Planning for health and social care

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Brendan Walsh delivered this presentation at the Dublin Economics Workshop on Saturday, 14th September. More information about the event, including other presentations delivered at the workshop, can be found here: https://www.dublineconomics.com/
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  • 1. www.esri.ie Planning for Health and Social Care DATE 14/9/2019 VENUE Dublin Economics Workshop AUTHOR Dr Brendan Walsh
  • 2. HEALTH AND HEALTHCARE SPENDING IN IRELAND SINCE 1995
  • 3. Mortality Rates in EU15: 1995 – 2014 60070080090010001100 Age-StandardisedMortality 1995 1998 2001 2004 2007 2010 2013 EU-15 Countries EU-15 Average Ireland All Cause - Male 300400500600700 Age-StandardisedMortality 1995 1998 2001 2004 2007 2010 2013 EU-15 Countries EU-15 Average Ireland All Cause - Female Source: Eighan & Walsh et al. (Forthcoming) • 15,300 fewer deaths in 2014 as mortality improved post-2000
  • 4. Health Spending in EU15: 1995 – 2018 0100020003000400050006000 US$PPP 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 EU-15 Countries EU-15 Average Ireland Total Health Spend Per Capita 0100020003000400050006000 U$PPP 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 EU-15 Countries EU-15 Average Ireland Government Health Spend Per Capita Source: OECD (2019) $837 $3,583 $1,129 $4,869
  • 5. DEMAND FOR CARE & WAITING LISTS
  • 6. Hospital Capacity & Waiting Lists • Inpatient beds per capita amongst lowest in OECD • Ireland has the highest inpatient bed occupancy in the OECD at 95% • Waiting list figures amongst worst in OECD (Sicilliani et al., 2014) 175,662 218,589 0 50,000 100,000 150,000 200,000 250,000 Waiting >12 months Waiting 3-9 months Outpatient Waiting (Assessment) – July 2019 10,665 30,039 0 5,000 10,000 15,000 20,000 25,000 30,000 Waiting >12 months Waiting 3-9 months IP/DC Active Waiting (Treatment) – July 2019 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% Waiting >24 Hours Waiting 6-24 Hours Emergency Department Discharge Thresholds All Ages Aged 75+ • 333 Waiting for a Hospital Bed (‘Trolley’) – 11/09/2019
  • 7. Community Care Waiting Lists 40,716 50,121 11,154 10,523 75,616 56,804 - 16,329 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 Physiotherapy Occ. Therapy S&L Therapy Psychology Community Care Waiting Numbers (Assessment) – 2017 Waiting 3-9 months Waiting >12 months • 1 out of every 16 inpatient bed filled by delayed discharges • Waiting for community care also high, and increasing over time
  • 8. Projected Demand for Care • ESRI HIPPOCRATES Model report found increases in projected health & social care demand from 2015-2030 (Wren et al., 2017) • Projected Increases: • Inpatient bed days: 32% – 37% • GP Visits: 20% – 27% • LTRC places: 40% – 54% • Home Care: 38% – 66% • Projections driven by population increases and ageing (pop. aged 65+ to increase by 60%) • Sláintecare outlines moving care from hospital into the community • This will increase projected community demand • Health Service Capacity Review and NDP have outlined projects to increase capacity and workforce
  • 9. Health Service Capacity Review & NDP 10,500 11,500 12,500 13,500 14,500 15,500 16,500 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 Inpatient Bed Supply Base Case Optimistic Case Actual (Open Beds Report, April 2019) • Optimistic case based upon large investments in non-acute care • NDP plans for 2,600 additional acute hospital beds by 2027 with €620m allocated (post-2022) • Are plans sufficient from the beginning?
  • 10. RESOURCE ALLOCATION (Are we spending money efficiently?)
  • 11. Allocation of Spending and Resources • Is health and social care spend efficient? • Unique for a largely tax-funded system, Ireland lacks a systematic allocative decision process • Activity-Based Funding now incorporated in public hospitals • No single correct way to allocate health resources exists (Vega et al., 2010; Brick et al., 2010). Other systems: • Match population need to supply and resources • Allow for substitution and integration of care across sectors • Aid Workforce Planning • Ensure equity across regions and population groups
  • 12. Resource Allocation – Regional Inequities Source: Smith & Walsh et al. (2019) • Lack of allocation mechanism has resulted in regional inequalities in supply exist • Supply difference do not related to population need differences • Dublin commuter belt have low supply across all ten services examined • Allocation mechanism would allow for supply to follow population increases, age difference, disability, deprivation etc. (Sláintecare)
  • 13. DATA LIMITATIONS
  • 14. Data Limitations - Overall No unique Individual Health Identifier (IHI) • Comparing simple outcomes such as hospital length of stay is difficult Data on community-based care severely poor. Little information on • # visits, age/sex of patient, follow-up care, etc. NB: Lack of unit cost information Ireland lacks consistent and comprehensive health cost data • E.G. Ireland, Greece and Romania only EU28 countries with no age- related public healthcare expenditure profile (Euro. Commission 2018) International expenditure comparisons are fraught • OECD System of Health Accounts is a work in progress (where does home care and nursing home care fit?)
  • 15. Data Limitations - Private Care • 31% of day cases and 15% inpatient bed days occur in private hospitals. Information on the following is lacking:  # ED att.  # outpatient att.  # day patient visits  # inpatients stays  Average length of stay  Bed occupancy  # day case/inpatient beds  Patient casemix  Nurse & doctors WTEs  # public patients treated (NTPF)  Salaries • Over 50% of non-acute physiotherapy care is privately provided (Eighan et al, 2019). Unknown for other therapies • Large proportion of publicly-funded care is privately provided: • >75% of long-term residential beds (including NHSS) in private facilities • 56% of publicly-financed Home Care provided by voluntary/for-profits • Workforce planning: Public and private ‘fishing from the same pool’
  • 16. FUTURE WORK ON HEALTH AND SOCIAL CARE EXPENDITURE AT THE ESRI
  • 17. ESRI HIPPOCRATES Model - Expenditure • Currently incorporating health and social care expenditure • Plan to project health and social care expenditure to 2030+ • Developing Expenditure Projections • Requires unit cost analysis by service and components • What drives individuals component of cost? • Allows decomposition of price and volume drivers • It is hoped this work will allow for better understanding of the impact different components of healthcare expenditure
  • 18. THANK YOU
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