Exploring how Ireland can effectively fund its health service

Implementation of a population-based resource allocation (PBRA) has the ability to “greatly improve the efficient and equitable allocation of health and social care resources”, research by the Economic and Social Research Institute (ESRI) asserts.

The ESRI’s report, entitled An analysis of Population-Based Resource Allocation for health and social care in Ireland, states that “substantial investment and political commitment are required to ensure the necessary changes are fully realised”, to implement a structured and organised healthcare system in Ireland.

The report focuses on evaluating the current resource allocation mechanisms within Ireland’s healthcare system and exploring the potential of implementing PBRA mechanisms within proposed HSE health regions (HRs).

PBRA mechanisms are employed successfully in other countries, and offer a structured approach to allocate healthcare resources based on population needs. These models consider various factors such as age, health status and socioeconomic conditions, with the ambition to ensure a more equitable distribution of healthcare services.

The report states that the implementation of PBRA will change “how funding allocations occur within the HSE and Irish health and social care more generally”. It calls for a “convergence or transition process”, akin to that used in the National Health Service (NHS) England, and should be employed to gradually move from initial funding levels to target allocations, ensuring that sudden financial impacts are mitigated.

Building on foundations

The ESRI’s report is set within a number of important contexts, most notably building upon the Sláintecare Report and the Government’s goal to increase devolution of decision-making to local decision-makers. Secondly, it is set within the context for the need to implement PBRA and to develop a more integrated system of care.

Since the publication of the Sláintecare report, and subsequent Sláintecare implementation plans, there has been increased preparation and governance. The Department of Health have outlined the appropriateness of a PBRA approach based upon the regionalisation of health and social care.

In 2020, then-Minister for Health, Simon Harris TD, outlined plans to develop six HSE HRs. These HRs would incorporate community healthcare organisations and hospital group structures in a conterminous geographical structure. However, the emergence of the Covid-19 pandemic stalled the establishment of regional bodies, with much of the response to the pandemic undertaken at a centralised level.

Potential in PBRA

The introduction of PBRA within Ireland’s healthcare system would represent a pivotal advancement for policymakers and healthcare users. The report states there is a “clear necessity” for Ireland to establish a system-wide PBRA system based upon the design fundamentals of PBRA systems used in healthcare systems internationally.

The report states: “The adoption of PBRA is not merely a policy change, it is a fundamental shift towards a more equitable, efficient and needs-based distribution of healthcare resources.”

The successes of PBRA in Ireland would therefore mark a significant milestone, not only in terms of policy implementation, but also in improving healthcare outcomes and addressing disparities across regions.

However, Ireland is currently experiencing “substantial challenges” in relation to waiting lists for health and social care. In many instances, these waiting lists are a consequence of workforce shortages or potentially lack of capacity.

While these shortages, at both national and regional level, are caused by many factors, implementing PBRA may improve the ability of policymakers to better plan the resource requirements in the medium term, as well as reduce inequities in workforce and capacity across different health and social care sectors, and across regions.
In 2022, the Department of Health published a report entitled Towards Population-Based Funding for Health, presenting options for a new PBRA mechanism for Ireland. The report outlined a potential model for allocating HSE resources, with the proposed PBRA formula being based on models from other countries, such as the UK, Australia, and Canada.

The proposed PBRA formula in particular, as stated in this paper, lays the foundation for future iterations of PBRA. It incorporates fundamental elements from international PBRA mechanisms, focusing on population size, age-sex composition, deprivation and rurality, parameters consistently used when determining healthcare demand and expenditure requirements.

However, as the first such model to be potentially implemented within the Irish healthcare system, this process demands ongoing evaluation and refinement. In addition, its practical application in the unique Irish healthcare context will require careful monitoring and adjustments, in order to ensure it meets the specific needs and challenges of the Irish healthcare system as they arise.

Conclusion and analysis

The ESRI’s report states that the introduction of a PBRA model in Ireland “has the ability to greatly improve the efficient and equitable allocation of health and social care resources”.

It notes that while developing a PBRA formulae is essential in addressing the constraints and problems the State’s health care system is facing, the most difficult factor is securing stakeholder agreements and embedding PBRA mechanisms across the healthcare system.

The report concludes: “It is vital that the introduction of PBRA is not treated simply as an important key performance indicator, but rather that PBRA and HSE HRs represent the first stage in a multi-year process of integration, coordination and transparency, and devolution of important decisions to local decision-makers.”