The OECD has today published the Economic Survey of Ireland 2022 including, for the first time, a thematic chapter on health sector performance and efficiency.
The OECD Economic Survey reviews a country’s structural policies that have the potential to improve the economy’s long-run performance and people’s living standards. The chapter on health provides an independent, expert assessment of the Irish health system. Through evidence and cross-country comparisons, the OECD make policy recommendations to maximise sustainability, efficiency, and equity.
The report highlights that the health of people in Ireland has improved significantly over the last twenty years with life expectancy now one of the highest in OECD. In addition to acknowledging Ireland’s successful response, in relative terms, to COVID-19, the report spotlights significant achievements and promising initiatives, such as the successful measures taken to reduce tobacco use and increasing five-year survival rates across almost all types of cancer.
Like all other countries’ health systems, Ireland’s health sector faces challenges. Importantly the OECD recommendations on addressing these challenges reinforce the direction of reform that is already under way – including the development of
· The health system performance assessment1 tool – a framework that uses a set of indicators, such as life expectancy and number of health professionals, to allow policy makers and members of the public understand how the health service is functioning
· A single assessment tool2 – this allows a single, comprehensive assessment of a person’s health and social care needs to inform decisions such as whether residential care is appropriate
· The health information bill3 – this will allow data to better flow through the system to support patient care and health reform.
· Measures to support the uptake of generic and biosimilar drugs in Ireland4 - this will allow for greater substitution from branded medication to available low cost alternatives where clinically appropriate.
· Increased investment in data and capital infrastructure – for example to procure an Electronic Health Record system, and modernising hospital buildings.
· Implementation of the Waiting List Action Plan5 – to reduce waiting times in Ireland.
Together with benchmarks on reform in other health services, these initiatives will allow Ireland to better manage challenges that are highlighted in the chapter. For example:
· As the population begins to age, strategic planning of long-term care is necessary.
· Data availability is poorer than in some other countries. This inhibits understanding of how health services are financed, prevents patient records from being efficiently shared between clinicians, and prevents people from being able to quickly access their own ehealth records.
· Pharmaceutical spending is growing rapidly compared to our neighbours.
· Progress on reducing waiting lists has been negatively impacted by the pandemic.
Further key recommendations of the report include:
· Establishing integrated funding and service delivery of home care with other community-based health, long-term care and social services to ensure those who need those services can easily avail of such support.
· Implementing the reforms to create the Regional Health Areas6, which will decentralise some aspects of the health service, and rebalance healthcare delivery across primary, community and long-term care and hospitals.
· Introducing a population-based resource allocation7 funding model as planned, which distributes funding according to the needs in a local population, to improve financial reporting and management and strengthen equity in health outcomes.
· Prioritising the adoption of a unique health identifier3 and centralising governance and appropriate national health information functions within a single independent body.
Minister for Health Stephen Donnelly welcomed the publication saying: “Under the Programme for Government and Sláintecare, the Department of Health is committed to delivering the right care at the right place at the right time – significant investment and reform is underway to deliver a modern, high quality and effective patient-centred system. I welcome the OECD’s commentary on the performance of the health sector - from the excellent health outcomes of people in Ireland to the success of major health initiatives in recent years.
“However, while we have seen unprecedented investment in capacity and people in our health service in recent years, we must also ensure efficiency in the delivery of services. We have high costs in the health sector by international standards and in the current economic climate, it is also important for the health sector to deliver value for money. The issues Ireland’s healthcare services faces are shared by many of our OECD peers and learning from the initiatives of other countries is a major benefit of work like this. The OECD provide a broadly positive assessment of the current reform direction, which we will use to further enhance and accelerate these reforms, to deliver an efficient, effective, patient-centred health service.”
ENDS
Notes to Editor:
1. The Health System Performance Assessment Framework was developed last year by the Department of Health along with key stakeholders and the university of Amsterdam. This is an overarching measurement tool which will be used to allow a high-level view of the performance of the health system. It provides measurable and quantifiable outcomes-based indicators which can be linked to relevant health policies and strategies enabling the integration of policy and reform into an overall view of performance for the health system. The Framework consists of five Clusters – Structures, Process, Outputs, Outcomes and a Cross Cutting Cluster and within this there are 16 domains and currently there are a total of 277 indicators proposed for the Framework. The OECD note that:
“The new Health System Performance Assessment will improve measurement, monitoring and reporting processes. It will thus enable a better understanding of health policy performance. Shifting towards a measurable and quantifiable outcome-based model, and away from the current activity-based indicators, the new tool will significantly support better evidence-based health policy decisions, particularly if increasingly underpinned by more coherently linked datasets.”
