Healthcare reform threatened by geographic inequalities in services

Plans to move patient treatment away from hospitals and into the community will be undermined by significant inequalities in the spread of health services, a major study has found.

Research by the Economic and Social Research Institute (ESRI) found a geographic imbalance in services will have implications for Sláintecare, the plan partly aimed at reorganising medical treatment to reduce pressure on acute hospitals.

"Without reform of allocation mechanisms, limited levels of provision of non-acute care in many areas could impede progress towards the equity goals of Sláintecare," notes the report, entitled Geographic Profile of Healthcare Needs and Non-Acute Healthcare Supply in Ireland.

The Government’s Sláintecare strategy is expected to take 10 years to implement and part of it aims to provide “the majority of care at or closer to home”.

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The ESRI study focuses on the locations of the 10 most used forms of healthcare including GPs, community and public health nurses, physiotherapists, occupational therapists, speech and language therapists, social workers, counsellors and psychologists, and long-term residential care and home care.

Comprehensive analysis

Although the data relates to 2014, the authors of the report say it provides the most comprehensive analysis on the distribution of primary, community and long-term care supply ever published.

“Overall, the report finds significant inequalities in the supply of . . . services across counties in Ireland,” it states. “The findings have important implications for future planning of the Irish health system.”

As a result of the limitations in data, it mainly focuses on publicly employed or publicly funded non-acute services. As well as calculating supply on a per capita basis, it adjusts for several “need factors” including age, mortality, disability rates, medical card rates and chronic illness rates.

The counties with the largest shortfall – where the majority of their services were more than 10 per cent below the national average in terms of supply – were Kildare, Meath, Wexford, Wicklow, Kilkenny, Waterford and Clare.

The greater Dublin commuter belt area and the southeast have the lowest supply of primary and community care and while the report does not delve into reasons why, the results are believed to be directly related to population growth in those areas.

In Dublin, the supply of services in the north and south is similar to the national average. Some variation arose, however. Dublin north has a low relative supply of GPs, counsellors and psychologists, and long-term residential care while Dublin south lacks counsellors and psychologists, and publicly funded home care hours.

“These findings have important policy implications,” the report notes. “There are substantial variations in primary, community and long-term care supply across regions in Ireland. In order to achieve equity in supply, considerable increases in supply of non-acute care would be required in many counties.”

The ESRI also points out that its report highlights the need for an accurate and timely collection of health and social care data.

One of its authors, Brendan Walsh, said evaluating local health service provision was vital to inform policymakers on future needs.

“The findings demonstrate that in the absence of a national resource allocation system that relates supply to population need, inequalities in the supply of health and social care could impede progress towards proposed Sláintecare policies,” he said.