Health now 'doing less with less'

The Irish health system has moved from 'doing more with less' to doing 'less with less' since last year, a new study has warned.

The TCD study has found that between 2008 and 2012, the health system, through increased efficiencies and cost-cutting managed to provide more with fewer resources.

However, the study also found that some of the efficiencies were achieved by transferring the cost of care onto people using the health system and through significant resource cuts.

These included imposing prescription charges and raised hospital charges.

The researchers also found that since 2013, the indications are that the health system has no choice but to do less with less.

"They indicate diminishing returns from crude cuts, evident in declining hospital cases, increased wait times, as well as cuts to home care hours and rising costs of agency staffing," the researchers said.

Around €2.7 billion has been cut from the Irish health system since 2009, the study pointed out.

The system also has 12,000 fewer staff since 2007, due to recruitment freezes and early retirement/voluntary redundancy schemes.

The study says that while the number of patients being treated in hospitals increased between 2008 and 2012, since the end of that year there has been a decrease in inpatient activity a levelling off and day case activity in hospitals, despite increased demand and an increase in emergency department admissions.

It says emergency admissions are set to increase by 45,000 between 2012 and 2014.

The TCD study also says the cost of drugs has reduced in recent years due in part to increased efficiencies around costs of medicines and changed prescribing practices.

The cost to the State of the Drugs Payment Scheme more than halved between 2008 and 2012, driven by declining numbers using the scheme due to large increases in the reimbursement threshold, which is now €144 a month.

The TCD study points out that trolley wait numbers decreased by 36% between 2011 and 2013.

It says while the numbers waiting for hospital treatment for over two years has been eliminated since 2011, there has been a trebling of those waiting over six and 12 months for treatment since November 2012.

The study says these hospital wait times indicate increased demand on the public health system, due to people giving up their private insurance, an ageing population and a greater number of people with serious long-term illnesses.

The research indicates that the priorities for the HSE in recent years have been running the system effectively within constrained resources rather than meeting healthcare targets under the Programme for Government.

The researchers say one quarter of the time of HSE officials is taken up with living within the budget and managing change.

Dr Sara Burke, Research Fellow at the Centre for Health Policy and Management at TCD said the health system's ability to achieve the Government's reform programme was in doubt.

"Differences between the Departments of Health and Public Expenditure may be putting the sustainability of the public health system in jeopardy if more money is taken out of health in the year ahead," she said.

The study was carried out by researchers at TCD under a three-year Health Research Board-funded programme, 'the Resilience Project'.

[Posted: Mon 31/03/2014]

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