Cuts in Irish health care may foretell changes in U.S. system

Ireland’s public health system is facing unprecedented cuts as the country grapples with the aftermath of a banking crisis and the global economic downturn. Mary Harney, the minister for health, has conceded cuts of 1 billion euro to the health budget will be necessary for fiscal year 2011. The proposed 7 percent cut in funding is sending shivers down the spines of both health professionals and patients.

One senior clinician has referred to an abrupt cut of this magnitude as an “impossible task.” With just six weeks to decide on where the axe will fall before the publication of the national budget in early December, there is understandable concern that time constraints will not permit a targeted approach. A crude top- slicing of services would represent the worst possible outcome.

Next year will be the second consecutive year that Ireland’s health budget has endured a cut, albeit the first of this magnitude. The effects will be especially severe on the 40 percent of the population who are entitled to free primary and secondary medical care. Some 60 percent of Irish people carry health insurance, although all citizens are entitled to free care in the public hospital system. Increasing unemployment means the number of people with private health insurance is dropping steadily.

Links across the Atlantic
Muiris Houston reports that the Irish health system is moving toward deep cuts in the country’s mental health system. Mental health services in Ireland are perennially underfunded as they are in the United States.

This year, as states grapple with funding shortfalls generated by the recession, cuts in mental health services provided by Medicaid programs may be inevitable. That’s a good story.

Local reporters may want to document what’s happening in their own state. What cuts are in the wind? What are the trade-offs with other Medicaid services? Who wins and who loses? What will people do if services disappear? How will they cope?

Most important, how will the communities fare? Will there be more people on the streets, in shelters, going without their medications, going hungry?

Context is important in stories like these. By telling your readers or viewers what’s happening in Ireland, and even in neighboring states, how other governments cope with such dilemmas can add depth to your stories.

Home help hours and rehabilitation services have already been reduced significantly to the point where those who suffer a stroke or develop other chronic neurological illness are provided with less community support. There are many “soft” targets such as these that are less likely to attract negative headlines and which represent attractive “low-lying fruit” in the context of a quick and immediate cull.

But strains are also beginning to show in acute health care services. For example, cancer patients are complaining that it is harder to get surgeries. It appears inevitable that waiting times for joint replacement surgery will lengthen, and the existing public – private imbalance in access to hospital services will get even larger.

Because 70 percent of health funding goes to staff salaries, which cannot be cut under the terms of a current union agreement with the government, most savings will have to be achieved from just one-third of the health budget. And while non-core pay such as allowances and overtime will, according to the minister for health, be targeted in an “aggressive fashion,” patients are likely to see significant cuts in the free availability of items such as drugs and medical appliances.

The “Cinderella” of the Irish health system – mental health – will suffer even more. Chronically underfunded, mental health will suffer disproportionately in any crude percentage based cut to the health service. This would represent the worst possible scenario, something highlighted recently by Economic and Social Research Institute.  “While the emphasis in the current discourse is on where to make cuts, and these are clearly very necessary, it is important that what is cut is viewed in the context of the total health system. If this is not done, crude cuts now may generate disproportionate losses in health care quality and the growth in hidden costs elsewhere,” it noted in an analysis.

Already there is anger at a government decision not to employ most of this year’s 1,600 nursing graduates in the public system. Having cost the taxpayers about 90,000 euros to train each new nurse, their expertise will now benefit patients in other countries. The same fate, and exchequer loss, applies to hundreds of speech and occupational therapists, many of whom trained in centres specifically set up and funded by a government responding to a clearly researched need for additional health care staff. Ireland is going through some turbulent times. A severe curtailment of public health services may be a barometer of some rough economic years ahead.

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