Ireland has one of the highest rates of long-term benzodiazepine usage in the elderly — even though older people shouldn’t be prescribed these drugs.
Prescription guidelines advise “complete avoidance” of these drugs, which are generally prescribed for anxiety, agitation, and sleep disorders, for people over the age of 65 as they pose a high risk of dizziness, confusion, and falls.
An OECD report entitled Tackling Wasteful Spending on Health says more than 60 people per 1,000 population are using such tranquilisers on a long-term basis here; the OECD average is less than half that at under 30 users per 1,000 population.
The OECD researchers describe such medical care as “low value” that can “unnecessarily harm” patients; and state that the patient would not have wanted such care if they were properly informed about the effects.
The study says one in 10 patients in OECD countries is unnecessarily harmed under the care of medics and that more than 10% of hospital expenditure goes to correcting preventable medical mistakes or infections that people catch in hospitals across OECD countries.
The study says Ireland has an adverse event rate of 10.3% and that 72.5% of these medical mistakes are preventable. Last year’s Irish National Adverse Events Study found 6.7% of these mistakes ended in death.
It found Ireland has the highest rate of post-operative sepsis during abdominal surgery, with nearly 3,000 per 100,000 hospital discharges.
The research highlights high Caesarean rates as an example of wasteful spending. One in three babies in the OECD is delivered by Caesarean section — international medical interventions suggests a maximum C-section rate of 15%. It stands at 29.1 per 100 births in Ireland but is as low as 15.3 per 100 in Iceland and Finland.
It notes that, internationally, “the rise may also be due in part to doctors embracing defensive medicine” due to litigious cultures.
The report highlights how money is being wasted by the underuse of generics, with generic drug usage varying from 10%-80% across the OECD. Ireland’s usage has increased but still stands at half the amount of the likes of Germany and the UK. The report notes Ireland is introducing incentives to increase use of such drugs but that it has been slow to introduce ‘biosimilar’ drugs, replicas of the original but with different biological material.
Robotic surgery has also been introduced in hospitals, particularly for prostate cancer, but the OECD describes it as a “costly intervention” whose cost- effectiveness has been questioned.
It notes how during the recent economic crisis, staff numbers at the HSE were cut by 6,000. “While an effective tool to contain administrative spending in the short term, cutting salaries or reducing the workforce does not necessarily tackle waste and can affect the provision of vital services,” it states.
The research says a third of OECD citizens consider the health sector to be corrupt or extremely corrupt and that 6% of health expenditure is lost to fraud or error. It notes that the HSE tracks fraud and abuse in the health services but does not have a dedicated unit.