MORE TOUGH and “perhaps even tougher” cost-cutting decisions will be required in the health service as the State grapples with the economic crisis, secretary general of the Department of Health Michael Scanlan has said.
Addressing more than 1,200 delegates from 53 countries at a conference yesterday in Dublin’s RDS, he said there may be a sense in Ireland that having got in early and having taken what were some very difficult decisions, “that we’re over the worst of it”.
However he believes that while “we are in one way . . . we’re not in another way because we still face some very difficult decisions”.
He said when he took up his job in the Department of Health more than five years ago – having moved there from the Department of Finance – the economy was growing and the whole emphasis in the healthcare system was on the extra investment needed for more staff and hospital beds.
There was not sufficient emphasis, in his view, on what core funding was being spent on.
“Now, five short years, on the whole scene has changed . . . we’ve already seen reductions in spending across the board, including in health, and we are going to see more,” he said.
The conference, organised by the Health Information and Quality Authority (Hiqa), revolved around health technology assessments (HTAs) and how they can be used to provide better-value services and improved patient outcomes.
Two high-profile assessments have so far been conducted by Hiqa. They were into the cost-effectiveness of a cervical vaccination programme and the cost effectiveness of a national bowel cancer screening programme.
It came down in favour of both, although the cervical vaccination programme was not introduced immediately in 2008 after Hiqa published its report due to cost considerations.
Mr Scanlan said that just because HTAs found something to be cost-effective did not mean it could afford be afforded.
“In a public system, there is a limit to how much we have to spend and it does seem to me that HTA has to recognise that,” he said.
Delegates raised questions about whether health systems should “disinvest” in some drugs and put the money into newer ones which technology assessments were finding to be more cost-effective.
Dr Seán Tunis, director of the centre for medical technology policy in Baltimore in the US, said that “it’s pretty hard to get rid of something just because its useless or you believe its useless”.
Dr Michael Barry of the National Centre for Pharmacoeconomics at St James’s Hospital said he had little doubt Ireland was going to have to look at disinvestment, adding that it would not be easy. “We can’t keep adding to the drugs bill with a finite budget,” he said.
Last year he questioned the value of some nutritional supplements that the State pays for.
While they were not removed from reimbursement schemes, there had been a significant fall-off in their use since their value was highlighted, he said.
Minister for Health Mary Harney, who opened the conference, said every country faced the challenge of ensuring its scarce resources delivered the best outcomes for patients and this was what HTAs were fundamentally about.
Hiqa is now drawing up a list of items on which it will carry out assessments in the coming months.