Transcript 2nd-presentationx - Trinity College Dublin

Indicators of
universal healthcare
in Ireland
Sara Burke
Project Co-ordinator: Mapping the Pathways to Universal Healthcare
Centre for Health Policy and Management, Trinity College Dublin
22 September 2015
Indicators of universal healthcare in Ireland
Developing a suite of indicators to reflect dimensions of UHC
– 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)
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Indicators of Universal healthcare:
Package of care
Homecare available on basis of need but rationed & supplemented privately & by family
GEOGRAPHICAL ACCESS
Prescription drug charge €2.50
per item, capped at €25 per
family
Hospital care without
charge for 37% of pop
Prescription drugs costs up to a max of €144 per
month for 63% of pop
45% of pop have PHI, mostly covers
cost of private elective hospital care
Charges capped at €750 per year for public
hospital care for 63% of pop
Mental health services, largely publicly provided, difficult to access, focus on acute
Many primary & social care services available privately at a cost
Primary care is free at the point of
use for 37% of population
GPs charge @€50 per visit, no entitlement to
other primary care services for 63% of pop
Some universal public health services such as maternal & infant scheme & immunisations
0%
100%
POPULATION
SERVICES & ESSENTIAL MEDICINES
Long-term residential care but subject to large contributions + assets, not all costs covered
2011: Promise of free GP care for all
2011:
Promise
of
Universal
Health
Insurance
• Subtitle — Source Sans Pro Regular 20pt
2015: free
GP care for
u’6s & o’70s
2001:
Medical
cards for
all over
70s
2008: Universal medical
cards for over 70s
withdrawn
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2015:
UHI costings
remain
unpublished
2013:
tightening up
of rules on
discretionary
medical cads
Indicators of Universal healthcare:
Quality of care
Numbers of outpatients waiting 2012-15
160,000
146,162
147,223
140,000
149,659
133,133
120,000
97,138
100,000
82,975
86,568
77903
80,000
101,715
76,290 76228
66,378
68,356
66,886
60,000
51,537
39425
40,000
25,716
20,000
12861
3,226
0
1-3 months
3-6 months
Nov-12
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6-12 months
Nov-13
Nov-14
12-24 months
Aug-15
24-36 months
Children & adults waiting for inpatient or day
case hospital appointment 2008 - 2015
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Delayed discharges 2011 - 2015
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Inpatient hospital mortality within 30 days of
AMI admission 2011 OECD
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COPD hospitalisation rates, 2011
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Indicators of Universal healthcare:
Coverage
Proportion of population with medical cards, private
health insurance, GP visit cards & no coverage 2008-15
60
50
40
30
20
10
0
2008
2009
% of GPVs
2010
2011
% of pop med cards
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2012
2013
% with PHI
2014
No cover
May-15
Indicators of Universal healthcare:
Resources
Current health spend per capita 2005-2014
4,000.00
3,500.00
3,000.00
2,500.00
2,000.00
1,500.00
1,000.00
500.00
-
2005
2006
2007
2008
DoH per capita
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2009
2010
2011
DPER REV per capita
2012
2013
2014
Total health expenditure components 2004-13 (WHO)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2004
2005
2006
General government expenditure on health
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2007
2008
Private insurance
2009
2010
2011
Out of pocket expenditure
2012
Corporations
2013
Indicators of Universal healthcare:
Financial protection
Cost shifting from State to people 2008-14
600
500
Reduced Medical Card Coverage
€ million
400
New Prescription charges
Increased IP charges
300
Higher threshold for drug
reimbursement
200
Higher ED charges
100
2008
2009
2010
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2011
2012
2013
2014
Indicators of universal healthcare in Ireland
Reflecting the five dimensions of UHC
– 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) – ???
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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
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Thank you, any questions?