Health reforms are the changes that occur in the existing health system which aims at improving the health and health care practices in a system. The reform plays an important role in shaping the health care system of a country/institution. Ireland is an independent country that is situated in the northwest of European continent. it is basically an island surrounded by Atlantic Ocean and Irish sea and its only land border lying in the northeastern part with Northern Ireland (a part of United Kingdom). The Irish healthcare system is majorly a two-tier system which has shown good improvement in the health status of the country as a whole may be because of the powers truck increase in the economy (Between 1992 and 2005 the country enjoyed a real annual gross domestic product (GDP) growth rate of 7.09%). They have both public – private involvement. They basically follow Bismarck type of frame work. Ireland also aims to develop a single tier system of healthcare focusing to provide universal health coverage in future for which the country has formed the Slaintecare Action Plan for 10 consecutive years in action from the year 2017.
FIGURE 1: Health System Framework
1.1 FUNCTIONS; Following table presents the simplified view of the function of the Irish Health system.
GOVERNANCE
• Public and private Funded
• Over all responsibility lies with the government which functions through the Department of Health and Children (DoHC), under the direction of the Minister of Health and Children (MoHC)
• Two-tiered health care system
• Funtions under HSE (Health Service Executive) since 2005
RESOURCE GENERATION FINANCING SERVICE DELIVERY
• Health Information and Quality Authority (HIQA) was established in 2007
• Migrant health professionals *
• General Practitioners and nurses who have been provided education in the country
• Other paramedics
• Community health professionals and health managers
• Increased bed capacity as per national health strategy 2001
• New private hospitals are being constructed within the grounds of public hospital
• National Patient Treatment Register
• National task force on Medical staffing Revenue collection# 44% private insurance# 80% public source# tax credit#community Rating# corporate that fund for the employees Risk Pooling# National Treatment Purchase Fund (NTPF)#voluntary health insurance has 20 different schemes# Health Service Executive is in charge of pooling Purchasing#78.3% of total health expenditure was from taxation including Pay Related social insurance. (2006)#GP visit card for eligible individuals#medical card scheme# same category cards to dependents #primary care strategy integrates primary, secondary and continuing care since 2001primary care: – For pre poor- free for people belonging to poor strata (30%) – others must pay out of pocket payment for GP. (70%)
Secondary care:- Referral from GP or emergency admissions.- practitioners treat publicly or privately.* “Data from the Organization for Economic Co-operation and Development show that 36.1% of Ireland’s doctors in 2014 were foreign trained. Recent data from the Medical Council of Ireland (MCI) confirm the high reliance (34.3%) on international medical graduates and to a lesser extent on non-national medical graduates. Ireland is also a source country from where locally trained health professionals migrate to other developed destination countries.” (Brugha et al 2015)
1.3 PROS AND CONS OF IRISH HEALTH CARE SYSTEMPROS CONS
• Implementation of community rated premium
• New standards of care
• Clients who have private healthcare insurance only have access to them
• Longer waiting periods
• No of physicians per patient is low
Table 2: pros and cons
2. HEALTH REFORMS Since its inception the health system of IRELAND is constantly changing and still it is in the process of reformation. For providing better health care services and also access to quality health services the health department has introduced various reforms which has left a major impact in the healthcare system of the country. After going through all the reforms that IRELAND has implemented and after conducting a brief study on all of them, I have chosen The NATIONAL HEALTH PROMOTION STRATEGY 2000-2005 as my topic of study for the given assignment. And further i will be elaborately discuss about the given reform.3.Method For the given assignment I have used the review of literature method for data collection. I have reviewed various articles, documents and journals to acquire adequate information regarding the issue in hand. Also, the reports released with the data have been used for the data collection.
