A MAJOR ESRI report into future healthcare demands provides a reminder of the significant infrastructural changes required to make the health service fit for purpose. It also emphasises how little restructuring has actually taken place since the Health Service Executive (HSE) was established during a time of economic buoyancy and underscores the severe and sudden pruning of resources faced by the public health system in the forthcoming budget.
The report, Projecting the Impact of Demographic Change on the Demand for and Delivery of Healthcare in Ireland, says the population will increase from 4.2 million in 2006 to 5.1 million in 2021. It predicts this demographic change will increase total GP consultations by 33 per cent by 2021. Given that the existing number of family practitioners is already inadequate and that it is Government health policy to transfer many hospital services to primary care, the projected shortfall in GP manpower represents a serious threat to the most fundamental plank of healthcare reform. If our GP numbers are to rise to the EU average of 87 GPs per 100,000 of population by 2021, we will need to recruit another 1,800 GPs. However, at present, just 121 GP training places are offered every year.
Dr Stephen Thomas of the Centre of Health Policy and Management at TCD, who wrote the paper on GP shortages, warned that a failure to act could even threaten current service levels in the community. And although involving nurses, pharmacists and other healthcare professionals in primary care teams may help ameliorate the GP manpower problem, a failure to increase GP training numbers is likely to cause a significant gap in the future availability of quality healthcare.
Separately, population growth and increased longevity will drive a greater demand for long-term care. Other factors include disability trends, and how the composition of the traditional nuclear family continues to change. In addition, requirements for a higher standard of care may increase costs. We have already seen how factors such as reduced length of acute hospital stay may translate into increased demand for long-term care.
In the face of inexorable demand across so many parts of the health system, is there any area where savings could be made? A sub-report into future drug costs may offer some hope. While the authors project a possible 250 per cent increase in the total number of prescription items dispensed here by 2021, previous reports have outlined how bloated drug costs are in the Republic compared to other countries. Improved bulk pricing deals, reimbursement of just the generic cost of drugs in community drug schemes and the introduction and enforcement of formularies and prescribing protocols in hospitals are initiatives that could be introduced in the forthcoming budget. At the very least, they would slow the double digit year on year increase in drug expenditure seen here in recent years.
In times of deep recession, additional funding can no longer paper over cracks in the health system; reform based on reliable research is the only way forward.