Even the Irish Recognise the Need for Better Health IT!

In a recent editorial the Editor of the Irish Medical Times (Colin Kerr) found himself lambasting the status quo in Irish E-Health and being frustrated at the lack of progress and the dismally low level of investment.

His remarks were as follows:

=========================================

http://www.imt.ie/displayarticle.asp?AID=11736&NS=1&CAT=18&SID=1

Ireland needs an E-health Minister

Colin Kerr says Ireland needs a Minister for E-health to work closely with the Minister for Health and with other Government departments. We are a nation of pioneers led by Luddites. While, individually, Irish people have been responsible for major breakthroughs in science and technology, this has been in spite of, rather than because of, the assistance they have received from their political leaders. With one or two notable exceptions, our politicians have shown a lack of vision, concentrating on short-term gains at the expense of long-term strategy.

Over the last 20 years, they have paid lip service to making healthcare more accessible through better use of information technology, but have failed to deliver on their promises.

In Ireland, public funding makes up approximately 78 per cent of all the money spent on healthcare. Private funding, through insurance arrangements, makes up approximately another 8.5 per cent of funding.

The balance is what individuals pay in ‘out-of-pocket’ expenses — for example, the fees non-medical cardholders pay for general practitioner and other therapy services. In concrete terms, as a sector, health accounted for 28.7 per cent of the Government’s voted revenue expenditure last year.

At €11.36 billion in 2005, health was the single largest cost to the State. It should be pointed out that the health system, as it is now structured, is very people-intensive, with over 70 per cent of the health budget made up of salaries and pensions. Savings might be made if the Government and Health Service Executive (HSE) honoured their commitment to reduce health service staffing — but that’s an argument for another day.

According to the interim Health Information and Quality Authority (iHIQA), and based on international studies, Ireland spent at least €2.8 billion in 2005 on procedures that duplicated one another and on other inefficiencies in the system.

Last November, the Minister for Health and Children, Ms Mary Harney announced overall funding of €12.64 billion for the health services in 2006. This represented an underlying increase of over €1 billion, or 9.25 per cent, over 2005.

As the Minster for Finance said in his Budget Speech (December 2005): “The spending on health at this stage amounts to €3,000 for every citizen in the State or over €9,000 for every taxpayer.”

Negligible spending

When it comes to IT development, Government spending is negligible. The amount that is actually available for capital spending on IT in 2006 (as per the Official Estimates), including Information Society monies, is set at €70 million.

That represents no increase on 2005, or indeed on the figure allocated in 2004. In a recent European study, it emerged that Ireland spends less than 0.5 per cent of its health budget on IT, compared to more than 4 per cent in the Netherlands. There are two main reasons for this.

First, IT spending has never enjoyed a high profile and has traditionally been a poor relation in healthcare funding allocations.

Second, the well-publicised ICT healthcare problems of 2005 have made it even less attractive, politically. As a proportion of total health expenditure, ICT only consumes in the order of 1 per cent. This low level of investment in ICT has left the health system in a very weak position with respect to its ability to manage itself and obtain value from the remaining 99 per cent of health spending. An analysis by the former HeBE (Health Boards Executive) indicated a need for a four to six-fold increase in expenditure in ICT for the health system over the years ahead.

An e-healthy State?

A study on e-health in Ireland was published by the Information Society Commission in December 2004.

The report found that Ireland spends less on ICT in healthcare than (i) investment levels internationally and (ii) accepted ICT investment levels in other economic sectors. It recommended a significant increase in Government spending on ICT in the healthcare sector, to deliver benefits and savings to all stakeholders in the healthcare system.

The strategy was supposed to have been published before the end of 2001. In the event, it was published in July 2004.

The majority of doctors and patients would welcome substantial investment in e-health. The implementation of a well thought out ICT policy should ultimately make our patients happier and healthier.

It will be interesting to see how much money is allocated to e-health in the next budget, but it is not enough to throw money at the health service as has been shown time and time again.

We need somebody in the Government to take personal responsibility for a comprehensive and deliverable information strategy. We have the money now (unlike in the 1980s and most of the 1990s) to do something substantial about remedying the major inequalities in health care services, especially access to services.

We have had the opportunity to learn from our own and others’ mistakes. We have an incredibly skilled group of people working across the private and public aspects of the health system (including the academic and research institutions).

We need a Minister for E-health, who will work closely with the Minister for Health and with other departments, to improve patient mobility.

=========================================

I must say reading this was much like reading “a guide book to the town of my birth” such was the familiarity of what was being said and how much it parallels the Australian progress to date.

(For background Ireland has a population of just over 4 Million and has a per capita GDP that is $US41,000 vs Australia at $US31,000 and 20 Million souls give or take a few)

The health budget is – scaled and corrected for population – looks to be about $A90 Billion (similar to ours) and the growth rate is, worryingly, even a tad higher than Australia at 9.0%+ per annum.

The inefficiency in the Irish system (and information systems) appears to be of almost epic proportions – amounting, when adjusted to $A24 Billion or a good quarter of the budget.

I know of no comparable figures for Australia however even if we are twice as good as the Irish – a very big ask – the opportunity costs of the non-deployment of Health IT in Australia are just enormous – conservatively say $A10 Billion per annum. Note the problems mentioned – duplicated tests, lost information, inadequate information etc - are all familiar to us in the Antipodes!

Even at half this figure I would suggest the idea that a Minister for E-Health is also needed in Australia is pretty compelling. Only with strong and co-ordinated political leadership can the available benefits of Health IT be realised. Imagining the spending $A130 Million over 4 years through NEHTA, without really effective political (read focussed and dedicated Commonwealth Ministerial leadership) commitment and leadership, will make any major difference is pure fantasy. (It is simply not enough)

We need the leadership, a plan and Federal Government insistence that progress be made to get the efficient (and safe and equitable) health system we all want!

How long will we have to wait?

David.