Prof. Charles Normand

1. Prof. Charles Normand Edward Kennedy Chair in Health Policy and Management, Trinity College Dublin

2. Health Policy Challenges in Ireland Charles Normand Edward Kennedy Professor of Health Policy and Management Trinity College Dublin

3. Three Major Challenges • Context • Coherence • Cost control

4. Context • Rising population • Population ageing • Changes in population composition • Changes in household structures • Changing expectations.

5. Population • 4,233,000 in 2006 • 5,696,000 by 2026 • Even if the growth is slower there will be large absolute increases • More people increase demands on all parts of the system.

6. Ageing • Population is ageing (but quite slowly) • Life expectancy is rising linearly and has been for many years • Older people are displaying some reductions in morbidity and disability • Life expectancy between the sexes is converging.

7. Life Expectancy at Birth, in EU 15 Source WHO Regional Office for Europe

8. Increases in Life Expectancy at Birth EU 15

9. Demographic Change and Service Use • Demands grow only slightly with age • Demands are more closely related to death • Older people need less acute care at the end of life but more social and community care • Ageing increases supply of carers and more viable households.

10. Medical Care Costs for British Columbia

11. Social Care Costs for British Columbia

12. Percentage who use each service by age in Ireland Source TILDA 2011

13. Nights in hospital for those who were admitted by age in Ireland Source TILDA 2011

14. Changing Expectations • Health services use is related to social class • Older people have often had low expectations • There is evidence both that class barriers are falling and expectations rising.

15. Coherence 1 • Current pattern of payments, charges and entitlements is incoherent • Incoherence leads to inefficient (and sometimes high cost) use of services • We need to design payment systems to provide the desired set of incentives to providers and users of services • Present patterns worse than road tolls.

16. Coherence 2 • We need to change incentives to use services at the right levels in the right locations • It is easier to level down than up, but it is not possible to develop appropriate pathways without doing one or other • We need to stop flying aeroplanes and start carrying passengers.

17. Cost control 1 • Irish services are 10-15% less efficient than OECD best • Worst Irish services 15-20% worse than Irish best • Scope for cost reductions increases by 2-3% per annum • Some evidence that funding cuts have already produced some important efficiency gains.

18. Cost control 2 • Some efficiency gains require more fundamental reengineering of services • More single rooms would lower costs • Better integration of primary and secondary care would reduce costs • More changes in skill/grade/professional mixes would reduce costs.

19. Cost control 3 • Income levels have fallen substantially but probably should fall more at least for some categories of staff • Many of these challenges will work only if managers are allowed to manage.

20. Where does this leave the manager? • Need to understand drivers of changing needs and their implications • Need to lead the reconfiguration of services for the existing and future needs • Need to move to lower costs for more and better services • Need for more power and more accountability.

21. THE END Thank you for your attention