How to ensure the best utilisation of healthcare resources in Ireland - the economist perspective
-
Upload
irish-pharmaceutical-healthcare-association-ipha -
Category
Health & Medicine
-
view
784 -
download
0
description
Transcript of How to ensure the best utilisation of healthcare resources in Ireland - the economist perspective
Improving Resource Allocation in the Irish Health Sector –
Some New InsightsPresentation to IPHA Conference on Enterprise and Health Solutions for
Irish Patients and the Irish Economy 25 November 2010
Frances Ruane, ESRI
Outline of Presentation
Context: Expert Group Report which sought to develop resource allocation and financing systems that support better health and better health services
Approach of the Expert Group Characterisation of the Systemic Issues Today’s system failures Guiding Principles for the future Key Recommendations
Better health through better health services
Focus on health and wellbeing requires The right services delivered by the right skills and facilities
in the right places Fairness, equity and focus on greatest needs Sustainable and efficient Joined up and fit for purpose All of these are stated objectives of Irish health policy How do we do better at achieving them?
Perspective: clinical, managerial, economic, administrative
Achieving these objectives
Sustainability
Achieving these objectives
Stated Policy Objectives
Service Delivery Systems Financing Methods
Achieving these objectives
Stated Policy Objectives
Service Delivery Systems Financing Methods
Expert Group Methodology
Gathered international* evidence on best practice and sought local submissions
Focus on integrated care: chronic disease Analysed stated health policy in Ireland Derived Guiding Principles Compared current arrangements with Guiding
Principles to identify failures systematically Systemic Approach: Aim to change how
things work so that individuals are supported
Integrated Care
Equity & Fairness
Population Health Needs
Allocation
Funding & Financial
Incentives
Public & Private Involvement
Key Elements
in System
Integrated Care
Equity & Fairness
Population HealthNeeds Allocation
Funding & Financial Incentives
Public & Private Involvement Integrated
Health Care System
Integration is essential
Current Systemic Failures [1]
Planning Vacuum No integration of capital/current expenditure No whole system analysis [public/private] No rational basis for national planning Focus on fiscal rather than total health cost
Incentives out of line with stated objectives Incentives to use hospital care No rewards for improvements in efficiency/safety No governance structures / budgeting processes to
locate service delivery in the appropriate setting
Current Systemic Failures [2]
Financing Unregulated GPs [fees/quality] for majority Access to care overly related to ability to pay Widespread anomalies in what/who is covered Continuing issues with consultant contract
Sustainability GP contract is totally inappropriate Pharmacy / GP charges are comparatively high Prescription rates have risen dramatically Little use of techniques to improve sustainability
What are the Guiding Principles? [1]
Money should follow need not history
Policy and entitlements should be set nationally, and delivered locally
We should fund activity not organisations
We should support integrated, safe, cost-effective sustainable care in the best settings – focus on Chronic Disease requires integrated system.
Primary Care Acute HospitalCare
Community andContinuing
Care
Is this the current system?
Primary Care
Acute HospitalCare
Community and
Continuing Care
This is what we have!
Institutional Care
Care inHome Settings
This is what we also have!
This is what we need!
What are the Guiding Principles? [2]
Financial incentives should:a) encourage providers to meet priorities and quality
standards set in policy at minimum costb) encourage users to use the appropriate services
People should pay according to their incomes and have access according to their needs
Arrangements should be sustainable.
Resource Allocation Recommendations:Systems
Strengthen planning frameworks / processes
Distribute resources based on real population need
Deliver locally within national frameworks and strengthened management – not => health boards!
Pay providers for what they deliver at (case-mix adjusted) prices that reflect efficient delivery.
Resource Allocation Recommendations:Delivery
Strengthen clinical protocols to manage major diseases fairly and efficiently
Develop and strengthen primary/community services and shift services from hospitals to community where appropriate
Guarantee rights to timely care – NTPF approach to apply to all HSE funding – phase out current NTPF role on waiting lists.
Financing Recommendations
Less pay as you go, more prepaid
Fairer and clearer entitlements
Increase transparency of flows to providers
Replace tax reliefs on medical expenses and private insurance with more targeted subsidies*
Lower and fairer user fees for GP services and drugs, based on income and health status
Sustainability Recommendations
Measures to improve information More fit-for-purpose contracts More evaluation of drugs and treatments Improved cost control Better regulation and performance management Better capital planning. Major changes for: DoHC, HSE, Hospital Care,
Primary Care, Community & Continuing Care
Relevance of the Report to Pharma Sector
Focus on Health and Health care Focus on moving to new models of care Focus on Chronic Disease Management – and
making sure that resources support it Focus on care provision outside institutions Focus on value for money and efficiency linked to
high standards [clinical protocols] Focus on sustainability – keeping down unit costs Specific recommendations
Specific Recommendations [1]
Evaluation of all high-cost, high-use drugs on the current GMS/DP lists, based on Irish costs and international experience of their outcomes
HSE and DoHC engage immediately in the development of official guidelines and clinical protocols on the use of new technologies
Develop reference pricing Review choice of comparator countries used for
setting ex-factory price of pharmaceuticals Extend tendering for sole supply contracts for
additional pharmaceutical products
Specific Recommendations [2]
Establish treatment and prescribing protocols that promote the use of generics
Introduce regulations to mandate that all prescriptions for public and private patients must contain the generics name so the drug prescribed
Introduce regulations to mandate all pharmacists to dispense the lowest cost version of the drug unless the patient specifically request a particular brand and is willing to pay the additional cost
Extend information on generics more widely among doctors, pharmacists and patients
Appendix
What will change for C&C* Care Before
~ Historic budgets Uneven resources Weak infrastructure Weak links to HC*/PC* Overlap of purchasers
and providers
After
Prospective funding Pop. health budgets Improved infrastructure Systemic links to HC/PC Move to separate
purchasers/providers
*C&C = Community and Continuing Care; HC = Hospital Care; PC = Primary Care
What will change for the DoHC?
Before Fragmented Policy
Framework Resource usage policy
oriented towards public health-care system
Lack of multi-annual capital/current system planning
Unclear boundary with HSE in relation to resource allocation
After Integrated Policy
framework Resource usage policy
covers total health-care system
Five-year planning framework to cover all health-care spend
Clarity with respect to resource allocation roles of DoHC and HSE
What will change for the HSE?Before
Integration of HSE roles as purchaser & provider
Separate budgeting for hospitals / PCCC*
Separate structures for resource allocation, management and clinical leadership
Targeted waiting times
After
Planned move to purchaser/provider split
Integrated budgeting for all sectors
Integrated leadership across resource allocation, management and clinical standards
Guaranteed waiting times
*PCCC = Primary, Continuing and Community Care:
What will change for Hospitals?
Before
Mostly Block Grant Inefficiency unknown Budgets supporting silo
work practices Large barriers between
hospitals and other care settings
After
Prospective funding Efficiency rewarded Budgets promoting team-
based approach Resources linking
hospitals and other care settings
What will change for the Patient?
Before
Unplanned eligibility patterns
GP/Drug payments not related to incomes and need / charge rates unregulated
Fragmented care – people getting services they do not need and lacking those they need.
After
Clear eligibility related to need
GP/Drug payments related to income and need – tiered medical card for all
Individual care pathways – crucial for caring for the ageing population