An Bord Snip: Health

I’m opening this strand to facilitate more specialized discussion on the cuts in Health proposed by An Bord Snip, which total over €1.2 bn or 8% of the €15 billion currently spent through the HSE.

Cuts here include: staffing roll-back of over 6000; a tightening of the eligibility requirements for medical cards; increased co-payments for prescriptions and walk-ins to A&E; and some rationalization of agencies.

10 thoughts on “An Bord Snip: Health”

  1. Before we get into a discussion of the merits of any cuts, could we dispense with this notion that far-right economists and commentators keep propagating that the increase in health expenditure since around 1999/2000 was wasted and had no effect on the nation’s health.

    Au contraire!

    Between 1986 and around 1999/2000, when first there were savage health cuts, then later relatively slow growth in health expenditure, both life expectancy and age standardised mortality rates (particularily infant mortality) in Ireland fell further and further behind the EU15 average. By 2000, Ireland had the highest infant mortality rate in western Europe and higher even than that in many eastern European countries, even though we were by that time one of the richest countries in the EU. Our overall age-standardised mortality rate was about 20% higher than the EU15 average, representing about 5,000 excess deaths annually.

    Starting around 1999/2000, much to the dismay of far-right economists and commentators (particularily in the Sunday Independent), spending on health increased dramatically.

    The result:

    Since around 1999/2000, our life expectancy has increased at an unprecedented rate and our age-standardised mortality rate has fallen at an unprecedented rate to the point where they are now both very close to the EU15 average. The gap has been virtually eliminated. And, our infant mortality rate has now fallen to well below the EU15 average and much lower than in the U. Kingdom – in fact, in 2007 it was one of the 3 or 4 lowest in the entire EU. On a crude calculation, I reckon the increased health expenditure since around 1999/2000 has saved about 80,000 lives in Ireland.

    In case anyone thinks I’m making this up, Garret Fitzgerald wrote an article about it in the Irish Times on 21st October 2006 – (link below):

    http://www.irishtimes.com/newspaper/opinion/2006/1021/1160606842028.html

    And, if memory serves me right, Professor Brendan Walsh published a paper on the internet on the phenomenon a year or two ago (apologies if I got that wrong – I think it was him). Perhaps, he could post here on the phenomenon of Ireland’s massively improved mortality record since health spending began to accelerate around 1999/2000?

    I hope these facts are borne in mind when the inevitable invective against doctors, nurses and health service employees begins later this morning.

  2. Thanks for the infomercial.

    Some of the clapped out ministers need an inspiring consigliere like you or maybe they are listening to this type of reassuring stuff already.

    No wonder Bertie is flummoxed that a grateful public is not still kissing the hem of his cloak.

    So everything running efficiently and double-digit rises in the heath insurance tax are OK or the payers are fools because the public service is so good?

    Maybe Micheal Martin’s 46 commissioned reports as minister for health, had an impact after all!

    It would indeed be very sad, if the truckloads of money hadn’t had an impact.

    I’m sure there’s room for improvement in the best health services but is Ireland among them after 15 years of the Celtic Tiger?

    Just hope that you’re not booked into a Limerick hospital and the lights go out!

    http://www.healthpowerhouse.com/files/2008-EHCI/EHCI-2008-report.pdf

  3. Folks:

    The survival of an essentially unmoderated blog depends on those who wish to post comments exercising restraint.

    There is absolutely no need for ad hominem comments, whether directed towards other bloggers or public figures.

  4. @Patrick
    One person’s “ad hominem” may be another’s ” Socratic irony”, within reason of course.

  5. @Michael Hennigan

    Why don’t you try to debate seriously, instead of always making cheap sneers at Bertie Aherne? For your info, I have no connection with FF. And, if you read my posts you’ll see I’m consistently attacking the deflationary policies of the present Government.

    My post made a very serious point.

    Namely, those who have advocated cuts in health expenditure in recent years have often claimed that it can be cut with no ill-effect because the large increase in that health expenditure since around 1999/2000 has produced no improvement in health. That’s what they claim. You only have to read the Sunday Independent to see that. My post was pointing out that this claim is untrue and that the large increase in health expenditure since around 1999/2000 has brought an unprecedented fall in Ireland’s mortality rates. And, I quoted Garret Fitzgerald in support, and he isn’t FF. That has to be borne in mind if its now proposed to cut it. Its reasonable to assume that any such cuts will partially reverse the fall in mortality rates.

