1. Indicators of universal healthcare in Ireland Sara Burke Project Co-ordinator: Mapping the Pathways to Universal Healthcare Centre for Health Policy and Management, Trinity College Dublin 22 September 2015

2. Trinity College Dublin, The University of Dublin Indicators of universal healthcare in Ireland –Full package Community, Acute, Long Term Care Needs based –Quality Timely Integrated – Continuity Appropriate, Best Practice Clinical –Coverage for all Universal means everyone –Resources Sufficiency (threshold) Efficiency (Allocative, Technical – Right mix) –Financial protection Free Care (at point of contact) Affordable care (progressive, avoid catastrophic payment and risk of impoverishment) Developing a suite of indicators to reflect dimensions of UHC

3. Indicators of Universal healthcare: Package of care

4. Charges capped at €750 per year for public hospital care for 63% of pop Primary care is free at the point of use for 37% of population Homecare available on basis of need but rationed & supplemented privately & by family POPULATION SERVICES & ESSENTIAL MEDICINES 0%100% Hospital care without charge for 37% of pop GPs charge @€50 per visit, no entitlement to other primary care services for 63% of pop Prescription drugs costs up to a max of €144 per month for 63% of pop Prescription drug charge €2.50 per item, capped at €25 per family Some universal public health services such as maternal & infant scheme & immunisations 45% of pop have PHI, mostly covers cost of private elective hospital care Long-term residential care but subject to large contributions + assets, not all costs covered Mental health services, largely publicly provided, difficult to access, focus on acute Many primary & social care services available privately at a cost GEOGRAPHICAL ACCESS

5. Trinity College Dublin, The University of Dublin Subtitle — Source Sans Pro Regular 20pt 2001: Medical cards for all over 70s 2011: Promise of free GP care for all 2008: Universal medical cards for over 70s withdrawn 2015: free GP care for u’6s & o’70s 2013: tightening up of rules on discretionary medical cads 2011: Promise of Universal Health Insurance 2015: UHI costings remain unpublished

6. Indicators of Universal healthcare: Quality of care

7. Trinity College Dublin, The University of Dublin Numbers of outpatients waiting 2012-15

8. Trinity College Dublin, The University of Dublin Children & adults waiting for inpatient or day case hospital appointment 2008 - 2015

9. Trinity College Dublin, The University of Dublin Delayed discharges 2011 - 2015

10. Trinity College Dublin, The University of Dublin Inpatient hospital mortality within 30 days of AMI admission 2011 OECD

11. Trinity College Dublin, The University of Dublin COPD hospitalisation rates, 2011

12. Indicators of Universal healthcare: Coverage

13. Trinity College Dublin, The University of Dublin Proportion of population with medical cards, private health insurance, GP visit cards & no coverage 2008-15

14. Indicators of Universal healthcare: Resources

15. Trinity College Dublin, The University of Dublin Current health spend per capita 2005- 2014

16. Trinity College Dublin, The University of Dublin Total health expenditure components 2004-13 (WHO)

17. Indicators of Universal healthcare: Financial protection

18. Trinity College Dublin, The University of Dublin Cost shifting from State to people 2008-14

19. Trinity College Dublin, The University of Dublin Indicators of universal healthcare in Ireland –Full package Complicated, have to pay for it, geography? –Quality Timely – Deteriorating access Integrated – Difficult to measure Appropriate, best practice, clinical: Pockets of good practice, not mainstreamed, largely hospital based, hard to quantify progress –Coverage for all NOT UNIVERSAL –Resources Sufficiency (threshold) - Declining Efficiency (Allocative, Technical – Right mix) – Shift out of hospital - difficult to measure –Financial protection Free Care (at point of contact) – NOT Affordable care (progressive, avoid catastrophic payment and risk of impoverishment) – ??? Reflecting the five dimensions of UHC

20. Trinity College Dublin, The University of Dublin Progress on universal healthcare? –Little change in breadth of coverage except for Free GP Care –No change in scope except increased waiting lists, getting worse? –Decline in depth of coverage due to new & increasing charges (except for free GP care) –More snakes than ladders

21. Thank you, any questions?