Funding universal health and social care in ireland
-
Upload
nevineconomicresearchinstitute -
Category
Healthcare
-
view
37 -
download
0
Transcript of Funding universal health and social care in ireland
![Page 1: Funding universal health and social care in ireland](https://reader036.fdocuments.us/reader036/viewer/2022071814/55a71d4c1a28ab3a4a8b460a/html5/thumbnails/1.jpg)
Funding Universal Health and Social Care in
Ireland:
Charles Normand
Edward Kennedy Professor of Health Policy and Management
11 February 2015
Ageing, dying and affordability
![Page 2: Funding universal health and social care in ireland](https://reader036.fdocuments.us/reader036/viewer/2022071814/55a71d4c1a28ab3a4a8b460a/html5/thumbnails/2.jpg)
Trinity College Dublin, The University of Dublin
Outline of Presentation
• Why is health different?
• Stated objectives in Irish health policy (and what happened)
• What do we mean by universal health care?
• Nothing comes from nothing
• Funding what?
• Ageing and dying
• System capacity and plausibility of UHC
• Dealing with legacy issues
• Towards affordable universal coverage
![Page 3: Funding universal health and social care in ireland](https://reader036.fdocuments.us/reader036/viewer/2022071814/55a71d4c1a28ab3a4a8b460a/html5/thumbnails/3.jpg)
Trinity College Dublin, The University of Dublin
Why is health different?
• Information issues, monopolies and other market failures
• Fees discourage both useful and less useful use
• The perfect storm – we can pay when we do not need and we
need when we cannot pay
• As a society we are not willing to allow access to be
determined only by ability to pay.
![Page 4: Funding universal health and social care in ireland](https://reader036.fdocuments.us/reader036/viewer/2022071814/55a71d4c1a28ab3a4a8b460a/html5/thumbnails/4.jpg)
Trinity College Dublin, The University of Dublin
Stated objectives in Irish health policy (and
what happened)
• Access to good quality services
• On basis of need and not ability to pay
• Efficient provision, with access at lowest feasible level of
complexity
• No significant changes in entitlements
• Retention of fees despite evidence
• Poorly thought out organisational changes (with new ones
under way now)
• Continued support for private insurance and provision.
![Page 5: Funding universal health and social care in ireland](https://reader036.fdocuments.us/reader036/viewer/2022071814/55a71d4c1a28ab3a4a8b460a/html5/thumbnails/5.jpg)
Trinity College Dublin, The University of Dublin
What do we mean by universal health care?
• Everything that is good value
• Good value generally in terms of being effective and cost-
effective
• As a rough guide, everything with cost/QALY below €45,000?
• We should cover all of some things and NOT some of all things
• None of this implies a callous approach or a refusal to support
innovation and development.
![Page 6: Funding universal health and social care in ireland](https://reader036.fdocuments.us/reader036/viewer/2022071814/55a71d4c1a28ab3a4a8b460a/html5/thumbnails/6.jpg)
Trinity College Dublin, The University of Dublin
Nothing comes from nothing
![Page 7: Funding universal health and social care in ireland](https://reader036.fdocuments.us/reader036/viewer/2022071814/55a71d4c1a28ab3a4a8b460a/html5/thumbnails/7.jpg)
Trinity College Dublin, The University of Dublin
Funding what?
• All cost-effective services
• Efficient provision of care – evidence suggests we could still get
10-15% more from system and an extra 2-3% per year
• Explicitly rationed (or explicit priorities set)
• Carefully considered approach to rare conditions and very high
cost (price) services.
![Page 8: Funding universal health and social care in ireland](https://reader036.fdocuments.us/reader036/viewer/2022071814/55a71d4c1a28ab3a4a8b460a/html5/thumbnails/8.jpg)
Trinity College Dublin, The University of Dublin
Ageing and dying
• Ageing will increase health care costs (but only very slowly and
slightly)
• Balance of needs will change substantially
• Dying is much more important than ageing
• Some of recent growth has been giving more to existing older
people and not more older people – the weakening of implicit
rationing
• Changing demographics bring some gains from more care of
older people by older people
• Some interesting new challenges from multi-morbidity and need
for more team work and skill mix changes.
![Page 9: Funding universal health and social care in ireland](https://reader036.fdocuments.us/reader036/viewer/2022071814/55a71d4c1a28ab3a4a8b460a/html5/thumbnails/9.jpg)
Trinity College Dublin, The University of Dublin
System capacity and plausibility of UHC
• People are generally willing to pay more to get more, but not
more for the same
• Even those in Ireland with higher levels of entitlement tend to
face constraints in access
• UHC as conceived in this paper needs increased capacity and
co-ordination of care, especially around primary care and areas
of chronic disease management and continuing care.
![Page 10: Funding universal health and social care in ireland](https://reader036.fdocuments.us/reader036/viewer/2022071814/55a71d4c1a28ab3a4a8b460a/html5/thumbnails/10.jpg)
Trinity College Dublin, The University of Dublin
Dealing with legacy issues
• Private medical insurance – enshrines unequal access but
contributes relatively little to funding (around 10% cash but less
value)
• Supported and subsidised despite conflict with policy objectives
and effects on wider system
• Current model clear evidence of path dependency!
• Difficult to see how community rating can survive as a genuine
feature of PHI in Ireland
• It is not useful to have full fee access to GPs, and it makes
integrated care hard to develop.
![Page 11: Funding universal health and social care in ireland](https://reader036.fdocuments.us/reader036/viewer/2022071814/55a71d4c1a28ab3a4a8b460a/html5/thumbnails/11.jpg)
Trinity College Dublin, The University of Dublin
Towards affordable universal coverage
• How universal is a choice, but what kind of universal is a given
• We could have a pretty good universal service for what is currently
paid in tax, PHI and out of pocket
• There would be some losers – who currently get better access from
PHI
• The often criticised USC provides a possible framework for a single
contribution to UHC
• Long term care will be an areas of growing need – some mechanism
like Fair Deal is probably best, but covering all aspects of care
• Two tier systems tend to advantage the rich and the very poor and
disadvantage the low paid working population.
![Page 12: Funding universal health and social care in ireland](https://reader036.fdocuments.us/reader036/viewer/2022071814/55a71d4c1a28ab3a4a8b460a/html5/thumbnails/12.jpg)
Thank You for Your Attention