Sir, – It is of concern, but perhaps not surprising, to read that the HSE is now relying on the advice of a Harvard professor of leadership development and management practice to inform health policy in Ireland ("Health cuts 'wrong way' to reform system, Harvard expert says", Home News, May 16th).
The nub of Prof Kaplan’s proposal is that the HSE should base reform and rewards on “excellent outcomes and efficient processes” rather than simply “being there”. The suggestion is that general practitioners should specialise in particular conditions rather than dealing with the “whole range of conditions”.
In this primary care utopia, it seems the “general” is to be removed from “general practice”. GPs are the only clinicians trained in multi-morbidity. This is why mortality figures improve the more general practitioners there are in the community. GPs manage patient care. We operate at the highest level of complexity – not the lowest, as health economists and politicians like to say. We manage 98 per cent of the Irish population’s illnesses and multi-morbidity needs daily and over 24 million consultations take place in general practice each year. Local GPs keep up to 95 per cent of patients out of costly secondary care.
General practitioners deal with the full range of medical conditions presenting in their community. This is what makes the general practice service so successful. The very idea of a specialist-based primary care medical service is just allowing the expensive, fragmented and inaccessible hospital-centric model for health to creep into primary care.
Our model and training for general practice is so effective that such countries as Australia, Canada and the UK are actively recruiting our GPs. The HSE fails to recognise the talent and expertise on its own doorstep. Irish general practitioners are trained in the European definition of general practice and family medicine.
The Irish College of General Practitioners would be delighted to address the educational deficit in HSE leadership at any time. Our college comprises almost over 3,500 members. We work alongside five university departments of general practice. We are not short on expertise, neither are we short on the research that supports our work. As those currently delivering primary care in Ireland, we have earned the right to have our views on reforming the system to be heard. – Yours, etc,
KIERAN RYAN,
Chief Executive,
Irish College of
General Practitioners,
4/5 Lincoln Place, Dublin 2.
Sir, – If the HSE and Department of Health top brass addressed by Prof Robert Kaplan heed his advice to reward and pay people in the health system for delivering superior outcomes and efficient processes, his hefty speaking fee will have been worth it.
Ireland’s healthcare bill of nearly €17 billion is the sum total of thousands of decisions that are made every day by doctors, patients, nurses, hospital administrators and others.
Given the sheer number of decisions that are made, to attain greater system-wide efficiency, we must move from blunt, top-down cost-control measures to using appropriate incentive schemes and information to improve the decision-making process at the micro level, with an understanding as to the consequences of these decisions at the system-wide level.
In seeking to introduce a new universal health insurance (UHI) system it is clear that this Government is trying to meet the key health policy objective of providing an equitable health system. What is less clear is whether the proposed UHI system will promote efficiency and quality, what should be a second key health policy objective.
The essence of ensuring the proposed UHI system meets the requirements of promoting efficiency and quality will be to create a truly competitive healthcare market with consistent incentives and structures that motivate all of the various market participants to act in the best interest of patients.
It is important that the ground rules that are put in place reward health insurers for partnering with efficient providers who work with them to manage effectively quality and cost, and not for anti-social behaviours like risk selection, market segmentation and generation of consumer confusion, as happens in the health insurance market currently, in spite of risk equalisation.
While it does not appear to warrant mention in the Government’s recent white paper on universal health insurance, public accountability for performance by health insurers and healthcare providers will be an integral element of making the new UHI system work. If consumers know about relative performance, they buy from high performers. Healthcare quality metrics are already well developed and in use in other countries.
We know more about the quality of our washing machines and vacuum cleaners than we do about the quality of our healthcare insurers and providers. – Yours, etc,
Dr MICHAEL MOORE,
Morehampton Road,
Dublin 4.