2/2/17: What Euro Health Index 2016 Tells Us about Ireland's Health System?

Some pretty harsh ratings of the Irish Health system have been released by the Euro Health Consumer Index back at the end of January. Overall, based on data across 35 countries, including European Union member states, Norway, Iceland, Switzerland and the Balkan states (Montenegro, Albania, Serbia and FYR Macedonia), Irish health system ranks miserly 21st, scoring 689 points across 6 key macro-categories of assessment (or sub-disciplines).

The sub-disciplines on which assessments were based are:

1) Patient Rights and Information

2) Accessibility (waiting times of treatment)

3) Outcomes

4) Range and reach of services

5) Prevention

6) Pharmaceuticals

Ireland’s total score is statistically indistinguishable with a higher-ranked FYR of Macedonia (20th place), not exactly a known powerhouse of social or public services and Italy (ranked 22nd). With exception of Italy, Ireland’s ranking is the weakest amongst all high income countries present in the EU and in the sample overall. 

The issue of income and relationship between amounts spent on healthcare and the system performance is a complex one. And the report does attempt some analysis of this. However, it might be an interesting exercise to see, just how much better would Ireland’s system perform were we to adapt the best practices found across each sub-discipline amongst two subsets of the countries, both with vastly lower incomes than here. 

I undertake this exercise below under two scenarios. For each sub-discipline:

1) Scenario IRL “Peripheral” assumes that Ireland adopts the best practice found in the group of the euro ‘peripherals’ states (Greece, Ireland, Italy, Portugal and Spain); and 

2) Scenario IRL “Emerging” assumes that Ireland adopts the best practice found in the group of the sampled states that comprise emerging economies of East-Central Europe (Slovenia, Estonia, Croatia, FYR Macedonia, Slovakia, Serbia, Lithuania, Latvia, Hungary, Poland, Albania, Bulgaria, Montenegro and Romania).

Note: these are not exactly scientific exercises, so treat them as an indicative analysts, rather than an in-depth and conclusive. However, I did perform some simple statistical robustness checks on these findings and they do not appear to be complete ad hoc.

The two scenarios are co-plotted in the following charts alongside the actual Euro Health Consumer Index scores:

As shown in the last chart above, adopting best practices from the countries with vastly lower incomes (and, thus, lower per capita expenditures on healthcare - controlling for the argument that the issue with Irish system is lack of money) would have resulted in a vastly better performance of the system across the board. That is because with exception of just one sub-discipline (Pharmaceuticals), Ireland’s performance is substantially sub-par when compared to the lower income countries best practice experiences. 

The truth is: the Euro Health Consumer Index suggests that the real problem with Irish health system's abysmal performance is not necessarily solely down to the lack of money (although that too might be the case) but may be significantly down to the lack of will to adapt some of the better practices that are, apparently, available and accessible for lower income economies. Yet, despite this pretty simple to grasp observation, majority of Irish analysts and media continue to insist that improving Irish health system requires only one thing: more cash from the taxpayers. What's the margin of error on this argument, given Macedonia scores better on Health Index than Ireland? I would say it is huge.

15/6/2013: Irish Health Pricing Policy: Stupid, Short-Termist & Costly

Per Irish Times article, the Government is planning to impose a massive price hike on hospital beds, leading to health insurance prices hike of estimated 30%.

This Government has been disastrous when it comes to containing the costs of healthcare. Here are three charts showing:

1. That the within the category of Miscellaneous Goods and Services, to which Insurance Services belong, Insurance Connected with Health posted the highest price inflation since December 2011, with index of prices rising to 127.4 in May 2013 against the benchmark of 100 in December 2011. 
2. In last 12 months, through May 2013, health insurance costs rose 12.5%. This represents the highest rate of cumulated inflation over 17 months from January 1, 2012 through May 2013 for any non-food item of expenditure recorded by the CSO and the second highest rate of annual inflation for any non-food line of expenditure after a bizarre 21.2% price hike in 'Cultural admittance' costs.
3. Across all categories of consumer expenditure, Irish Government controlled or regulated prices (with controls exerted either via high incidence of specific goods and services taxation, where taxes imposed by the state account for over 1/2 of the product final cost; or via State regulation setting prices; or via semi-states dominance in the sector allowing monopoly power pricing, etc) dominate heaviest price increases categories.

The charts below are easy to read: in Yellow, I mark the State-dominated sectors, with blue bars marking other sectors. All price indices are through May 2013. All data is from CSO.

Charts above confirm the observations made in points (1)-(3).

This Government is clearly on an economic suicide course. Raising health insurance costs will multiply demand for public healthcare & increase the cost of this demand by forcing more patients into emergency rooms. Worse, the completely moronic (and I cannot find any other way of expressing this) system will create a cascading cost increase to public system.

Currently, an insured patient in a hospital yields: vat and other tax revenues to the State, and generates positive return per bed occupied. In addition, the patient is pre-screened for hospital admission by a private doctor 9also generating vat and other tax revenues to the state) thus avoiding emergency room admission.

