Comparing health expenditure across countries is not straightforward, and there are a variety of ways of measuring health spend e.g. as a proportion of Gross Domestic Product (GDP), modified GNI* (a national indicator that excludes the globalisation effects that disproportionately affect the measurement of the size of the economy), or per capita; or the public versus private spend.
The System of Health Accounts (SHA) was devised by the Organisation for Economic Co-operation and Development (OECD) and has been adopted for joint reporting of health care expenditure by the OECD, Eurostat and the World Health Organisation. It provides a basis for uniform reporting by countries with a wide range of different models of organising their national health systems. Since the inception of the SHA methodology in 2013, Irish current expenditure has increased each year and this aligns with other OECD countries reflecting changes in demographics, macroeconomic growth and technological change.
The latest figures for Ireland according to the SHA methodology were included in the CSO statistical release, 20 June 2019. Overall there was a 5% increase in health expenditure in Ireland between 2016 and 2017. Ireland’s current health expenditure was €21.1 billion in 2017, which represents 7.2% of GDP or 11.7% of GNI* (Modified Gross National Income).
If modified GNI* us used, Ireland is above the OCED average and if GDP is used Ireland is below the OECD average.
From the most recent report, the majority of health expenditure (73%) was funded by government, with the balance funded by private sources including health insurance (14%) and household out-of-pocket expenditure (12%).
Even within a country, accurately measuring healthcare expenditure can be challenging due to uncertainty over what constitutes expenditure on health. A key feature of the SHA methodology is that it focuses solely on expenditure for health purposes which excludes expenditure on social care, and the implication of this is not insignificant for countries including Ireland where health and social care is delivered by the same providers. The Department has commissioned the Economic and Social Research Institute to examine this issue to assist the Department in a more forensic and more meaningful comparable examination of health expenditure and value for money.
The HSE National Service Plan (NSP) is an important accountability instrument in use by the Department in determining how the HSE is performing against its targets as it captures in a clear and quantified way the range of health and social care services to be provided by the HSE for the allocation it has received. It establishes links between funding, staffing and services and it incorporates activity measures, outcome-based performance indicators and deliverables in key service areas, which are matched with targets and timescales. In line with this, the NSP incorporates a value improvement programme with agreed savings to be achieved in 2019.
The Department provides oversight of the performance of the HSE in relation to the delivery of the services set out in the NSP, including the ongoing monthly performance management of the health system against the agreed activity and savings targets.