ESRI report: The Republic fares poorly in a comparison of 22 national health systems to be published by the Economic and Social Research Institute (ESRI) today, writes Dr Muiris Houston, Medical Correspondent
Adopting a model developed by in Canada, which uses three "benchmarking areas" to indicate performance - health status, health outcomes and non-medical factors - the authors found the Irish health system came last and second last in two categories.
Ms Anne Nolan and Mr Brian Nolan, authors of Ireland's healthcare system, some issues and challenges, found that under the heading non-medical factors, which include tobacco and alcohol consumption as well as road traffic injuries and immunisation rates, the Republic's health system was joint last with Japan.
While we performed well on road traffic accidents and pollution levels, we were in the bottom range for alcohol consumption and childhood immunisation. When the authors focused on key health outcomes such as rates of heart attack, cancer and suicide, we ranked just above the US in second-last position.
The Republic scores particularly poorly on male and female mortality for heart attack (the highest rates in the OECD) and for potential years of life lost due to female breast cancer. Sweden and Switzerland ranked highest for health outcomes.
In their analysis of health status, the authors found the Republic ranked joint 14th. Iceland and Sweden were top of this league table, and while we performed well in terms of proportion of babies born with low birth weight, we scored poorly on infant mortality. The Republic's performance when life expectancy at birth for both men and women was measured was in the bottom one third of countries.
Emphasising the benefits of the Conference Board of Canada approach - which awards gold, silver and bronze medals for each indicator - the authors say: "It is based on how close to or far away from the best performances each country is, rather than simply on where they rank on each indicator." They also modified the approach to include 22 OECD countries in Europe, North America, Australia and Japan.
Noting the performance of the Republics healthcare system was "disappointing", the paper then looks at financial resources devoted to health across the 22 countries. Based on 2001 figures, we are the lowest spender, alongside Finland, devoting 7.3 per cent of GDP to health spending. This compares with an average of 9 per cent across all 22 states.
The authors also looked at the use of GP services by income level and medical card status. While the overall average of 3.6 visits to the doctor per person per year, is about the mid range for the "old" 15 EU countries, there is a marked difference across income distribution bands.
"In Ireland, visiting rates are almost twice as high towards the bottom compared with the top, whereas in most other countries that ratio is rather lower, at approximately 1.5," the paper says. But the authors found a sharp fall in GP visiting rates between the second and the third income bands which roughly corresponds with the cut-off mark for medical card eligibility. The Republic was unique among the countries in this regard, with the visiting rate dropping from 6.6 to 3.6 visits per person per year.
"These figures certainly suggest that it is worth investigating in some depth whether the distinctive features of the 'pricing system' from GP visits in Ireland has implications for use of the service," the authors state. They conclude that "the key difference in terms of GP visiting rates in Ireland is simply between those with and without medical cards".