2. The Single Assessment Tool (SAT) is a digital standardised assessment – based on the international interRAI framework – of the health and social care needs of frail older persons or people with disabilities applying for either home or nursing home support schemes. The OECD note that:
“The comprehensive assessment, which is set to replace a paper-based procedure, takes into account a broad set of information across several dimensions. These range from the individual’s (physical and mental) health status, functional performance and well-being to more detailed aspects of daily life, like medication management, physical activities, dietary habits and social interactions. Progress is already underway. The evaluation of the outcomes of four pilot projects of a reformed model of home support services – based on the use of SAT – is expected to inform the design of the new statutory home support scheme. Recruitment for 128 Care Needs Facilitator posts has commenced. […] The Single Assessment Tool (SAT) is a key IT tool to support enhanced operational integration across all health and social long-term care providers, enabling large efficiency gains and the provision of more effective person-centred care services.”
3. The Health Information Bill is a major piece of legislation focussed on transforming the current health information landscape to deliver a modern, fit-for-purpose health information system. The bill will provide a robust legislative basis to allow the flow of information through the health system. The OECD comment that the introduction of a unique health identifier:
“Should be complemented by a legislated national data governance framework, as is currently under discussion in the Health Information Bill. Centralising the governance and appropriate national health information functions in a single, independent body could ensure greater data protection and support confidence. The new institution could be responsible for linkage and de-identification services across available health data collections and act as their single custodian. The new entity should take a lead role in the implementation of a national data governance framework, outlining the conditions for data collection, secondary use and secured sharing in an anonymised form.”
4. A biosimilar is a biological medicine that is highly similar to another biological medicine (known as a reference medicine) which already has a marketing authorisation and has been approved for use in patients. The OECD comment that in Ireland:
“The use of generics and biosimilars remains modest. The European Medicines Agency has recently confirmed that biosimilar medicines approved in the European Union are interchangeable with their reference drug.”
The OECD go on to recommend that Ireland should:
“Enhance competition in the off-patent and biosimilar drug market, ensuring that market penetration of medications is not artificially suppressed by the existing system of mandatory price reductions; regularly update the Health Products Regulatory Authority list of interchangeable medicines in order to increase utilisation of lower cost non-originator products, and; encourage the increased use of biosimilars, including by considering making them as interchangeable as generics.”
5. The 2022 Waiting List Action Plan allocates €350 million to the HSE and NTPF to reduce waiting lists. Under this plan the Department, HSE, and NTPF will deliver urgent additional capacity for the treatment of patients, as well as investing in longer term reforms to bring sustained reductions in waiting lists. The Plan identifies 15 high volume procedures, including cataracts, with a commitment that anybody waiting 6 months, who is clinically suitable, will receive an offer of care by the NTPF. As of the end of October the NTPF advise that they have authorised treatment for 80% of patients waiting over 6 months for one of the targeted procedures. The OECD note that the 2022 Plan aims to build on the waiting list reductions achieved under the 2021 Waiting List Action Plan and go on to recommend that Ireland:
“Keep the path of increases in public hospital capacity in line with planned objectives and improve waiting time management, and build a proper information base to monitor progress of the Waiting List Action Plan.”
6. The six new Regional Health Areas (RHAs) are in line with recommendations made in the Oireachtas Committee on the Future of Healthcare Sláintecare Report that regional bodies should be responsible for the planning and delivery of integrated health and social care services. The OECD state that:
“The creation of six new Regional Health Areas (RHAs) is a key step to deliver decentralised integrated care. Having approved RHAs’ geography in 2019, the Government recently agreed on a preferred geographically-based model to regionalise service delivery. Set to be operational by early 2024, each RHA will be endowed with an annual budget via a Population-Based Resource Allocation (PBRA) funding model, with an executive manager directly accountable to the HSE board. These new regional units will take on responsibility for delivering integrated (physical and mental) health and social care services, gradually replacing the current network. Tasked with planning, funding, managing and delivering integrated and patient-centred care based on local population needs, RHAs will empower community-level decision making and local ownership. They should also facilitate more cost-effective access to health and social care services closer to patients’ home.”
7. Population based resource allocation (PBRA) is a funding model for health planning that seeks to distribute available healthcare resources according to population need to promote efficiency and equity in both health outcomes and distribution of resources. A PBRA model is due to be implemented in the Irish healthcare system by 2024. The OECD state that:
“Linking the creation of Regional Health Areas to the adoption of a PBRA funding model could significantly enhance the efficiency of public healthcare spending. By distributing healthcare resources in ways that reflect the specific needs of varying population profiles, rather than based on the requests from different categories of providers as is currently the case, PBRA will enable better service planning, while promoting equity in health outcomes and more effective resource allocation. Moreover, on the back of RHAs’ clearly defined responsibility for delivering integrated care services to their citizens, PBRA will support enhanced accountability. This will pave the way for stronger incentives to improve corporate governance and the system’s transparency, allowing for better spending traceability and more meaningful assessments of its effectiveness.”