Thursday, June 20, 2019

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Hospitals are by far the most expensive part of our health system, soaking up more than a third of the €21.1bn expenditure on health in 2017, new figures from the Central Statistics Office (CSO) show. In fact expenditure on hospitals increased by 20% between 2012 and 2017.

The figures bolster the case for shifting more care into the community, as envisaged in Sláintecare, the government blueprint for health reform. The figures also show that administration of the health system, public and private, amounted to €625m, 3% of total health expenditure.

Long term residential facilities such as nursing homes and disability services accounted for almost one fifth of expenditure at €3.72bn. The majority of spending (€11.8bn) related to “curative” and “rehabilitative” care, with almost half of this for inpatient care.

The government funded 71% of this spend while voluntary health insurance payment covered 18%. Pharmaceuticals accounted for 13% of expenditure on health in 2017.

The figures also show a 22% increase in expenditure on home-­based long­term care over the period 2012­-2017. Recently the HSE introduced restrictions on the number of new clients it can offer home support services to. The restrictions will remain in place until November.

Health spending on preventative care such as immunisation and health promotional activities, amounted to €555m between 2012-2017, more than 20 times less than the amount spent on curing and rehabilitating people.

Of the €11.8bn spent on curative and rehabilitative care services in 2017, the government funded over 71% (€8.365bn) and 18% (€2.1bn) was funded by voluntary health insurance payments. Government financed 86% (€3.84bn) of long term care services in 2017. Almost all of the remainder was paid for by household out-­of-­pocket payments.

The Government also funded the majority (79%) of pharmaceutical expenditure. The research says health expenditure in Ireland expressed as a percentage of GDP exceeded the OECD average in 2008 and remained consistently above the average until 2015. It says the large increase in GDP in 2015 “led to a drop in this ratio”.

Writing in The Lancet journal last year, Dr Brian Turner, an economics lecturer at University College Cork, said Ireland’s health spending as a percentage of GDP rose above the OECD average in 2008, “not so much because of higher health spending but because the economy contracted sharply”.

“Similarly, health spending as a percentage of GDP declined sharply in 2015, despite an increase in health spending, as Irish GDP increased by 26%.” Ireland’s 2017 health expenditure represents 7.2% of GDP, down from 7.4% in 2016.

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