Serial cuts to annual health budgets have led a number of analysts to fear that a tipping point for the public health system will be reached in 2013. The need for a supplementary health budget of some €360 million this year and the failure of the Health Service Executive and Minister for Health James Reilly to gain control of health service spending do not augur well. Just over three-quarters of a billion euro in savings will have to be made next year, a steep target for a system already under great pressure.
Demand-led schemes such as medical cards and drug repayment schemes are once again likely to exceed expenditure targets and thereby threaten funding earmarked for treatments in hospitals and the community. The tripling of the prescription charge in the recent budget may result in increased expenditure due to the negative health effects of people forgoing necessary care. Dental care for medical card holders has already been greatly reduced, while cuts to the provision of aids and appliances to enable people to resume independent living in the community reinforce the perception that much of the talk of prioritising primary care services is lip service.
The Irish Medical Organisation has predicted that 2013 will see the introduction, for the first time, of waiting lists for people wishing to avail of general practitioner services. At present over 95 per cent of requests for care are provided on a same-day basis. Such a change would be significant, with a likely knock-on effect on the numbers attending hospital emergency departments. Combined with a reduced ability to provide chronic disease management in general practice, these changes would represent a significant threat to the Minister’s plans for a universal healthcare system.
Additional funding of €35 million for the mental health sector is welcome. But it must be matched by action to improve services on the ground. Recruiting mental health professionals in the December of the year they have been specially budgeted for, as has been the practice in recent years, represents false accounting.
2012 will stand out for the tragic case of Savita Halappanavar, who died at University College Hospital Galway when 17 weeks pregnant. It highlighted the continuing failure to legislate for the European Court of Human Rights ruling which found Ireland had failed to provide for abortion in circumstances where the mother’s life is at risk. Although the State enjoys a low maternal mortality rate, comments by respected obstetricians in the aftermath of Ms Halappanavar’s death indicate a worrying lack of certainty for women who develop certain conditions while pregnant. This deficit must be addressed in 2013. Next year may be a pivotal one for the health system, but as services are further cut, every effort must be made to protect the most vulnerable in society.