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408 Economic crisis, health systems and health in Europe: country experience
• Plans to increase the cap on nursing home charges (from 15% to 22% of
post-death assets) announced (2013).
Changes to health service planning, purchasing and delivery
Prices of medical goods
• Deals with pharmaceutical companies were renegotiated (from 2010); a
new agreement announced savings in excess of €400 million in the price of
prescribed drugs over the following three years (2012), but as this deal also
allowed access to new (often very expensive) drugs, at a cost of €70 million
annually for three years, the net savings were in fact €190 million.
• Legislation introducing a system of reference pricing and generic
substitution signed into law (2013).
• New rules allow international prices to be considered when setting
national prices.
Salaries and motivation of health sector workers
• Policies over the period 2009–2013 included a moratorium on
recruitment and promotion, non-replacement of staff on leave, reduced
agency and locum staffing, ending of temporary contracts, staff transfers,
voluntary redundancy, and cutbacks in education and training. Moreover,
the Health Services Executive shed 10 000 staff members between March
2009 and November 2012, with an additional gross reduction of 4000
full-time equivalent positions required if 2013 employment ceiling
targets are to be met.
• Payment reductions have included: lower fees paid to contracted GPs
and other health professionals (beginning in 2010), producing estimated
savings of €659 million. From October 2012, starting salaries for new
entrant consultant medical staff cut by 30%. In 2013, the health service
would hire 1000 graduate nurses and midwives at around 80% of the
existing pay rate, a move designed to mitigate the current dependency on
agency staff and overtime pay.
• Currently Ireland is heavily reliant on foreign trained doctors to staff
the health system. Since 2011 an active recruitment drive has replaced
passive migration of foreign trained doctors to Ireland.
• Reduction of all professional fees by 8% and pharmacy fees by 24–34%
(2009); introduction of further cuts in fees of 5% for health professionals
(2010 and 2011); further reductions in professional fees for health
service providers (2013). It is estimated that pay-related savings will reach
€308 million in 2013.