Doubts remain over HSE and hospital change plans

IMPACT has highlighted continuing doubts over whether health minister James Reilly’s “money follows the patient” health reform plans will work. In a new information bulletin, which describes new health service structures, the union questions whether the minister’s model can be implemented in practice.

The bulletin also explains how new hospital cluster and trust structures are being rolled out, and details how HSE corporate functions are being transferred to new divisions within a new HSE directorate. It says experience of the roll-out of new structures has so far been mixed, but warns that outsourcing will continue to be a threat as the plans are implemented.

The “money follows the patient” system is meant to ensure that funding for each hospital is directly linked to the number and type of procedures it delivers to patients. The HSE aims to put a standard value on medical procedures and, in theory, hospitals will only be funded for procedures that they actually perform.

The IMPACT bulletin says it remains to be seen whether, and how, this will operate in practice. “There are no international examples of how the ‘money follows the patient’ system envisaged by the HSE would work in a public hospital,” it says. The union says there are a number of potential flaws in the approach adopted by the HSE, including:

  • While it is possible to see how a system like this would work for straightforward procedures, it will be much more difficult to place a standard ‘price’ on treatment for patients who present with complex or multiple conditions.
  • The system will not take account of complications that arise, even from simple procedures.  If complications leave hospitals spending more than the ‘price’ placed on a procedure they will have to chase the HSE for additional funding after the event.
  • It has been suggested that the HSE may underestimate the cost of procedures in order to ‘promote competition’. If it does, it is virtually inevitable that funding crises will emerge.
  • All hospitals will get the same sum for a given procedure regardless of the age and condition of its facilities. This may mean significant underestimation of the real costs of providing services in some hospitals or result in a bias towards better-equipped hospitals, leaving patients with longer distances to travel for treatment.
  • It is not yet clear how the necessary data about procedures will be collected. However, it’s clear that a significant additional administrative burden will be placed on already short-staffed hospitals, which do not currently have systems in place to track procedures and costs to the level of detail required to make “money follows the patient” work. It is by no means certain that all hospitals will be able to put the required systems in place.

The IMPACT bulletin also describes plans for a new Child and Family Agency.

Further information

New Health Service Structures

The future of healthcare in Ireland

Red card for health reforms