Ireland below Macedonia in healthcare rankings

The Euro Health Consumer Index 2016, results of which were published earlier this year, found good news generally, with continuous improvement across the surveyed countries, and throughout the financial crisis too. Survival rates of heart disease, stroke and cancer are all increasing too, while infant mortality is going down.

In all, 11 countries – up from eight in 2015 – are now scoring above 800 points, from a maximum 1,000, putting them at the top of the leader board. Ireland, at 689 points, is not among the leaders, however and, in fact, ranks below Macedonia.

The Netherlands tops the rankings, followed by Switzerland and Norway. At the bottom of the list are Albania, Bulgaria, Montenegro and, finally, Romania.

The survey, which is undertaken each year, throws up some interesting insights, such as the fact there is no correlation between accessibility to healthcare and the amount of money spent. This is “because it is inherently cheaper to run a healthcare system without waiting lists than having waiting lists,” say its authors. “Contrary to popular belief, not least among healthcare politicians, waiting lists do not save money, they cost money.”

Healthcare “is basically a process industry”, it concludes, and “as any professional manager from such an industry would know, smooth procedures with a minimum of pause or interruption is the key to keeping costs low.”

This should be of special interest here, given that Ireland’s per capita spend on healthcare is rated higher than its overall rankings would suggest. Ireland also had one of the lowest scores of the 35 countries in terms of accessibility. Equally, Macedonia’s rise from 27th on the index in 2014, to 20th today, is largely due to its more or less eliminating its waiting lists, which it has done by implementing an e-booking system.

Ireland, along with the UK and Sweden, was found to have the worst patient organisation feedback on accessibility in the survey.

Ireland’s poor performance

Ireland's poor performance on this front was, it says, confirmed by the HSE after the release of the 2015 report, "when they said in a memo that the programme initiated to reduce waiting times in Ireland aims at a target of no more than 18th months' (!) (the report author's punctuation) wait for a specialist appointment. Even if and when that target is reached, it will still be the worst waiting time situation in Europe, " it concludes.

Also highlighted for concern was the fact that Ireland has the highest percentage of the population (more than 40 per cent) with private healthcare insurance. “Should that be regarded as an extreme case of dissatisfaction with the public system, or simply as a technical solution for progressive taxation?” it asks.

Copying the most successful health systems would save and improve lives elsewhere, as well as save money, it points out.

Macedonia's improvements, driven by a highly transparent e-booking system, "shows what can be achieved by imagination, determination and firm leadership," says Professor Arne Bjornberg, head of the EHCI research. "This being possible in a not too wealthy country challenges many conventional attitudes in healthcare. Even if the EHCI shows steady progress in European healthcare, much more needs to be done. If governments stop trying to reinvent the wheel, in favour of copying proven progress, health-reform speed could increase. That would reduce mortality, improve quality of life and save money."

Ireland, he says, “sticks to the inefficient, unequal semi-private funding”, rather than copying proven best practice elsewhere.