Dáil Éireann debate -
Tuesday, 25 Feb 2003

Vol. 562 No. 1

Written Answers - Health Expenditure.

Finian McGrath

Question:

358 Mr. F. McGrath asked the Minister for Health and Children his views on the fact that Ireland only spends 7.5% of its national income on the health service, while France spends 9.4%; and if he will consider sending a high-powered delegation to France to investigate the way in which value for money can be obtained in the health service and to bring it up to international standards. [5352/03]

Minister for Health and Children (Mr. Martin)

The Deputy should be aware that the approach of comparing health expenditure based on percentage of national income can provide misleading comparisons. Increases in GDP will reflect growth on the basis of the economy expanding over a period of time. This may mean that although funding provided for a particular sector such as the health service may increase significantly in real terms, the percentage committed may fall due to overall GDP growth, this being particularly evident in a fast expanding economy such as has been evident in Ireland in recent years. For example, OECD figures indicate that the public expenditure on health as a percentage of GDP in Ireland fell from 5.2% in 1999 to 5.1% in 2000 although investment by the Government actually increased by 17% in the same timescale. However, experience from 1997 to 2002 has shown that increases in the level of health funding have in fact outstripped the rate of increase in GDP by an average of 6.4%.

Evidence from the World Health Organisation report 2000 on health funding and delivery indicates that greater expenditure alone does not guarantee a better performing health service. For example, the United States spends the highest proportion of GDP on health care, at 13.6% of GDP in 1998, with Ireland ranked 25, and yet this level of expenditure did not translate into a high ranking in terms in either performance on level of health or in overall health care system per formance. In fact, in both of these categories Ireland performed significantly better than the United States, particularly in the overall ranking with Ireland ranked at 19 and the United States ranked at 37.

The Deputy will be aware that in 2001 the Government commissioned a report on value for money in the Irish health system which was carried out by the consultants, Deloitte and Touche. Many of the recommendations contained therein are being put in place, through the health strategy Quality and Fairness – A Health System for You. In addition I commissioned a review of health delivery structures, both internal and external, undertaken by Prospectus Consultancy. The report from the Commission on Financial Management and Control in the Health Services, which was established by my colleague the Minister for Finance, is nearing completion. Both reports should be submitted to Government in the near future and will inform the Government's early consideration of a programme of change to reform the health delivery system.