DELSA/GOV 3rd Health meeting - David MOLONEY

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This presentation by David MOLONEY was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm

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DELSA/GOV 3rd Health meeting - David MOLONEY

  1. 1. Irish Health Reforms 3rd Meeting of the Joint Network on Fiscal Sustainability of Health Systems OECD 24-25 April 2014
  2. 2. Evolution of public spending in Ireland relative to economic output Source: Dept. of Finance 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 0 20 40 60 80 100 120 140 160 180 200 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 Departmental Expenditure GDP Departmental Expenditure as % of GDP
  3. 3. Allocations by spending area in 2014 3 Source: Dept. of Public Expenditure and Reform 37% 26% 17% 4% 6% 10% Social Protection Health Education Justice Capital All Others
  4. 4. Expenditure Reductions 2008 to 2014 Since 2009 peak, there has been 10 percentage point reduction in Departmental Expenditure as % GNP and a 8 percentage point reduction in Departmental Expenditure as % GDP 15% 20% 25% 30% 35% 40% 45% 50% 2008 2009 2010 2011 2012 2013 2014 % Year Departmental Expenditure as % GDP / GNP Departmental Expenditure as % GDP Departmental Expenditure as % GNP
  5. 5. Expenditure Reductions 2008 to 2014 -12 -10 -8 -6 -4 -2 0 2 PS Pay PS Pensions SW - Live Register SW - Other Health non- pay Education non-pay Other Gross Capital Expenditure Gross Total Expenditure €billion
  6. 6. Health Expenditure 2009 - 2013
  7. 7. Pay in the Irish Health Sector
  8. 8. User Charges 2010 (Introduced) 2013 Medical Card Holders (43% of population) Co-payment of €0.50 per item up to a max of €10 per month per household Co-payment of €2.50 per item up to a max of €25 per month per household Private Clients (under the Drug Payment Scheme Clients pay full cost of Drugs up to max of €120 per month per household Clients pay full cost of Drugs up to max of €144 per month per household Charges for Drugs
  9. 9. User Charges 2009 2013 Private Clients without GP referral €66 per visit €100 per visit Medical Card Holders Private Clients with GP referral Certain other named groups Free of Charge Free of Charge Statutory Charges for attendance at Hospital Accident and Emergency Department
  10. 10. Current Reforms Current system is primarily funded through taxation, including tax breaks on private medical insurance, user charges and private insurance The delivery of a single-tier health system, supported by Universal Health Insurance is a central pillar of the Government’s health reform programme Aiming at a health system where access is determined by need and costs are borne fairly
  11. 11. Overall Health Basket* Services covered by UHI Basket Services outside UHI basket comprised of  Funded By UHI through insurance premiums  GP, acute hospitals, acute mental health services  Government will decide on basket with advice of Expert Commission  Funded by Exchequer/ General Taxation/ Out of pocket  Social care services, long term care, public health, social inclusion Services Outside the Health Basket Supplemental Services e.g. Alternative Medicine  Funded by private out of pocket payments  May purchase supplementary insurance for these services if available Health Service Provision * Provided by Public & Private Providers
  12. 12. How Will the UHI Model Operate? • Pay Premiums to Insurers to finance the delivery of health services in UHI basket Consumers • Pay Subsidies to Insurers for those who qualify • Centrally fund some services, e.g. ED Government • Commission health services from public and private providers Insurers
  13. 13. What Will All This Mean For…? • Consumers • Insurers • Public Providers • Private Providers • Regulatory Bodies

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