The figures for acute hospital spending quoted by the Deputy are compiled on a global basis and are not broken down between pay and non-pay costs. There are pay and non-pay figures available in respect of voluntary hospitals which are published annually in the Revised Estimates for the public service. It should be noted that these do not include regional and county hospitals administered by the health boards. Over the period 1993 to 1998 the total increase for these hospitals was 51 per cent which was made up of a 48 per cent increase in pay, including superannuation and PRSI costs, and a 73 per cent increase in non-pay costs.
These are overall increases and do not distinguish between the increases in pay and non-pay which went towards maintaining existing services and standards of service and the increases which went towards developing new services and improving the quality of services. This is the key distinction required if the costs associated with medical inflation are to be separated from costs attributable to service improvements, as requested by the Deputy.
Unfortunately, reliable estimates tracking medical inflation in the Irish public health system do not exist. In a previous reply, I gave the figures quoted by the Deputy in his question and I explained the particular measurement difficulties which arise in calculated medical inflation. It is a feature of all health systems that it is extremely difficult to disentangle cost increases attributable to medical inflation from increases in cost associated with improvements in the level or quality of service. To take an example, the cost of treating a particular disease may increase but this may, in part, be driven by the adoption of new technologies which bring about improvements in patient outcomes and/or increased activity levels. If account is only taken of the increase in cost and no allowance is made for the improvement in service the impression will be created that the cost of delivering existing services has increased whereas the introduction of this new treatment has actually changed the level and quality of service received by patients.