Web-economic-crisis-health-systems-and-health-web

Chapter 5 | The impact of the crisis on the health system and health in Ireland
157
3.3 Changes to health service planning, purchasing and delivery
As noted, there is evidence that in several areas the health system is doing more
with fewer resources (e.g. inpatient, emergency and day case activity) (Fig. 5.4).
Fig. 5.4 Inpatient, emergency and day case activity in Ireland, 2008–2012
900,000
Number of discharges (admissions for ED)
800,000
700,000
600,000
500,000
400,000
300,000
200,000
100,000
0
2008
2009 2010 2011 2012
Inpatient Emergency Day
Note: ED: Emergency department.
Sources: HSE, 2010, 2011b, 2012b, 2013g.
Further improvements in efficiency have been achieved by:
• reducing the unit costs of health system inputs (such as human resources
and pharmaceuticals);
• improving productivity; and
• moving some activities to more cost-effective levels of care.
Nevertheless, there is still scope for more efficiency in the system.
Payments to health workers and human resources policies
As pay accounts for approximately 50% of overall public health expenditure
(but can be as high as 70% in the acute hospital sector) (Brick & Nolan, 2010),
securing greater efficiencies in this expenditure via reductions in numbers, as
well as optimal use of existing staff, has become a key mechanism for cutting
costs. In common with the general public service, the public health service is
subject to a moratorium on recruitment and promotions (since 2009), albeit
with some exceptions (medical consultants, physiotherapists, etc.). In addition,
there have been reductions in pay, and a number of incentivized voluntary