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A spoon of sugar with the health medicine?
[Posted: Wed 09/12/2009 by Niall Hunter, Editor www.irishhealth.com]
While there is harsh medicine in the Budget health measures, in truth it could have been worse.
Strange though that may seem in light of as prescription charges, dental scheme cuts, drug refund hikes, and pay reductions for all health workers and non-salaried health professionals, the expected further severe cuts to frontline HSE services have been avoided.
The reason for this is simple. Cuts of over €1 billion to the health service had been mooted for a number of weeks, and these might have entailed the wielding of a very sharp axe to frontline services.
However, it now transpires that €695 million of the €1.06 billion to be saved in health next year will come from the controversial pay cuts for public servants, including health workers at all levels, which include big cuts for high earners such as hospital consultants.
This savings figure also includes planned further reductions in fees for GPs and other independent contractor health professionals and savings - some would say cutbacks - already accruing from the moratorium on recruitment.
These and other savings not directly affecting most frontline care may spare the health services from Armageddon in 2010.
However, we should hold off on breaking out the champagne - now 60c a bottle cheaper - at the prospect that things might not be as bad as they might have been.
Health services are already suffering from cutbacks and a severe shortage of hospital capacity that has yet to be properly addressed by Mary Harney and the HSE.
The public hospital service is still relying on private hospitals through the NTPF to deal with this pressure and to keep waiting lists at a barely acceptable level.
While further frontline service cutbacks might have been avoided for now, the Budget health cuts are still severe and everyone will be affected.
The remaining €400 million in health savings next year will come through a variety of measures including drug cost savings, prescription charges, free dental care cuts and some further HSE economies totalling €106 million.
The health budget for next year totals €14.83 billion, down from a €15.6 billion outturn for 2010. Health Minister Mary Harney admitted the cutbacks were over and above what might be expected in normal economic circumstances.
The controversial 50 cent per item prescription charge for medical card patients is a "modest amount" that will hopefully help change behaviour in terms of prescribing patterns, according to Health Minister Mary Harney.
Announcing the health estimates for 2010 following the Budget, the Minister said this was a small charge which might cause prescribers and patients to reflect on whether so many items on a prescription were necessary.
She said one in seven of medical card prescriptions had a large number of items prescribed - more than 10 in many cases.
The charge will apply to medical card patients and those in the long-term illness schemes. There will be a monthly ceiling of €10 a month on the charge, which will be introduced from April 1. The charge will raise €15 million in 2010 and €25 million in a full year.
While supporters of such a charge will argue that it will promote rational prescribing and drug-taking, its opponents say these effects could be limited, that it is a tax on the lowest income group in society and that it could prevent access for many low income people to necessary medication.
The charge may be less controversial than the over 70s medical card withdrawal, but it could cause the Government a lot of trouble for the sake of a €25 million saving.
In another cost increase for health consumers, the monthly threshold for the Drug Payment Scheme is being increased from €100 to €120 from January. This means anyone who is not a medical card holder will now have to cover the monthly cost of medicines up to €120 themselves.
This could severely affect low and middle-income families hit by public service pay cuts and child benefit reductions.
The Minister, at a press briefing, said the increase on this scheme was less than had been proposed in the "Bord Snip" report.
In a surprise move, the Minister announced there would be no increases in 2010 in emergency department, day, inpatient and long stay hospital charges.
She said she was conscious of the impact that increases in these charges at this time would have on families who did not qualify for a medical card and who did not have health insurance.
There is a touch of playing to the gallery here. The truth is, savings being made in other areas, in particular the "one off" drastic measure of pay cuts, have allowed the Minister to be generous this year on hospital charges, which are already quite high in any case.
The Minister said there would also be no increases in charges for private beds in public hospitals. She said she was aware that these charges had increased quite substantially in recent years.
A hike in these charges usually has a knock-on effect on health insurance premia and the Minister said she was conscious of the fact that people were under pressure to pay these premia.
However, she indicated that another factor in freezing of private bed charges was that there was shortly to be a minor updating of the recently-introduced levy scheme aimed at keeping health insurance affordable for older people following the courts' overturning of risk equalisation.
This levy scheme has aready contributed to overall health insurance increases and the updating measure could push up health insurance costs further next year.
These costs are already increasing, as a result of previous bed charge hikes and the risk equalisation fall-out. Already, health insurance premia have increased by 20% over the past year and companies have announced increases around the same level for 2010.
In any case the Minister said bed charge increases will be revisited for 2011, so there is little sign of a respite there.
In another bid to reduce the amount the State pays for drugs in hospitals and in the community, the Minister said said there will be a cutback from January of €141 million in the amount drug companies are paid for supplying drugs to State schemes.
She said agreement had been reached on this with the pharmaceutical companies.
These drug cost savings are in addition to the full year savings of €133 million introduced this year through reductions in pharmacists' fees, a move that led to the unsuccessful strike by pharmacists.
In another drug cost measure, the Minister said she had set up a working group to implement a drug reference pricing and generic substitution system, with the aim of achieving further drug savings through such a scheme from 2011.
Under reference pricing, a limit on the price the State is prepared to pay for many pharmaceutical products would be set and the State would only cover the cost up to this limit, with any additional cost met by the patient.
The Minister said fess for doctors, dentists and some other health professionals with the exclusion of pharmacists would be increased further in the new year, following an 8% increase earlier this year. She intends to cut €45 million more from fees paid to professionals but the percentage level of fee reduction has not yet been announced.
Drug cost cuts and hiking professional fees, although not pleasant for those affected by them, will be more popular with the public than measures such as prescription charges, as they do seek to give better value for tax dollars.
The Government, and many members of the public reeling from the recession, feel we pay many of our health and other top professionals far too much, and action is now being taken on this.
The Government wants to save €45 million on professional fees next year and the Minister said she would engage in a consultation process before implementing the increases, which were likely to be of the order of at least 5%.
Hospital consultants too will face major income cuts following the Budget, as they are to be included in the pay cuts for higher earning public servants. Earnings above €200,000 are due to be cut by 15%.
Consultants, however, only this year received a major pay increase of around €30,000 per head on average for accepting a new contract.
There are also to be cuts in the medical card dental treatment scheme provided by dentists in private practice.
So all in all, we can try to grasp at straws, and drown our sorrows in beer - now 12c less a pint - as we try to come to digest the severe health medicine.
However, inevitable and necessary though the cuts and savings may be in the context of our dire economic straits, it should be pointed out that we are still waiting for an equitable, streamlined or reformed health service.
But that's probably another core 8am to 8pm day's work.
View further details of the Budget health provisions here
|purple Posted: 11/12/2009 23:05|
the budget was a disgrace. So many people ringing up on the radio, one girl crying that she had to go back to face her parents which she didn't want to. I hope that minister knows what he has done to the people of ireland.
|foxy Posted: 12/12/2009 08:25|
It seems that, for medical card holders, even those with long term illness, like cancer or ungoing coronary disorders, for whom medication is essential, must pay the 50c levy per item prescribed.
These patients have no choice since none of the essential items may be deleted. Didn't the Minister not realise this?
Where is the fairness here???
|Anonymous Posted: 14/12/2009 16:41|
I don't beleive anyone takes medicine unless they actually need to nor does any competent doctor perscribe where it is not neccesssary
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