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Adapting International Best Practice to Transform Irish Health Care. Ed Walsh NAGP AGM Dublin 23 November 2013. Barringtons Limerick. Consultants Barringtons Hospital. Procedures Barringtons. Health Expenditure. Irish Health Expenditure. HSE. m. Private.

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Adapting International Best Practice to Transform Irish Health Care

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adapting international best practice to transform irish health care

Adapting International Best Practice to Transform Irish Health Care

Ed Walsh



23 November 2013

public expenditure as gdp age adjusted
Public Expenditure as % GDP Age adjusted

Source: Paul Redmon, Public based on OECD health data 2012. GNP used for Ireland

total health expenditure as gdp age adjusted
Total Health Expenditure as % GDPAge Adjusted

Paul Redmond, Expenditure and outputs in the Irish health system: a cross country comparison. Public c 2013

Age demographic adjustments are author’s own calculations. The denominator for Ireland is GNP.

potential savings gdp 2009 from greater efficiencies in public healthcare spending3
Potential Savings % GDP 2009from greater efficiencies in Public Healthcare Spending



keys to sorting irish healtcare
Keys to Sorting Irish Healtcare
  • Not more Funding


  • Smarter Spending
key issue
Key Issue
  • Misallocation of Resources
    • Too few medics at the front line
    • Too many others in offices
  • Failure
    • to rationalise HSE when created
    • Integrated computer system
medics key action
Medics Key Action
  • Increase number of GPs by factor of 2
  • Increase number of Consultants by factor of 2.5
  • Redeploy resources
redeployment of resources
Redeployment of Resources

Where the savings?

management administration support staff
Management Administration & Support Staff
  • If numbers reduced by 25%
  • Potential savings ≥ €500 m

*Number November 2012, NSP 3013

treasure island
Treasure Island
  • Pharma sector dub Ireland: ‘Treasure Island’
  • Atorvastastin
    • UK €2
    • Ireland (new reference price) €9.14
expenditure on pharmaceuticals per capita gdp 2009
Expenditure on pharmaceuticals per capita % GDP, 2009

Irish expenditure 36% above

OECD average

cost of month s supply 2012
Cost of Month’s Supply 2012

Source; Sligo Today 10 Aug 2012

savings drugs
Savings: Drugs
    • Current expenditure €1.9 b
  • Cut expenditure by 36% to OECD average
    • Savings €690 m
  • Or cut by 73% to UK level (based on Donegal/Derry report)
    • Saving €1,380 m
absenteeism rates 2012
Absenteeism Rates 2012
  • Varies between 2.9% and 7.06%
  • Mean value ~ 5%
  • Private sector norm ~ 2.5%
  • Medical/Dental 1.2%
  • Nursing 5.3%
savings cut absenteeism
Savings: cut absenteeism
  • HSE pay bill 2013:
    • €7,147 million/y
  • cut in absenteeism from 5% to 2.5%
    • saving €180 million/y
practising nurses per 1 000 population 2011
Practising Nurses per 1 000 population 2011

Note: Data includes all nurses in healthcare , including those who work as managers, researchers, etc

  • HSE had 37,540 nurses in 2009
  • Number reduced by c. 4,000
  • OECD numbers list all practicing nurses including those in management, education, etc.
payments per gms patient
Payments per GMS patient

GMS income before variable and fixed costs of each practice

hse payment to doctors 2011 headline news
HSE Payment to Doctors 2011Headline News

26 Doctors receive

more than €500,000

One receives €729,485!

hse payment to doctors 2011
HSE Payment to Doctors 2011

Not made clear payments is

Gross to large practice


hse pay cuts 2010 cuts
HSE Pay Cuts %2010 cuts


€105k max

€79k max

€44k max



primary care key actions
Primary Care Key Actions
  • Transfer €800m/y of c. €2b/y savings to Primary Care
    • Increase spend on GPs by €400 m/y
    • Increase spend on practice support by €400m/ y
  • Primary care is more cost-effective than hospital care
recruitment education key actions
Recruitment & Education Key Actions
  • Double numbers of GPs
  • More than double numbers of Consultants
  • Reduce numbers of ‘other’ medics accordingly
  • Develop Irish training/education system for new reduce % that go abroad
  • Phase out traditional educational system in favour of ‘Graduate Entry’
  • Bidding for Patients (& funding)
    • Hospitals that meet contracts can bid for patients and funding on other hospital waiting lists
  • Basis forPayment
    • Initially on ‘Average Costs’
    • Subsequently on ‘Best Practice Costs’
stockholm revolution
‘Stockholm Revolution’
  • Since 1994 private encouraged to compete with public
  • Strict quality regulation
  • 200 new private health facilities opened
  • 25% Primary Care Clinics run by private firms
  • 450 state pharmacies sold to private firms
  • All public hospitals in Stockholm now under private management
st gorgan s
St Gorgan’s
  • Stockholm’s main acute hospital
  • ‘One of the glories of the Swedish welfare system’*
  • Private management under contract since 1994
  • Remains under public ownership as a public hospital
  • Capio uses Toyota’s ‘lean’ management model
  • Waiting lists down, patient satisfaction up

*Woodldridge, Adrian, Economist.


Introduce state of the art Information Technology

  • Fewer in offices more on the ‘front line’
    • Primary Care
    • Hospital Front Line
  • Create competition to drive reform
    • ‘Money-follows-the-patient’
  • Stockholm Model
    • Private/Public Hospital competition
    • Level playing pitch/ strong regulation
    • Management of public hospitals out to tender
gps the key to it all
GPs the Key to it All
  • GPs run cost-effective small businesses
  • 22 million patient visits per year
  • Support and motivation of Ireland’s 2,728 GPs fundamental
  • General Practice part of healthcare that works
  • Transferring resources to Primary Care the key to reform of the whole system