News stories about the Irish hospital system

Report proposes subsidised GP care for all

An independent expert group has said that while disease prevention is often cheaper than a cure, there is no incentive for this in the current Irish health system.

In a report to the Health Minister, Mary Harney, the Expert Group on Resource Allocation in the Health Sector recommended a number of changes to the current system, including the introduction of a graduated GP and drugs payment scheme involving subsidised or fully covered GP care and drug costs for the entire population.

The proposed GP care subsidy scheme would involve:

• A 'Standard' Card: Capped GP and prescription drug fees for all who register with a GP - €40 maximum payment per GP visit and the State would pay 20 per cent of patients' drug fees.
• Standard Plus Card: Reduced capped fees and cheaper prescription drug fees for those with a chronic illness and incomes between 40-50% of the average. Patients would pay €30 to visit the GP and the State would cover 40 per cent of their drug costs.
• Enhanced Primary Card: Further reductions in fees and the cost of prescription drugs for those with chronic illness and incomes between 30-40% of the average. The State would pay 60 per cent of their drug fees and they would pay €20 to see the doctor.
• Comprehensive Card: No fees or prescription costs for those with incomes under 30% of the average. This is identical to the current medical card.

The group, which was established by Minister Harney in April 2009, was tasked with reporting on how current levels of resourcing in health could be better allocated to deliver the objective of health policy.

It found evidence that some current methods of resource allocation undermine these policy objectives, for example:

• Disease prevention is often cheaper than cure but there is no incentive for this in the current health system.
• Stated HSE policy promotes the transfer of care from expensive hospitals to primary and community settings, yet incentives for hospital doctors, GPs and patients often lean towards institutional rather than community care.
• Cost effective management of chronic disease requires integrated care across the whole health sector, but there is no governance or funding mechanisms to meet this demand.
• The high levels of ‘pay-as-you-go' financing ignore the ability to pay and give those who can afford it faster access to care.
• Safe and cost effective hospital care is a key policy objective, but the current resource allocation systems reward neither.

The group said that in its view, what is needed is a structure of resource allocation which ‘explicitly and transparently supports stated policy objectives'. To this end, it made 34 recommendations, including:

• By the end of 2011, the Department of Health and the HSE should establish a common framework for health and social care expenditure, based on the best available evidence, that sets out current and future health needs.
• The department and the HSE should agree priorities for a 5-year planning cycle to provide a stable foundation for development.
• The immediate development of a resource allocation model to underpin the 5-year plan that systematically distributes financial resources by predictors of health need such as age and social deprivation across the country.
• The immediate commencement of a project that would specify in detail a framework for graduated GP and drug payments, which would take account of individual income and healthcare need. This would replace the medical card scheme.

"Our aim in this report is to assist in advancing our health system to a level where our limited resources are clearly targeted to achieve the best possible health for the population as a whole, and the best outcomes for all patients, irrespective of their means," commented the group's chairperson, Prof Frances Ruane.

The report is to be considered by Health Minister Mary Harney and proposals based on its recommendaitons are to be brought to Government later this year.