Ireland had mixed performance on gauges of hospital productivity

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Ireland had a mixed performance on gauges of  hospital productivity as proxied by discharges per hospital doctor, the share of certain surgeries performed as day cases, and for avoidable hospital admissions, according to a paper produced by the Department of Health.

It says there is a need for an increased focus on ways to improve productivity and efficiency of the  hospital sector, particularly for areas with a substantial impact on elective care.

This paper examined the determinants of inflows to and outflows from waiting lists for elective care and examined how Ireland compared internationally on determinants of inflows and outflows.

The report Acute Hospital Waiting Lists and Times: International Comparison of Determinants of Inflows and Outflows was prepared by the Research Services and Policy Unit, Research, Development, and  Health Analytics Division, Department of Health.*   The views presented in the paper, do  not  represent  the  official  views of the Minister for Health.

It said it would be desirable to be able to compare the relative size of inflows onto and outflows from waiting  lists  in  Ireland  to  that  of  other  countries.  However,  readily available collated data on inflows onto and outflows from hospital waiting lists for OECD countries was not available.

It also said it was  important  to  note  that  there  were  limitations  to making  internationa comparisons  across  countries due to data on health systems varying in definitions and/or data collection methods, and variation in the structure of health systems.

The report said indicators of health status suggested a relatively low potential  demand for hospital care relative to the population compared  to international averages, as Ireland had a low share of the population aged  65 plus, a low share  reporting their health as poor and a low share with chronic conditions. 

It said Ireland had a below average supply of acute care beds per 1,000 population compared to EU and OECD averages. Ireland had the eighth lowest supply in the EU22 and thirteenth lowest in the OECD33.

Data related to 2019, the most recent year for which comparable data is available across a large number of OECD countries. The analysis therefore did not capture any recent increases in capacity both in Ireland or in other OECD countries since then.  A substantial number of acute care beds have been added in Ireland since the start of the pandemic, e.g., the number of available inpatient and day case acute care beds increased by 536 from end 2019 to end 2021.

In 2019, Ireland had an estimated 2.69 acute care beds per 1,000 people compared to an EU22 average of 3.64 and  an  OECD 33 average  of 3.54 – so  compared  for  every  1,000  people, Ireland had approximately one less bed than the EU and OECD average.

In 2019, Ireland had the third highest occupancy rate out of 27 OECD countries, and was one of only four countries in this cohort with an occupancy rate above 85%. Ireland was in the same quintile as: Portugal, Costa Rica, Israel and Canada. This was not a once off occurrence and the OECD has noted frequent instances of extremely high (e.g., 95%) occupancy rates.

The report said Ireland had a relatively low share of specialist versus non-specialist doctors compared to the OECD average, with just a 30% share of specialists compared to the OECD32 average of 65%.

While data comparability could be more constrained in this area, available data suggests that Ireland ranked fifth lowest in terms of specialist medical practitioners per 1,000 population in the OECD34, with 1.5 specialists per 1,000 population compared to 2.3 in the OECD34, 2.5 in the EU14, and 2.6 in the EU20.

Ireland also had the fourth lowest rate of doctors employed in hospitals per 1,000 population in the EU22 and the tenth lowest rate in the OECD32.

The report said that given the importance of hospital activity to reduce waiting lists and wait times, there was a need to evaluate the extent to which annual waiting list plans delivered increased activity and the associated impact on reducing waiting lists and times.

Murphy, R.,and Kelly, A. (2023). Acute Hospital Waiting Lists and Times: International Comparison of Determinants of Inflows and Outflows. Waiting Lists Series: Report No. 1. Department of Health.