Tackling hospital waiting lists

According to an OECD overview, Health Policy in Ireland, Ireland has seen remarkable improvements in the health of its population in the last decades, but several challenges lie ahead for its health system.

Based on its analyses, progress could be made to promote efficient use of hospital resources, strengthen primary care, address high pharmaceutical spending and prevent the spread of risk factors, including obesity and alcohol consumption.

Irish hospitals are working near full capacity, it says. The occupancy rate for acute care beds is among the highest in the OECD countries and has risen substantially in recent years. While that can be a sign of hospital efficiency, it notes, it can also mean too many patients are treated at the secondary-care level. Very high occupancy rates can also have a negative impact on access to care, and increase waiting times.

Waiting times have increased in recent years for a number of activities, it found. The percentage of patients on a list waiting more than three months in Ireland for cataract surgery, for example, went from 48.8 per cent in 2010 to 67.1 per cent in 2013. For hip replacements, the figure rose to 57.7 per cent and for knee replacements, 63.4 per cent. “The increase in waiting times in Ireland can be partially linked to measures introduced in the wake of the financial and economic crisis, such as the postponement of hospital investment and the reduction of hospital staff,” it says.

Total hospital employment in Ireland, per 1000, fell from 60.1 to 57.2 between 2008 and 2014. The average length of stay in Ireland is below that of most other European countries. The OECD average stay is 8.1 days. In Ireland it is six.

Among OECD countries, Ireland has the highest rate of hospital admissions for chronic obstructive pulmonary disease (COPD) and asthma. Both are long-term-care conditions that can be effectively managed in primary care without requiring hospital admission, it says.

For example, average OECD hospital admissions for COPD and asthma, per 100,000 of population, is 242. In Ireland the figure is 436.

The report recommends that avoidable hospital admissions should be treated in a primary-care setting. Day-case surgery should be encouraged where appropriate. Hospital payment reforms should continue to be replaced by activity-based financing and patient choice, and competition among hospitals should be enhanced to bring down waiting times. Modernising our hospital infrastructure to better cope with increasing demand would also help, it suggests.

It also recommends that Ireland improves access by implementing universal healthcare coverage for primary care – currently less than half of the population has free access to primary care, it points out.

Technology can help. According to the Euro Health Consumer Index 2016, a survey of the healthcare systems of 35 countries, Macedonia – which scored better than Ireland – did so because the introduction of real-time e-booking systems enabled it to eradicate waiting lists.

The advent of apps such as Healthmail, which enables doctors to communicate patient data securely over the internet, also helps boost efficiencies, says Karl McDermott of telecoms company Three. The company is also working with the National Association of GPs to launch GP Online, a video consultation service.

‘Wearable devices’

“The Internet of Things will also help improve efficiencies, particularly where doctors can monitor, say, heart rate or blood pressure via wearable devices, and so only need to see you once a limit is breached,” he says.

“One of the big needs in the healthcare system is to keep people out of hospital, and mobile devices are one way of doing that.”

Health informatics, where IT and healthcare meet, has the potential to bring down treatment waiting times, believes Prof Michael Thick, chief medical officer of IMS MAXIMS, a medical technology company. The company is a pioneer of electronic patient record software and has since expanded into data analytics. So called “big data” has the potential to impact on everything from an individual patient wearing a monitoring device, to national health organisations looking to identify health trends early on and respond effectively, he points out.

“At its most basic, the way healthcare is run, in Ireland and elsewhere, is for the benefit and convenience of those delivering it rather than of those who need it. It has become set in its ways,” says Prof Thick.

Finding a better way of doing things in healthcare won’t, of course, come from technology, but, once it is established, technology can help deliver it, he reckons. “Healthcare is 10 or 15 years behind other major industries” in relation to the adoption of digital technology, he says: “It is ripe for disruption.”