Rising cost of health services - Credibility needs to be restored

IT would take a brave politician to tell us that we will have to pay more in taxes if we want our health service to continue to provide the level of cover we enjoy today. 

That person, if they were very brave, might tell us that we may have to pay even more if we want improved services. In reality any politician confident enough to offer that opinion would need to have a career mapped out in something other than politics after the looming election.

As ever we’d shoot the messenger and then, more than likely, repent at our leisure.

Yet that is the core message in a new OECD report — Fiscal Sustainability of Health Systems Bridging Health and Finance Perspectives. The report warns that 13 EU countries, including Ireland, face a very real threat of being swamped by the cost of healthcare.

The OECD also warns that costs will increase by a third over the next 15 years and probably by more if costs cannot be contained.

Health spending as a share of GDP in Ireland is about 9%, 6% coming from Government and the rest from the private sector. It represented 14% — almost a sixth — of Government spending in 2012, a ratio just below the OECD average.

The OECD warns too that it is probably unwise to expect Government spending in other areas to be curtailed to provide an increased health budget. Those sobering predictions take on a slightly different complexion when seen through the filter of a recent WHO report.

The WHO pointed to strengthening evidence that health promotion and disease prevention can improve health at relatively low cost but these programmes were curtailed because of economic difficulties.

The WHO says that between 20% and 40% of the money spent on health does not improve people’s health. This figure takes account of fraud and abuse, not providing proper, agreed levels of care, over-treatment and top-heavy administration.

The European Health Care Fraud and Corruption Network believe that the costs globally are about $300bn a year because of mistakes and corruption alone.

Irrespective of how these figures are considered it seems obvious that some sort of game-changer is needed if we are to enjoy the kind of health service we want and the kind of service most people employed in health provision want to offer.

As in so many areas that so very obviously need reform, credibility is a huge issue. Health minister after minister has tried to confront a system that seems more a trundling behemoth unable to change course than a proactive, energised and self-aware entity.

Taxpayers look at the vast sums the Government spends on healthcare — something around €14bn this year — and wonder, rightly, how that cannot provide a decent service for a population of fewer than five million people.

Is it time to establish a quango that might do some good? One that is not staffed by the usual insiders and will quickly access costs and practices and assure taxpayers are getting the best deal possible?

Without re- establishing credibility in this area it is very hard to see how health spending can be increased to match OECD predictions — and in that event we will all suffer the consequences.


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