White paper on health ignores key issue of cost
For all the money the State spends on this vital system, its inefficiencies are inexcusable.
The Irish health service employs around 10 per cent of the working population. Most, including HSE employees, are paid directly out of the State budget. For the rest, their incomes come in large part from the State through indirect channels such as the general medical service payments to GPs and State subvention of pharmacy costs. Health is, by far, Ireland's largest nationalised industry.
The recent white paper on health insurance draws attention to some important features of Irish health expenditure, of which two are particularly striking. Health spending per capita in Ireland is high by reference to the peer group of OECD countries, while the population age structure would point in the opposite direction: Ireland does not have a preponderance of elderly people, who make the greatest demands on the system.
Average expenditure per capita in Ireland, for any given standard of health care, should be lower, not higher, than the OECD average. There are unique difficulties in controlling health expenditure, including the unavoidable feature that, in a system of largely free provision, the level of demand is not under State control.