  6. There is a provative observation by Sarah Burke (http://www.progressive-economy.ie/2009/07/bord-snip-attack-on-health-of-nation.html) concerning the impact of increased demand on health services arising from the – if implemented – proposals of the Special Group; namely, those proposals that are targeted at low income groups. The headline proposal is cutting social welfare rates but there are plenty of others coming under other Heads (Health, Housing, etc.). At the very moment that services are being cut back, demand will almost certainly rise.

    There is, at times, an unfortunate tendency to address particular budgetary items in isolation from contributing economic and social factors. An Bord Snip is a case in point. While it may well be possible to cut health employment from administration and support services without affecting front-line service (though this differentiation is sometime more grounded in rhetoric than evidence) as Sarah points out, the HSE is already cutting 3,000 jobs so the Special Group is actually calling for 9,000 jobs in total to be cut. Can this really be done without affecting service quality?

    And not to even refer to, never mind caclculate, the necessary increase in services to accomodate the increased demand arising from a growing population living on ever low incomes, is to short-change the debate which is in desperate need of fact-based proposals.

  7. Patrick,

    I do find the easy use of gratuitous abuse from behind the shield of an anonymous handle, as one of the negatives of the web.

    As regards non-personal comments on public figures, I do not see a problem where the language is not generally perceived as offensive.

    I do believe that in Ireland, there can be too much deference, to the detriment of serious scrutiny.

    People in several positions of authority in Government; the senior levels of the civil service and central bank, who have guaranteed high earnings for life, have never had to answer detailed questions on decisions or the lack of them, which have had appalling consequences for tens of thousands of people.

    A comprehensive forensic interview by an informed journalist is rare because it’s usually the officeholder who calls the tune.

    During the boom, surveys of business executives invariably showed strong support for the Government; Charlie McCreevy was viewed as the greatest minister for finance since 1922 and some visitors to our site used to question criticism from a business website of the “pro-business” party, the PDs.

    We took a different tack, not because we had any prescience compared with for example some small farmers in West Cork I used to talk to.

    In Ireland, it is not common to challenge conventional wisdom because the default view is what is the point of risking some direct income or a
    handy earner on quango or the like?

    In fact, the people who go with the flow are more often than not the winners, if money is the metric.

  8. During the boom, surveys of business executives invariably showed strong support for the Government; Charlie McCreevy was viewed as the greatest minister for finance since 1922

    Would those be the same business executives who are now relentlessly hammering home the message that all efficiency, nay, all virtue resides in the private sector and that, if we face a calamity now it can only have been the public sector’s fault?

  9. @John

    I did try to shed light on the decline in Ireland’s mortality rates in the 1990s and 2000s: see

    http://www.tara.tcd.ie/bitstream/2262/28007/1/brendan+walsh+07-08.pdf

    For what it’s worth here is my concluding comment:

    “Plausible explanatory factors include increased spending on health care, increased efficiency of this expenditure, improved environmental conditions (especially reduced air pollution and better housing conditions), and the dramatic reduction in the incidence of unemployment and poverty among the population. Given the coincidence of the timing of the improvement of many of these factors in Ireland towards the end of the 1990s, they could well account for the dramatic improvement in mortality that was recorded but nonetheless the suddenness of this improvement remains somewhat of a puzzle and a phenomenon that merits much further research.”

    The trajectory of mortality rates during the current recession and fiscal retrenchment should provide more evidence on these issues for future researchers.

  10. At a time when the US is obsessed with the “uninsured”, Ireland proposes to create more of them, it seems.

    The problem with the Irish health system is the co-existence of private and public health, as opposed to the Canadian system where public systems cover basic needs and private systems are barred from displacing them. Any attempt to extend medical card coverage to the population as a whole, rather than society’s dependent classes, is bound to be opposed by the private insurers, not least the State’s bastard child, VHI.

    The medical card system in Ireland is resented because the people who pay for it get virtually no benefit from it and instead have to fund their own care separately from the taxes that fund the jobless neighbour’s care. The rapacious costs of seeing a GP discourage prompt and/or preventative care. The public system in Canada, being universal, is politically fireproof.

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