4.NATIONAL HEALTH PROMOTION STRATEGY 2000-2005,
4.1INTRODUCTION: Health promotion in Ireland has emerged since 1980” s, but there were some inadequacies in some health profiles like mortality, provision of care, immunization and other various aspects. Taking the blooming economy in view the government formulated the National Health Promotion Strategy This Health Promotion Strategic Framework (HPSF) provides the HSE (health service executive) with the means by which it can meet its commitments to protect and promote the health of the population. (dept of health & welfare 2000)This reform was published on 20th July 2000 to develop sensitive and appropriate health promotion programme to meet needs of those who are disadvantaged or from lower socioeconomic groups and also recognize the need to improve the health and social gain. ((2017), 2017)
4.2 PRESSURES/CRISES THAT HAVE PUSHED FOR THE REFORM: In nineties the Department of health and children acknowledged the important role of health promotion. The national health strategy paved the way for A Health Promotion Strategy making the healthier choice the easier choice, which identified priority issues, topics, settings and population groups. (Dept of health and welfare, 2000) Increased rate of cardiovascular disease (Fig.4) Ranked 4th and 11th in the EU for cancers for males and females respectively. Increased road traffic accidents (Fig.5) Fluctuating maternal and infant mortality rates (Fig.6) Inadequate methods of funding Need for proper primary care setting and access to health care Longer waiting periods in public hospitalStatistical:
Parameter 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007Maternal and infant mortality deaths per 1000 live births 5.9 5.9 6.2 5.7 5 5.3 4.6 3.8 3.9 3.2Health expenditure and financing as per share of GDP 5.6 5.6 5.9 6.4 6.7 7.0 7.2 7.6 7.5 7.8Life expectancy at birth in years 79.1 78.9 79.2 79.9 80.4 80.7 81.1 81.3 81.7 82.1Causes of mortality due to neoplasms per100000 population 268.7 269.7 269.4 264.1 255.5 252.8 254.8 246.6 252.1 246.8Road traffic accident per million population 3439 3332 3213 2693 2385 2109 1955 2278 1999 1770Hospital employment 37006 38778 42118 46695 50533 54255 53371 55699 57650 60021% of children immunized 84 86 86 84 83 86 89 90 91 92Social protection 100 100 100 100 100 100 100 100 100 100
Table 4: Statistical DataJOURNAL, ARTICLES AND DOCUMENTS: The department of health and children (2001) noted that primary care infrastructure is poorly developed with fragmented service for which Primary care Strategy was undertaken aiming at integrated care and development of 550 multidisciplinary Primary Care Teams across the country and greater access to GP Cooperative Out-of-Hours Services ((2017), 2017) Led to formation of health promotion strategic framework that operated under Health service executive (F, 2011) (Fig 3) National Development Plan was implemented which aimed at sustainable national economic and employment growth Developed national health promotion initiatives specifically focused at young people. Focus on various communicable and non communicable disease were given to provide care to the patients and also to educate them on the same. (Dept of health and welfare, 2000) Health Service Reform programme was introduced with the need to modernize health system so that they can deal with the increasing demand also integrated nursing informatic system was formed. Health service executive came into operation which led to reorganization health department and abolition of all health boards. ((2017), 2017) NATIONAL TREATMENT PROTECTION FUND was established in 2002 to reduce longer waiting time. National Task force on medical Staffing was formed to provide equal access and information. By referring the results of table 5 and also going through articles and journals, it is been obvious that there was no depreciation in the health status of the country taking all the parameters in consideration and also may be due to increase in health expenditure due to rapid outgrowth of the economy.
After the reform has come to its end in 2005, the report was made and accordingly new reforms were introduced some of which are mentioned in Table no 3 and one of the majors was access to E-Health Portal. Lastly, there was a moderate change in the former typological characteristics of the country’s health system, as the strategy put forth the introduction of Health Service Executive that led t abolition of all health board. Care was more primarily driven with low income group individuals being eligible for Medical cards. DOHC (department of health and child) was restructured as a part of which there is now Primary Care and Social Inclusion Public Health Division. I hereby would like to conclude that after referring to all the databases and information collected “The National Health Promotion Strategy 2000-2005” was a productive reform for the Health Department of the Republic of Ireland. Brugha, R., McAleese, S. and Humphries, N., 2015. IRELAND, A destination and source country for health professional migration,
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