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160 Economic crisis, health systems and health in Europe: country experience
Hospital services
In terms of acute hospital services, the Programme for Government contains
a commitment to pay hospitals according to the care they deliver and to
incentivize them to deliver more care in a “money follows the patient” system
(Government of Ireland, 2011a). Up to 2012, all public hospitals received
annual budgetary allocations in return for undertaking activity levels specified
in the HSE's annual national service plans, with allocations largely determined
by historic factors (with a small proportion of resources allocated on a casemix
basis). From 2013, public hospital resources will be allocated on the basis
of projected expenditure, in preparation for the “money follows the patient”
system in 2014 (HSE, 2013e).
The payment of public hospital consultants has been the subject of much
discussion since the agreement of a new consultant contract in 2008, with the
degree of compliance by some consultants in relation to private practice also
coming under particular scrutiny (Comptroller and Auditor General, 2010).
Currently, public hospital services are delivered by a network of 52 hospitals, 34
of which are owned and operated by the HSE. The Programme for Government
contains a commitment to establish all acute public hospitals as independent,
non-profit-making trusts (Government of Ireland, 2011a).
Delivery of integrated care
Previous analyses of the Irish health system noted the barriers to the delivery
of integrated care, such as incompatible financial incentives (on the part of
both users and providers), human resource constraints and poorly developed
community care services (Ruane, 2010; Brick et al., 2012). Such issues will
have to be resolved to secure the full potential of efficiency gains.
4. Implications for health system performance and
health
4.1 Cost savings and efficiency
Ireland entered its Troika bailout in October 2010 with regular reporting by
both the European Commission and the IMF. These reviews were published
along with the quarterly renewed MoU in a specific section of the Department
of Finance's web site (2014), demonstrating the high level of monitoring of
the agreement. The review reports provide a detailed analysis on how Ireland
was meeting its commitments under the MoU. Up to 2012, there was little
if any mention of the health system. However, throughout 2012, there was
growing attention to health. This culminated in the European Commission
Working Document, Economic Adjustment Programme for Ireland, where the