Forcing this patient from insurance into public system removes all of the above tax revenues and leads to the patient going via emergency room into admission. This means higher emergency room costs, plus higher treatment costs, because by the time a patient goes through with emergency room their admitting point condition would be most likely worse than were they to go through more preventative care and monitoring with private doctor pre-screening.

The word for this policy on health costs inflation is idiocy. Pure and simple.

Economics 16/05/2010: IMF on fiscal stability IV

So continuing with the IMF Fiscal Outlook report data, building on the three previous posts: Part 1 (here), Part 2 (here) and Part 3 (here), take a look at another wonderfully ludicrous myth perpetrated by the Irish Left: the Myth of Underinvestment in Public Health in Ireland.

The Myth of Healthcare has two parts to it: Part 1: "Irish Government has under-invested in Irish public health." Part 2: "We need to ramp up Health spending to achieve better services".

Hmmm:
The data above is taken from the paper that formed the background to the IMF report, titled “From Stimulus to Consolidation: Revenue and Expenditure Policies in Advanced and Emerging Economies”, Prepared by Fiscal Affairs Department, Approved by Carlo Cottarelli (30-Apr-10). My calculations cover GNP comparatives and ranked results, plus the change between 1990 and 2007. IMF reports changes between 1960 and 2007 and 1970 and 2007. I find these data problematic, because of a large number of gaps in the data for these years. In addition, I would have trouble comparing Ireland between 1960 and 1970 through 2007 to majority of the countries on the list, as arguably, Ireland was not a developed or advanced economy in the decades prior to 1990.

What the table above clearly shows is that:

• In 2007 Irish Government spending on public healthcare was 8th highest in the group of advanced economies, measured as a share of our income.
• Accounting for the size of the recession in Ireland and a lack of significant fall-off in public spending on health in Budgets 2009-2010, one can relatively safely assume that we at least retained this position in 2010.
• In terms of increases in spending, we are clearly nowhere near the bottom of the league. We recorded 8th highest increase in spending in the last 17 years of all countries in terms of GDP.
  
• We achieved second highest increase in spending as a share of national income in the sample of developed nations.
• Our increase in health expenditure as a share of GDP was 21.4% above the average for the group of countries. It was 107% (more than double) above the average in relation to our GNP.
• A large number of countries - marked in bold red - to my knowledge offer superior health services to their citizens compared to Ireland while spending less, sometimes vastly less, public resources on healthcare provision. This statement does not take into account that many of these countries have much older population than Ireland.
• Have the FF/PD Governments been any worse (or better) than other Governments in financing health expenditure increases (or dumping good money after bad, if you want)? I don't know - the data above cannot tell me quality differentials or efficiency of spend. But what I can tell is that until 200 we were spending less than the group average on health. In 2007 we were spending above the average (based on GNP).

The problem, of course, is that we cannot perfectly measure the output we get for the money we spend on public health. Alas, somehow, I know that any foreigner living in this country runs for the airport the minute they get sick, desperately trying to avoid HSE's kingdom. French, Italians, Germans, Belgians, Spaniards, Czechs, Dutch - you name a country within the EU - all have been dreading the need to face our 'centres of excellence' where medical staff needs to be reminded to wash their hands and lines of sick patients stretch the length of the lines to the infamous Lenin's Tomb's in the hey days of the CPSU.

It looks like, according to hard data, this adverse reaction is not due to the lack of cash in the health system...

Economics 29/09/2009: Socialism is Bad for Your Health

International health services ratings 2009 Euro Health Consumer Index (EHCI) were published today. These provide comparisons for a number of EU countries, plus Switzerland and Canada. Tables below show Irish performance over 2006-2009 in the rankings and the performance of our closest peers - small European economies.

Summary of overall performance:
Before looking at the tables, here are some facts:

• All leading healthcare systems (top 4 in the table) have separated provider of services (mixed models of private, publicly-owned but independent, locally-owned & non-profit) from payee (state) for services.
• Of top 10 performers, 5 have fully separate functions of service providers and payees for service, 3 others have a mixed system. In contrast, Ireland has not even a mixed system, with all primary, emergency and non-elective medical service providers being captured by the state.
• Ireland is ranked a lowly 14th this year, although it is a marked improvement on the past years performance (see below).
• Fully nationalized system of healthcare practiced in Canada scores marginally worse than Ireland in patients rights and access to information. Only Latvia, Portugal, Romania and Spain score worse or equally poorly as Canada in this area.
• Canada scores worse than Ireland in waiting times for treatment. The only other country that scores as poorly as Canada in this area is Latvia.
• In terms of healthcare system outcomes (designed to gauge basic treatments effectiveness), Canada scores as highly as Ireland, with both countries ranked between the 4th and 8th places.
• In terms of range and reach of health services provided within the system, Canada (100) scores marginally above Ireland (92), with Canada ranked between 12th and 14th places, while Ireland ranks between 15th and 22nd places.
• In terms of access and quality of pharmaceuticals within the system, Canada ranks between 26th and 27th. Ireland ranks between 2nd and 8th.
• Thus, contrary to the noise about 'socialised medicine for Ireland's future' movement within Irish Left, global data shows year after year, that using objective criteria, socialised medicine is bad for your health.

Now more detailed tables compiled by me from previous years' reports: