Ireland second-highest OECD health spending, poorest outcomes

Ireland has the second-highest health spending ratio in OECD area which comprises of 34 mainly developed countries but it has some of the worst health outcomes among advanced countries.

Ireland's public spending on health in 2014 was almost 20% of government expenditure (capital + current) — the highest level in the European Union.

Ireland’s current (i.e. not including capital spending) health expenditure was €18.4bn in 2013 according to the Central Statistics Office (CSO). This represented 10.2% of gross domestic product (GDP) or 12.4% of gross national income (GNI). Government funded over 70% of this expenditure with household out-of-pocket payments and health insurance funding the majority of the remaining expenditure.

In November 2015, the Organisation for Economic Cooperation and Development (OECD) reported in its 'Health at a Glance 2015' annual data that spending on health in the US consumed 16.4% of GDP in US, followed by the Netherlands at 11.1%, an OECD average of 8.9% and an Irish ratio of 8.1% in 2012 while the rate in the UK in 2013 was 8.6%.

As GDP in Ireland is distorted by the huge profits of the foreign-owned multinational sector, GNI, although also distorted, is viewed as a more reliable comparator.

Last Month the CSO published data for 2013, based on a revised methodology, which showed a GDP ratio for current health spending of 10.1% of GDP in 2012 compared with the OECD' November level of 8.1% and a GNI level of 12.4% in both 2012 and 2013 — in effect the Irish had overtaken the Dutch in respect of health spending. Spending on health peaked at 12.8 % of GNI in 2009 compared with 6.8% in 2000.

The CSO said that the majority of health expenditure in 2013 (€13.08bn or 71%) was financed by government, mainly related to expenditure of the Health Service Executive but it also included other government expenditure such as Department of Social Protection transfer payments to households and Treatment Benefit payments from the Social Insurance Fund.

The statistics office said that the remaining expenditure was financed in almost equal parts by household out-of-pocket payments at €2.68bn and voluntary health care payments, the majority of which related to voluntary health insurance (€2.18bn). Other voluntary payments came from income such as car-parking, restaurant receipts and fund-raising.

About one-third of health expenditure happened in hospitals while a further 20% related to long-term residential facilities e.g. nursing homes and residential disability services. Ambulatory health care providers, which were predominantly made up of GPs and dentists, also accounted for 20% of expenditure.  

Retailers of medical goods (predominantly pharmacies) accounted for a further €2.76bn or 15% of all health care expenditure.

The State's drugs bill doubled in 2002/2008 to €1.68bn — up from €332m in 1997. It is now about €2bn.　

Ireland's pharmaceutical expenditure per capita was at$652 per capita compared with $1,026 in the US in 2013; bankrupt Greece was at $713 and Denmark at $240. 

The share of generic drugs in the market is low in Ireland in both in volume (29% compared with an OECD average of 48%) and in value (16% compared with an OECD average of 24%).

The OECD said in its November report that the number of doctors per population in Ireland in 2013 was slightly higher than in countries like Canada and the United States, but lower than the OECD average (2.7 doctors per 1,000 population compared with 3.3 doctors for the OECD average).

Despite producing the highest number of medical graduates (for export), about one-third of doctors working in Ireland are foreign-trained doctors — the fourth highest for the number of foreign-trained doctors.

The OECD says that there have been recent efforts to increase the number of graduates from medical schools in Ireland, although some new medical graduates intend to go work overseas. By contrast with other OECD countries, the number of nurses per population in Ireland was not greater in 2013 than what it was in 2000, but nonetheless remains higher than in most other OECD countries, except in Nordic countries and in Switzerland and Germany.

Despite the high health spending, the OECD data in its 'Health at a Glance 2015' report show that Ireland had the worst incidence of asthma and COPD (chronic obstructive pulmonary disease) of 32 countries surveyed, and rank 24th for rates of stroke deaths.

Ireland ranked just 20th for cervical and breast cancer survival, and 19th for colorectal cancer survival while the rate of prostate cancer in Ireland is the fourth highest in the OECD. Ireland is sixth for the incidence of all cancers and seventh for breast cancer.

Ireland's is also among the poor outcomes for hospital beds; adult obesity; alcohol consumption; and female life expectancy at age 65.

While Ireland's alcohol consumption remains high, it has dropped sharply since 2000, when Ireland had the highest consumption in the OECD.

Pic on top: Leo Varadkar (centre), health minister, launches a National Physical Activity Plan for schools, Dublin, 14 Jan, 2016.