The development of community health centres with enhanced GP, nursing and general health services is a key strategy for improving the efficiency of the Irish healthcare system, an international healthcare expert has proposed. Speaking at a Society of Actuaries seminar - "Towards a Better Healthcare System" - Dr Bradford Kirkman-Liff said the Government's health strategy, due to be introduced later this month, should invest in primary care facilities and integrate these fully with the existing acute hospital services.
Dr Kirkman-Liff, professor of the School of Health Administration and Policy at Arizona State University, said this trend was being followed by many better healthcare systems in the world, such as in the Netherlands and Denmark.
"There has not been sufficient investment in primary care in Ireland and I would urge those formulating health policy to look at this very closely."
Dr Kirkman-Liff also encouraged reform of healthcare financing.
The Republic has the highest number of people paying private health insurance of any public hospital system in the world. Based on an international analysis, he suggested two options. The first is to expand public health services - enhancing primary care in particular - and to finance this through direct and indirect taxation, as in Denmark.
The second is to introduce compulsory health insurance and use a mix of State co-financed and fee-for-service payments, adjusting patients' level of co-payment according to their income, and rewarding doctors for high-quality, effective care.
Mr Joe Durkan, director of the Centre for Health Economics at UCD, said: "The fundamental difference between those who have insurance and those who rely on entitlements is that those with insurance are buying a service, whereas those with entitlements are given services. One is market-driven while bureaucracy drives the other." Mr Durcan said that a comprehensive compulsory health insurance scheme was unlikely because it would involve changes in the structure of health services.
"A modest change would be the extension of the existing private health insurance system to the population at large covering elective treatment," he said.
