A new population-based resource allocation (PBRA) mechanism is due to be introduced for healthcare in Ireland for the first time.
It is proposed that the new funding mechanism will cover key health and social care services, including HSE-funded acute public hospital care, community care and some services for older people
Decision-making is to remain at central level (the HSE Centre) for many important health and social care services.
New ESRI research says that implementing PBRA across the Irish healthcare system and devolving decision-making to new HSE Health Regions has the potential to significantly improve the efficient and equitable allocation of health and social care resources and advance integrated care pathways. It believes PBRA has the potential to achieve some of the goals of Sláintecare and might allow for multi-year budgeting for healthcare.
However, it cautioned that it would be appropriate to include adjustments for medical cards and that since only half of HSE expenditure was proposed to be included in PBRA initially this might impede the full understanding of the actual resource needs of Health Regions.
“Given the unique nature of the Irish healthcare system and the evidence that medical cards are associated with higher healthcare demand, policymakers should consider including medical card coverage in resource allocation decisions.”
It said the proposed PBRA formulae for HSE Health Regions, developed by the Department of Health, represented a significant step forward for Irish healthcare in terms of resource allocation and decision-making. The formulae were based on population size, age and sex profiles, deprivation profiles and rurality profiles of the six HSE HRs, adjusted sequentially.
“Overall, the methodology used to determine the PBRA parameters, and the parameters included, closely follow those used in other countries and will likely lead to a more equitable allocation of funding.”
Expenditures on the Primary Care Reimbursement Scheme (PCRS) for general practitioner (GP) and dental care, and the Nursing Home Support Scheme (NHSS – ‘Fair Deal’), are notable exclusions from the PBRA formulae
Key findings
- The PBRA formulae proposed by the Department of Health that use Health Region population size, age, sex, deprivation and rurality to allocate resources are commendable and align closely with PBRA implemented by international peer countries.
- Due to the lack of universal healthcare in Ireland, and the importance of medical cards in accessing healthcare, additional adjustments for medical cards when allocating resources would be appropriate.
- Only half of HSE expenditure is proposed to be included in PBRA initially, with important services such as GP care, the Nursing Home Support Scheme, and Disability care not proposed to be included initially due to lack of data on these services. These exclusions may impede the full understanding of the actual resource needs of Health Regions.
- Keeping GP care outside of the PBRA formula is unique in an international context and potentially problematic. GPs are a key provider of healthcare, but they also play a central role as gatekeepers to community and hospital care, and in helping to coordinate pathways of care for patients. Inclusion of GP care in future iterations of PBRA is recommended.
- PBRA will take time to become embedded in the healthcare system, but transparency about how it works will be key to its acceptance and success. Clear evidence on how resources are being distributed and the use of an Advisory Group to oversee PBRA is recommended.
Brendan Walsh, an author of the report and Senior Research Officer at the ESRI said, “Healthcare systems that distribute resources equitably and efficiently improve health and well-being. The Irish healthcare system lacks a systematic mechanism for doing this. The implementation of population-based resource allocation (PBRA) along with a devolution of decision-making to local leaders represents not merely a policy change but a fundamental shift towards a more equitable, efficient and needs-based distribution of healthcare resources.
The report says its findings underscore the need for a resource allocation mechanism that could effectively address the varying healthcare demands across the country.
PBRA mechanisms presented an opportunity to enhance the efficiency and fairness of resource allocation.
The study funded by the Department of Health examined the proposed PBRA mechanism and establishment of HSE Health Regions.
