Health in a time of cutbacks


UNDER THE terms of the EU-IMF bailout, the Government will shave €3.8 billion from the December Budget. Much of this will have to come from the big-spending departments of health, social welfare and education. But already this year’s public health budget is showing strain: the deficit to date has reached €195 million. With that overspend increasing at a rate of €20 million a month and hospital budgets under particular pressure, patients may feel the pain of acute cutbacks well before 2012.

Many global health systems are under stress because people are living longer and medical science continues to offer newer and more effective treatments. There has been some discussion about the inevitability of healthcare rationing in both the US and Britain. But despite a similar mismatch between resources and demand in the Republic, there has been little debate on the implications for the public health system here.

Rationing is defined as the controlled distribution of scarce resources or services and is not a new concept in healthcare. It occurs most often in times of emergency such as the increased need for ventilators in the winter months during flu epidemics. Separately, organ transplants are dictated by the availability, or the shortage, of donor hearts, kidneys and lungs.

But research (including a recent Tasc report, Eliminating Health Inequalities – A Matter of Life and Death) shows that health funding cutbacks disproportionately affect those in the lowest socioeconomic groups. This is especially the case when cuts take the most simplistic route and budgets are top-sliced across the spectrum.

The health service is now facing a sharply reduced resource in the form of a sudden drop in exchequer funding. Research by the ‘We the Citizens’ group suggests a majority of people are against significantly raising taxes in order to minimise the depth of health cuts. Most of those surveyed favour spending cuts as the best way of dealing with the massive deficit.

So without additional taxation and with the EU-IMF monitoring spending microscopically, whither the health service? Minister for Health Dr James Reilly’s aim to end two-tier medical care and create a universal health system may be stillborn in the face of such swift and acute spending cuts. The progress made by the Health Information and Quality Authority (Hiqa) in prioritising patient safety within the HSE is also at risk.

In the context of the billions spent on the public health system, outdated practices and excessive pay levels persist. Inefficient use of resources such as operating theatres and MRI scanners must be changed. It is unacceptable to have some of the highest paid hospital specialists in the world left idle because they cannot access unused facilities to treat patients.

And there is a real danger that health practices and parameters hitherto considered unsafe will be approved under a rushed “must save money” mantra. Individual health professionals and agencies such as Hiqa must block any attempt by the HSE to reduce services below a safe and acceptable minimum.