State should not shift cost to users - report

PRESCRIPTION CHARGE:THE PRESCRIPTION charge imposed on medical card holders is "a crude instrument" for controlling public health expenditure, according to a report published by the Economic and Social Research Institute (ESRI).

Government health policy should focus on measures that increase efficiency in the public health system rather than shift the cost to users, the report by Aoife Brick and Anne Nolan states.

In The Sustainability of Irish Health Expenditure, Brick and Nolan distinguish between economic sustainability – the proportion of national income devoted to health – and fiscal sustainability, or the proportion of total government expenditure devoted to health.

The recent introduction of a charge of 50 cent on prescriptions for medical card holders has “the potential to ensure fiscal sustainability” but the charge does not ensure economic sustainability. As such, it is “a crude mechanism for controlling expenditure” on the medical card scheme, the authors state.

They further add that there is evidence to demonstrate that user charges deter “necessary” prescriptions and are “disproportionately borne by the poor and chronically ill”.

Policies encouraging doctors to prescribe generic drugs would be more effective in reducing expenditure, they conclude.

Public health expenditure in Ireland more than doubled in real terms to reach more than €15 billion in 2009, when it accounted for 11.9 per cent of national income. This compares to 6.3 per cent in 2000.

Up until 2007, health expenditure as a proportion of gross national income was still low in Ireland compared to other OECD countries, while the fiscal sustainability of Irish health expenditure has remained “relatively stable” over the decade.

However, the current economic crisis means that the economic sustainability of Irish health expenditure has deteriorated sharply in the past few years.

Some 80 per cent of health expenditure in Ireland is in the public system rather than the private sector.

The report concludes that there is no agreement on what constitutes an “unsustainable” level of expenditure.