Ireland experienced the greatest fall in health expenditure of 53 European countries between 2008 and 2011. Research on the impact of the economic crisis on the Irish health system reveals diminishing returns from crude cuts to healthcare system budgets over the past six years.
Despite budget cuts of over €2.7bn and 12,000 fewer HSE staff, the health system managed to do more with less, year on year, from 2008 to 2012. Since the end of 2012, the system has had no choice but to do less with less.
Doing more with less was achieved up to 2012 through the introduction of significant cuts to staff and pay, reducing professionals' fees, better deals with pharmaceutical companies and more flexible working arrangements facilitated by the Croke Park Agreement.
Some of these efficiencies were much needed. Ireland has long paid way more than other countries for the cost of drugs.
New agreements with pharmaceutical companies and changed prescribing practices have resulted in hundreds of millions of savings in publicly funded drug costs.
Indicators gathered for the Resilience project show that the poorest were somewhat protected during the economic crisis. Over half a million more people have medical cards now than they did in 2008. They also demonstrate a hospital system that provided more care to more people with significantly less money and fewer staff year on year until 2013.
However, austerity measures resulted in the blatant transfers of the cost of care from the State on to people. For example, those without medical cards paid €85 a month towards the cost of their drugs in 2008. Now they pay €144.
Similarly, the poorest who previously did not have to pay for prescription drugs now pay €2.50 per item up to €25 per month.
Counting the cost of new and increased prescription charges, higher hospital inpatient and emergency department charges as well as the removal of medical cards from some over-70-year-olds, means on average every person in Ireland is now paying an additional €100 more for accessing care and prescribing drugs in 2014 than they were in 2008.
Each of these measures was an arbitrary decision introduced solely as a mechanism to save money.
Since the end of 2012, and through 2013 and early 2014, the indicators expose a system that has reached its limit. For the first time since the HSE was established, it is predicting fewer people will be covered by medical cards at the end of 2014 than at the end of last year and fewer hospital treatments in all areas except emergency admission.
Emergency admissions are the only area of hospital care they cannot ration; if people present as an emergency, they will be treated.
It is very hard to gauge what's happened outside the hospital system due to the limitations of data.
There is good information on home-help hours, which shows a steady decline since 2008. In 2013, there were under nine million homecare hours provided, compared to over 12.6 million hours in 2008.
Some progress has been made on the most persistent problems in the Irish health system – very long waiting times in emergency departments and for elective treatment. The numbers of people waiting on trolleys in emergency departments has reduced by 36pc between 2011 and 2013. However, when figures from 2008 are compared to 2013, a 4pc reduction is counted. There has also been progress on the numbers of people waiting for inpatient and day-case hospital treatment, specifically in eliminating those waiting over two years – a key 2011 Programme for Government commitment.
However, between November 2012 and November 2013, there are more people waiting at every stage and a trebling of those waiting over six and 12 months for treatment.
These hospital wait times reflect increased demand on a much-depleted public health system resulting from fewer people with private health insurance alongside our growing, ageing population with a greater burden of chronic diseases.
Overall, the Irish system demonstrated reasonable resilience in the early years of austerity, with some positive efficiency gains.
However, as the austerity persists, recent indicators demonstrate a system under increasing pressure with unavoidable cuts, increased charges and rationing, risking patient care. Taking any more money out of health quite simply puts the sustainability of the public health system in jeopardy.
DR SARA BURKE IS PART OF THE TRINITY COLLEGE DUBLIN-BASED RESILIENCE RESEARCH TEAM, WHICH ALSO INCLUDES DR SARAH BARRY AND PROFESSOR STEVE THOMAS. THE RESEARCH WAS CARRIED OUT OVER THE LAST THREE YEARS. MORE AT HTTP://WWW.MEDICINE.TCD.IE/RESILIENCE4HEALTH/