Indicators of universal healthcare in Ireland Sara Burke Project Co-ordinator: Mapping the Pathways to Universal Healthcare Centre for Health Policy and.

Indicators of universal healthcare in Ireland

Sara BurkeProject Co-ordinator: Mapping the Pathways to Universal Healthcare Centre for Health Policy and Management, Trinity College Dublin

22 September 2015

Trinity College Dublin, The University of Dublin

Indicators of universal healthcare in Ireland

– Full package• Community, Acute, Long Term Care• Needs based

– Quality• Timely• Integrated – Continuity• Appropriate, Best Practice Clinical

– Coverage for all• Universal means everyone

– Resources • Sufficiency (threshold) • Efficiency (Allocative, Technical – Right

mix)

– Financial protection • Free Care (at point of contact)• Affordable care (progressive, avoid

catastrophic payment and risk of impoverishment)

Developing a suite of indicators to reflect dimensions of UHC

Indicators of Universal healthcare:Package of care

Charges capped at €750 per year for public hospital care for 63% of pop

Primary care is free at the point of use for 37% of population

Homecare available on basis of need but rationed & supplemented privately & by family

POPULATION

SER

VIC

ES

& E

SS

EN

TIA

L

MED

ICIN

ES

0% 100%

Hospital care without charge for 37% of pop

GPs charge @€50 per visit, no entitlement to other primary care services for 63% of pop

Prescription drugs costs up to a max of €144 per month for 63% of pop

Prescription drug charge €2.50 per item, capped at €25 per

family

Some universal public health services such as maternal & infant scheme & immunisations

45% of pop have PHI, mostly covers cost of private elective hospital care

Long-term residential care but subject to large contributions + assets, not all costs covered

Mental health services, largely publicly provided, difficult to access, focus on acute

Many primary & social care services available privately at a cost

GEO

GR

AP

HIC

AL A

CC

ESS

Trinity College Dublin, The University of Dublin

• Subtitle — Source Sans Pro Regular 20pt

2001: Medical cards for all over 70s

2011: Promise of free GP care for all

2008: Universal medical cards for over 70s

withdrawn

2015: free GP care for u’6s & o’70s

2013: tightening up of rules on discretionary medical cads

2011: Promise

of Universal

Health Insurance

2015: UHI costings remain unpublished

Indicators of Universal healthcare:Quality of care

Trinity College Dublin, The University of Dublin

Numbers of outpatients waiting 2012-15

1-3 months 3-6 months 6-12 months 12-24 months 24-36 months0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

133,133

68,356 76,290

66,886

25,716

147223

7790376228

39425

12861

146,162

82,975

97,138

51,537

3,226

149,659

86,568

101,715

66,378

Nov-12 Nov-13 Nov-14 Aug-15

Trinity College Dublin, The University of Dublin

Children & adults waiting for inpatient or day case hospital appointment 2008 - 2015

Trinity College Dublin, The University of Dublin

Delayed discharges 2011 - 2015

Trinity College Dublin, The University of Dublin

IMAGE

Inpatient hospital mortality within 30 days of AMI admission 2011 OECD

Trinity College Dublin, The University of Dublin

COPD hospitalisation rates, 2011

Indicators of Universal healthcare:Coverage

Trinity College Dublin, The University of Dublin

Proportion of population with medical cards, private health insurance, GP visit cards & no coverage 2008-15

2008 2009 2010 2011 2012 2013 2014 421250

10

20

30

40

50

60

% of GPVs % of pop med cards% with PHI No cover

Indicators of Universal healthcare:Resources

Trinity College Dublin, The University of Dublin

Current health spend per capita 2005-2014

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 -

500.00

1,000.00

1,500.00

2,000.00

2,500.00

3,000.00

3,500.00

4,000.00

DoH per capita DPER REV per capita

Trinity College Dublin, The University of Dublin

Total health expenditure components 2004-13 (WHO)

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

General government expenditure on health Private insurance Out of pocket expenditure Corporations

Indicators of Universal healthcare:Financial protection

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Cost shifting from State to people 2008-14

2008 2009 2010 2011 2012 2013 2014 -

100

200

300

400

500

600

Reduced Medical Card CoverageNew Prescription chargesIncreased IP chargesHigher threshold for drug re-imbursementHigher ED charges

€ m

illio

n

Trinity College Dublin, The University of Dublin

Indicators of universal healthcare in Ireland

– Full package• Complicated, have to pay for it, geography?

– Quality• Timely – Deteriorating access • Integrated – Difficult to measure• Appropriate, best practice, clinical: Pockets of

good practice, not mainstreamed, largely hospital based, hard to quantify progress

– Coverage for all• NOT UNIVERSAL

– Resources • Sufficiency (threshold) - Declining• Efficiency (Allocative, Technical – Right mix) –

Shift out of hospital - difficult to measure

– Financial protection • Free Care (at point of contact) – NOT• Affordable care (progressive, avoid

catastrophic payment and risk of impoverishment) – ???

Reflecting the five dimensions of UHC

Trinity College Dublin, The University of Dublin

Progress on universal healthcare?

– Little change in breadth of coverage except for Free GP Care

– No change in scope except increased waiting lists, getting worse?

– Decline in depth of coverage due to new & increasing charges (except for free GP care)

– More snakes than ladders

Thank you, any questions?