‘Crude cuts’ have led to diminishing returns in health service

Research says health system did ‘more with less’ after crisis but ‘less with less’ from 2013 on

“Crude cuts” affecting the Irish health system have led to diminishing returns from 2013 onwards a working paper from the Trinity-based Resilience Project has found.

The project looked at how well the health system had coped with reduced resources from the onset of the economic crisis in 2008 through an analysis of a range of performance indicators.

The research, presented at a conference held in Trinity today, pointed to a number of datasets which they said indicated that the health system has shown significant resilience in the period between 2008 and 2012 and had managed "to do more with less" in that period.

However, they said the indicators are that from 2013, the system will be doing “less with less” pointing to an increase in waiting lists from mid-2012 onwards, cuts to home help hours and a shift in the burden of medical costs back to the patient, which the reserchers estimated at around €100 more per person now than before the crisis hit.

Principal investigator and associate professor Steve Thomas said it appeared that austerity, up to mid-2012, delivered an "efficient jolt to the system" driving some efficiencies including a reduction in unit costs and increased throughput.

However, the working paper said the indicators were that there was a “limited window of benefit from austerity beyond which cuts and rationing prevail without structural change”.

Researcher Dr Sara Burke noted signs of resilience between 2008 and 2012, for example an overall significant growth in the numbers covered by public health schemes such as the Long Term Illness and High Tech Drug schemes while the costs of these schemes had simultaneously decreased.

Despite approximately €4 billion in cuts to the health system since 2008 and 12,000 fewer staff in December 2013 than in 2007, she noted that waiting lists for inpatient and day care hospital treatments had fallen between 2010 and 2012.

However, Dr Burke said that, while the system had been “relatively resistant” up to 2012 it then reached a “tipping point” with waiting lists rising between November 2012 and November 2013:

“We would be reading this as an indicator of a system that can’t continue to do more with less,” she said.

Dr Thomas said a problem also arose in the “shifting the burden of cost of access back onto households” including the automatic entitlement to a medical card for over-70s, increased costs for emergency department attendances, a much higher threshold under the drugs payment scheme and prescription charges for medical card holders which rose to €2.50 in the last budget.

“What we find is an increase in the shift of burden of costs of accessing care of around €100 per person more being paid by households now than they were before the crisis”.

Speaking at the conference Leo Kearns, HSE national lead for transformation and change described the value of the research as "enormous" and is "beginning to start, I think a more mature debate about healthcare in Ireland".

“We have pretty much reached the end of dipping into the well of resilience that we can expect from people in the health service. I don’t think we can go any further with that,” he said.

Mr Kearns said that reform was being taken seriously by the health service, noting that director general of the HSE, Tony O'Brien has established a system reform group to work with the HSE, the Department of Health and all other stake holders for this purpose but added: "A really important question is are we prepared for the 10- to 15- year journey that that needs?".