Health gains in Ireland have been substantial

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Dr. Douglas Sutherland

OECD figures showed that health gains in Ireland had been substantial between 1985 and 2019, with life expectancy at birth in Ireland above the OECD and US average, Dr. Douglas Sutherland, Head of the Structural Surveillance Division, OECD Economics Department, told the Conference.

He said an OECD economic survey showed the Irish economy weathered the COVID pandemic and was coping well with the repercussions from Russia’s war of aggression against Ukraine. While the fiscal position was currently strong, with buoyant reserves, a number of pressures were arising from aging, housing, health and climate change, which created fiscal risks in the longer term. Planned and changing investments to boost housing supplies and affordability and lower greenhouse gas emissions should be accompanied by reforms to reduce regulatory and legal hurdles.

The OECD Special Feature on Health Service Performance And Efficiency said that uncertainty and high spending efficiencies, including waiting lists and simplifying the interaction of different parts of the system were key to achieving health sector performance and sustainability. Moving towards a more integrated system of primary, community and hospital care should be prioritised to increase spending efficiency and the capacity to meet future challenges. Improving data availability and governance, as well as financial reporting and management could help track spending and reform implementation.

Dr Sutherland said that health spending was high (in % of GNI*) and accounted for a large share of total public spending. The OECD reported that Government spending on health services in Ireland, as a share of Government spending in Ireland, was above the OECD average and 22nd highest of 23 countries surveyed.

He said current spending had been on a roller coaster. Cost pressures were considerable. Prices in the health services in Ireland in 2017 were the third highest of 25 OECD countries surveyed and Ireland had the third highest remuneration of specialist doctors (ratio to average wage) in 25 countries surveyed .

Population ageing would increase fiscal pressure in terms of health and long term care expenditure and pension expenditure.

The structure of health expenditure seemed institution based, with the highest expenditure going to inpatient care followed by long term and outpatient care. Institutional long-term care was costlier than home support services, for those with severe needs. Severe needs corresponded to 41.25 hours of care per week.

He said the number of hospital beds was relatively low. Low hospital beds put pressure on bed occupancy rates and the availability of ICUs remained modest, with Ireland third from the bottom of 24 countries surveyed.

Avoidable hospital admissions were high for some conditions and the use of generics and biosimilars was underdeveloped. There appeared room to expand the number of specialists and retaining medical personnel appeared complicated. Waiting times for key healthcare services were substantial.

Health spending autonomy has been limited and there was room for potential efficiency gains.

Dr Sutherland said recommendations on improving health sector performance included implementing the reforms to create Regional Health Areas and rebalancing healthcare delivery across primary, community and long-term care and hospitals and introducing a Population-Based Resource Allocation funding model, as planned.

Reforms should be prioritised to enhance the adoption of a unique health identifier and centralise data governance within a single independent body, integrated funding and service delivery should be established to offer home care and admission to long-term residential care when needed and the implementation of the Single Assessment Tool to facilitate more effective person-centred care services, should be accelerated.