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Is a bloodless Budget acceptable?

27 Sep 2013

Lloyd Mudiwa

Lloyd Mudiwa reflects on the prospect of more cuts in next month’s Budget further running down the capacity of the Irish health service.

An asteroid could hit the earth, but it’s not something you should lose sleep over. Of more immediate concern is the Budget on October 15, certainly for the health system and the ‘sacrificial lambs’ (healthcare professionals and patients alike).

Commenting on the Association’s pre-budget submission in July, Mr Denis Evoy, President of the IHCA and Consultant Surgeon in St Vincent’s University Hospital, expressed concern that the Government may be planning to cut next year’s health budget by around ?300 million and this follows ?2 billion in cuts since 2008.

Praising the ‘big sacrifices’ made by Irish people, European Commission President José Manuel Barroso said at the turn of this year that Ireland’s commitment to economic reform was paying off — albeit not without financial bloodletting.

According to the recent OECD Health Data 2013 ‘How Does Ireland Compare’ report, 67 per cent of health spending was funded by Government revenues in 2011, down from 75.7 per cent in 2007, prior to the crisis. This reduction in the public share of health funding can be explained by a series of measures introduced to make people pay more out of their pockets, including increases in the share of direct payments for prescribed medicines and appliances. The public share of health spending is now below the OECD average of 72.2 per cent.

Consequently, in relation to key resources in the health sector (human, physical, technological), Ireland in 2011 rated below the OECD average. That is, physicians 2.7 per 1,000 population vs 3.2 per 1,000 population, hospital beds (3 per 1,000 population vs 4.8 per 1,000 population) and diagnostic technologies (13.1 MRI units per million population versus 13.3 per million population, and 15.7 CT scanners per million population versus 23.2 per million population).

Apart from the apparent financial strain on the health system, a glance at the health status and risk factors provides further justification, if any were needed, to opt for a bloodless Budget come October.

While life expectancy in Ireland stood at 80.6 years, half a year above the OECD average (80.1) it was still lower than in a number of other OECD countries, such as Switzerland, Japan and Italy, which have expectancies at least two years higher than in Ireland.

We have seen the proportion of smokers among adults fall from 45.6 per cent in the early 1970s to 29 per cent by 2007 (latest year available), but this is still well above the OECD average (20.9 per cent in 2011).

Alcohol consumption is among the highest in OECD countries, with a consumption of 11.6 litres of alcohol per adult also well above the OECD average 9.4 litres.

The obesity rate has increased in recent decades to, among adults, 23 per cent in 2007 (latest year available), which is higher than in other European countries and much higher than in Korea and Japan, at 4.3 per cent and 4.1 per cent, respectively, in 2011.

Obesity’s growing prevalence foreshadows increases in the occurrence of health problems (such as diabetes and cardiovascular diseases) and higher healthcare costs in the future.

Both the IHCA and the IMO have also recognised the need for a range of population measures and targeted interventions that can impact positively on suicide and mental health, given the link to the recession.

From the perspective of the patient, a way to ease the pain could be to prevent health inequalities and safeguard access to care based on need and not the ability to pay.

High out-of-pocket payments can create inequalities in access to healthcare.

Fearing cuts will blunt the health reforms, the IMO recommends there should be no further increase in out-of-pocket payments for all patients and the Government must ensure adequate human and financial resources are provided.

Investment in our health services is now undoubtedly needed if the Government is to achieve its Programme of Government.

Considering that we are in our sixth year of reducing resources with still no end in sight, one would expect the Government to make it up to the Irish people, given half the chance.

Given that the OECD has said it is not going to lose sleep over the nominal amount of cutbacks in October’s Budget as long as the deficit reduction targets agreed with the Troika are met, let us hope our Government pays heed and cuts both the doctors and their patients some slack on Budget Day.

27 September 2013

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