Press Release

Minister Harney welcomes launch of Health Funding Report

The Minister for Health and Children Mary Harney T.D. today welcomed the publication of the report of the Expert Group on Resource Allocation and Financing in the Health Sector, which she established in April 2009.

The Group was tasked with analysing the current resource allocation arrangements for health and personal social services, and recommending changes which would support the core objectives of the health reform programme. It was also asked to take a view on the most appropriate financing mechanism for this purpose in Ireland (see terms of reference and membership below).

Speaking at the launch, the Minister thanked the Chair, Prof. Frances Ruane, and the members of the Group for their detailed and comprehensive analysis of the many complex issues involved. She said, “The way we allocate resources and pay for health services is a powerful force for the achievement of best health for the people and best outcomes for patients.

“The priorities we set, and the incentives we create, will mean more care in the community, improved service for patients, and more transparency in how money is used.

“Alongside the progressive implementation of quality standards and licensing of hospitals, this is the next major step in health reform.

“It is certainly about making money follow the patient’s best health, that is, getting the outcomes we need, not just constantly more and more tests, treatments and consultations.”

The Minister welcomed the focus in the Report on the development of new population health based funding arrangements and on addressing the burden of chronic disease management through pro-active integrated care at all levels, including primary and community care, linked to internationally recognised clinical protocols.

She also welcomed proposals to move to a system whereby hospital treatments would be funded on a mainly prospective, episode of care basis, as compared to the current historic block grants. The National Treatment Purchase Fund had shown how this method could be used in purchasing treatments for public patients from private hospitals. The Group is now recommending extending and mainstreaming this method of purchasing from both public and private providers, building on the NTPF’s experience.

The Minister said “I will give detailed consideration to all the proposals and suggestions in the Report. There are recommendations that should be capable of fast implementation and will support the more effective use of resources in hospitals and community settings, with clear benefit to patient care. Others require more fundamental change over a medium timeframe, as resources and savings permit.”

“I intend to bring the report to Government for its consideration and decisions in the autumn.”

Background

The Expert Group on Resource Allocation and Financing was established to examine how the existing system of resource allocation within the Irish public health service can be improved to support better the aims of the health reform programme. The allocation of resources is a key driver of change and there is a need to see greatly-improved links between resources and patients’ interests, to support better each person’s health status and outcomes from healthcare. The Expert Group was asked to examine in detail the best ways to achieve this, within the level of resources available to health.

The Report of the Expert Group includes thirty-four recommendations on a wide range of issues. Some of the key recommendations are set out below:

Financing Health Care

The Group does not recommend a change from the present mainly tax-based financing of health care to universal/social health insurance. The Group was more concerned with how the mechanisms for collecting and managing funds are structured.

Possible Framework for Resource Allocation for Integrated Health Care Delivery.

The Group suggests a need for a new graduated form of eligibilty to better address the burden of chronic disease management. An illustrative framework proposed by the Group looks in particular at offering pro-active care at primary and community levels though a system of graduated eligibility for GP services and prescription medicines. The Report also identifies the need to develop other primary care services. The Report acknowledges that the roll-out of such an approach is dependent on resources.

The Group has recommended that a project be established to immediately explore in detail the way a coherent structure of entitlements to primary and community care services and drugs could be implemented.

Population Health Funding

The Group has recommended the development of an operational population health resource allocation model for Ireland. This model should become operational in 2012 and be fully implemented by 2015.

Prospective Activity Based Funding

The Group recommends that prospective based funding as a method of reimbursing health-care providers should be introduced for all relevant areas of health and social care system on a phased basis. National plans should be drafted and this method should be introduced in a phased basis beginning in the acute hospital sector where existing data collection arrangements could support such a development.

National Treatment Purchase Fund (NTPF)

The Group recommends that as prospective based funding mechanisms are rolled out the role of the NTPF in relation to waiting lists should be mainstreamed within the HSE. The transfer to the HSE would not only include the transfer of resources but also responsibility for monitoring waiting times to achieve centrally set targets to ensure that patient benefits are preserved.

Other Issues

The Group supports many of the recent health reform initiatives, including Fair Deal, the development of clinical care pathways, the policy of delivering integrated care outside hospitals as far as possible the work being done on a unique health identifier and the development of more individualised funding options more persons with a disability. It also favours a flatter organisational structure within the HSE.

Membership

The membership of the Group is as follows:

Chair – Professor Frances Ruane, Director, Economic and Social Research Institute (ESRI)

Mr. Brendan Broderick, CEO Sisters of Charity of Jesus and Mary, Moore Abbey

Mr. Ian Carter, CEO, St. James’s University Hospital

Dr. Colin Doherty, Consultant Neurologist, St. James’s University Hospital

Mr. Derry Gray, Partner in Charge of Consulting, BDO

Professor Arnold Hill, Professor of Surgery at RCSI and Beaumont Hospital

Ms. Nuala Hunt, Board of Governors, National Maternity Hospital

Professor Peter Kearney, Consultant Cardiologist, Cork University Hospital

Mr. Thomas G. Lynch, Chairman & CEO Amarin Corporation plc.

Mr. Pat Lyons, CEO, Bons Secours Health System

Professor Andrew Murphy, Dept. of General Practice, NUI Galway

Professor Charles Normand, Edward Kennedy Professor of Health Policy & Management, University of Dublin, Trinity College

Mr Manus O’Riordan – Head of Research, SIPTU

Professor Rowena Peechenino, Head Department of Economics, Finance & Accounting, NUI Maynooth

Ms. Patricia Purtill, Principal Officer, Sectoral Policy Division, Department of Finance

Ms Patricia Purtill joined the Group in August following a request from the Department of Finance for membership of the Group. She was subsequently replaced on the group by Mr. David Moloney, Assistant Secretary, Department of Finance, who attended the 9th and 10th plenary meetings and by Ms Judith Brady, who attended for the 11th and 12th meetings.

Ms. Patricia Sullivan, General Manager, Waterford Regional Hospital

Mr. Dermot Smyth, Assistant Secretary, Department of Health and Children

Mr. Liam Woods, National Director of Finance, HSE

Terms of Reference

The Minister has asked the Expert Group:

  • to analyse the strengths and weaknesses of the current resource allocation arrangements for health and personal social services;
  • to recommend appropriate changes in these arrangements, which would support and incentivise the achievement of the core objectives of the health reform programme;
  • in the light of its work, to take a view on the most appropriate financing mechanism for the Irish health service, and
  • to base its examination and recommendations on the existing quantum of public funding for health
  • To report to the Minister for Health & Children and Minister for Finance by April 2010.

Read the Report