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

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

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18.06.2015 Views

Country profiles of health system responses to the crisis | Ireland 409 Payment to providers • From 2008, annual fee to GPs who treat medical card holders reduced. • From 2009, reduction of 8% on all professional fees and cut to pharmacy fees of 24–34%. Further cuts in fees of 5% for health professionals were introduced in 2010 and 2011. In 2013 budget, professional fees for health services providers were to be further reduced. It is estimated that pay-related savings will reach €308 million in 2013. Overhead costs: restructuring the Ministry of Health and purchasing agencies • HSE commitment in 2009 to reduce administrative, management and advertising costs by at least 3%. • Cuts in administrative spending introduced in 2010 budget, including reducing HSE staff by 6000 (€300 million) plus additional efficiencies in the HSE (€90 million). • Cuts in administration (€43 million) proposed in 2011 budget. • Administrative savings in the Department of Health were to total €20 million. Provider infrastructure and capital investment • Measures to provide more services with fewer resources: hospital day care increased by 5% in the first six months of 2009 relative to 2008 and above the 2009 target; outpatient appointments increased by 3% between the first six months of 2008 and 2009 and the number of new outpatient attendances increased by 6% in the same period; hospital capacity reduced by 519 beds between January and July 2009. • The approval (subject to planning permission) for a new National Children's Hospital at the expected cost of €500 million was announced in November 2012. It is planned to be completed by 2018 (at the latest) and will merge the three existing children's hospitals. Priority setting or protocols to change access to treatments, coordination of care and patterns of use • Since 2008–2009, 31 clinical care programmes have been in place that utilize a model of care devised for improving the quality of cancer care; this model is now being applied to all diseases and conditions in all health care settings. Many of the efficiencies gained in 2012 are attributed to service improvements brought about by the clinical care programmes. Waiting times • Between January and September 2012, the number of people waiting on trolleys in emergency departments fell by 24%, the number of adults

410 Economic crisis, health systems and health in Europe: country experience waiting for elective treatment in public hospitals fell by 86% (waits over 12 months), 92% (waits over 9 months), 44% (waits over 6 months) and around 33% (waits over 3 months), reflecting political priority to reduce waiting times by increasing hospital activity through clinical care programmes, which had been implemented since 2010; however, there are 388 438 people waiting for outpatient appointments, waiting times for community services (e.g. physiotherapy) have increased and in 2012 there were 2.5 million fewer home-help hours provided than in 2008. Health promotion and prevention • Between 2005 and 2010, there was no designated budget for public health and many health promotion staff were redeployed to primary care and other services. The public health services that exist are very narrow, with a strong focus on immunization and some lifestyle-related initiatives. Public health and health promotion staff were categorized as population health staff and have seen a 20% reduction in numbers from 544 (March 2009) to 434 (November 2012). Plans for a new public health directorate within the HSE have been announced but no details are available as to its role or the extent of its resources.

410 Economic <strong>crisis</strong>, <strong>health</strong> <strong>systems</strong> <strong>and</strong> <strong>health</strong> in Europe: country experience<br />

waiting for elective treatment in public hospitals fell by 86% (waits over<br />

12 months), 92% (waits over 9 months), 44% (waits over 6 months)<br />

<strong>and</strong> around 33% (waits over 3 months), reflecting political priority to<br />

reduce waiting times by increasing hospital activity through clinical care<br />

programmes, which had been implemented since 2010; however, there<br />

are 388 438 people waiting for outpatient appointments, waiting times<br />

for community services (e.g. physiotherapy) have increased <strong>and</strong> in 2012<br />

there were 2.5 million fewer home-help hours provided than in 2008.<br />

Health promotion <strong>and</strong> prevention<br />

• Between 2005 <strong>and</strong> 2010, there was no designated budget for public<br />

<strong>health</strong> <strong>and</strong> many <strong>health</strong> promotion staff were redeployed to primary care<br />

<strong>and</strong> other services. The public <strong>health</strong> services that exist are very narrow,<br />

with a strong focus on immunization <strong>and</strong> some lifestyle-related initiatives.<br />

Public <strong>health</strong> <strong>and</strong> <strong>health</strong> promotion staff were categorized as population<br />

<strong>health</strong> staff <strong>and</strong> have seen a 20% reduction in numbers from 544 (March<br />

2009) to 434 (November 2012). Plans for a new public <strong>health</strong> directorate<br />

within the HSE have been announced but no details are available as to its<br />

role or the extent of its resources.

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