4. Paying for services
Adequate funding for health is important to manage the excess demands on the health system. This section considers how countries are PAYING FOR COVID-19 SERVICES. Health financing describes how much is spent on health and the distribution of health spending across different service areas. The section also describes who is covered for COVID-19 testing and treatment, whether there are any notable gaps (in population coverage and service coverage), and how much people pay (if at all) for those services out-of-pocket.
4.1 Health financing
The HSE is scaling up its actions to deal with a population impact over the coming months which could produce service demand beyond anything previously experienced. The estimated cost is in the region of €435 million in 2020 (https://merrionstreet.ie/en/News-Room/News/Government_agrees_next_phase_of_Ireland%E2%80%99s_Covid-19_response.html).
According to reports in national newspapers on 6 April 2020, the finance minister Paschal Donohoe told cabinet that the total additional health spend, including the further funding required for the Covid-19 National Action Plan, will amount to up to €2bn. He also is reported as saying that over 500,000 people in Ireland were in receipt of the Unemployment Benefit, almost 10,000 in receipt of illness benefit, and almost 40,000 businesses registered with Revenue for the Wage Subsidy Scheme (https://www.irishexaminer.com/breakingnews/ireland/covid-19-action-plan-will-cost-the-country-2bn-cabinet-told-992806.html).
Everyone in Ireland is allowed two GP telecalls related to COVID-19, for which the GPs are reimbursed €30 per call.
Update 14 October 2020: Budget 2021 announced
The new budget was announced on 13 October, with an additional €4 billion added to the health service, the largest ever budget increase. At the sectoral briefing on 14 October, the health minister Stephen Donnelly stated that the new budget “will not just be about the response to COVID-19, it is also about building positive permanent change into our health service. It provides the resources we need, and that our health care professionals and service users have asked for, to grow capacity, and deliver universal healthcare across our health service.”
Substantial development of health and social care services is planned, in line with Sláintecare reform efforts, including shifting the emphasis to providing enhanced services in community, along maintaining COVID-19 measures.
The new budget provides funding for the following services:
• COVID-19 services: testing capacity of 100,000 COVID-19 tests a week, supply of necessary PPE next year, continuation of all the necessary COVID-19 Action Plan measures introduced since March into 2021
• 2,600 additional permanent beds: additional 1,146 acute beds, increase in permanent adult critical care beds from 255 pre-COVID-19 to 321 in 2021 and 1,250 community beds, 600 of which will be new rehabilitation beds.
• Five million additional homecare hours following on from the 19 million provided in 2020
• Recruitment of 16,000 new staff across the health service, including significant investment in public health workforce
• Sláintecare Public-Only Consultant Contract implementation
• Addressing waiting lists with approximately 100,000 additional inpatient and day care procedures through investment in public hospitals and utilisation of spare private hospitals capacity
• New Access to Care Fund to facilitate improved access to care
• Healthy Ireland initiatives, aimed at supporting health and wellbeing and prevention (e.g. obesity, healthy eating, smoking cessation, addiction services)
• Support for services provided by voluntary/NGO sector
• New medicines and technologies, including enhanced eHealth and ICT infrastructure
Implementation of a number of national strategies and initiatives are funded, such as: National Cancer Strategy 2017-2026, National Maternity Strategy 2016 -2026, A Trauma System for Ireland, the National Ambulance Service Strategic Plan, Paediatric services including new children’s hospital, Organ Donation and Transplant Services, The Women’s Health Taskforce; Taskforce on Staffing and Skill Mix for Nursing, National Positive Ageing Strategy, Housing Options for our Ageing Population, National Dementia Strategy; National Carers Strategy; Palliative Care Strategy.
There is a substantial funding allocated to:
New mental health services:
• implementation of the national mental health strategy
• enhancement of mental health community teams, child and adolescent services, and crisis resolution services, step down beds in the community
• e-mental health supports
• increase in day services, timely intervention for children and young people and building capacity of adult services
• new residential places are to be provided but the focus is on moving people out of congregated settings and provide intensive support packages to support people to live in their community
• integrated model of care to be implemented as part of Sláintecare reform
• additional home care hours and other supports enabling older people to live in their community
• implementation of the recommendations of the COVID-19 Nursing Homes Expert Panel
• enhanced dementia and palliative services