This can only be achieved by a system wide approach, as encapsulated in Sláintecare, which synchronises an expansion of healthcare entitlements with appropriate financial, human and system resources.”
The research team also detailed the rationale and logic behind some of the key elements in the Sláintecare model.
Speaking about the rationale underpinning Sláintecare’s proposals on providing a universal entitlement to timely access to quality care, Dr Sara Burke, Research Fellow and co-ordinator of the Mapping the Pathways to Universal said: “Ireland is very unusual in a European and OECD context in that there is no universal entitlement to healthcare with the majority of the population facing high charges and often long waits to access care. The entitlement expansion in Sláintecare is underpinned by an evidence base using the best available data to determine how best to provide universal access to health and social care over a seven year period. This involves a complete re-orienting of the system where the vast majority of care is accessed through primary and social care without financial barriers. It is underpinned by a whole system response driven by public health aims as well as addressing current capacity deficits in the health system.”
Dr Burke also spoke about the benefits and risks of a policy process that involved political consensus on a particularly challenging policy area such as healthcare, saying: “International literature shows that achieving universal healthcare is an explicitly political process. The results of the last general election heralded ‘new politics’. Sláintecare is an example of ‘new politics’ delivering, as it is a first in Irish public policy where political consensus through a cross party approach has been used to devise a ten year plan for health reform.”
Speaking about the key challenges of moving to an integrated care model of healthcare, Dr Sarah Barry, Assistant Professor of Health Services Management, Centre for Health Policy and Management, Trinity said: “Sláintecare sets out a comprehensive vision for a universal healthcare service under the banner of integrated care. Appropriate health funding and entitlement policies are critical but so too is capacity building and resourcing real operational change. Essential ingredients for change include legislating for clinical governance, fast-tracking eHealth and committing to comprehensive workforce planning among other things.”
Dr Barry continued: “ In order to address critical issues such as ED overcrowding and long wait times for elective care, the integrated approach needs development and translation at every level and in each setting of the health service – international evidence shows this means more than creating the structures – working with culture and people is key. The cumulative change required for delivery of an operational, universal and integrated healthcare service will require sustained and sophisticated implementation work.”
Rosin Shortall, TD, and Chairperson of the Oireachtas Committee on the Future of Healthcare said: “Sláintecare is a 10 year strategy for a universal single-tier health service with a focus on early intervention and local chronic disease management. It is the culmination of almost a year's work by a cross-party group of parliamentarians. We consulted widely with patient groups, health workers and policy experts. We examined the evidence and learned from best practice in other countries. We believe that Sláintecare is the way forward for an equitable effective and efficient health service and is the only viable health policy which has cross-party support. We urge the government to urgently start the implementation process.”
Dr Josep Figueras, Director of the European Observatory on Health Systems and Policies and head of the WHO European Centre on Health Policy in Brussels said: “The Sláintecare report constitutes a major leap forward for health reform in Ireland as it addresses long standing challenges of its health care system. Moreover its broad political consensus and strong evidence base will be key to its success. Implementing such comprehensive reform, however, is bound to be fraught with complexity. Policy makers must now focus on change management including strengthening capacity, phasing the introduction of reforms coupled with the appropriate incentives as well as ensuring transparency, communication and participation of key actors in the reform.”
Mapping the Pathways to Universal Healthcare is a Health Research Board funded research programme which aims to provide an excellent evidence base that will inform the strategic direction and implementation of universal healthcare in Ireland. The project is running until 2018. The project is being undertaken by the Centre for Health Policy and Management in the School of Medicine in Trinity.
In May 2017, the Oireachtas Committee on the Future of Healthcare published Sláintecare, which details a ten year strategy for health reform in Ireland. Sláintecare is a unique opportunity to deliver a universal health system where everyone has equitable access to services based on need and not ability to pay. The Pathways project team provided technical support to the Oireachtas committee in the development of Sláintecare.