Published: 20 January 2010
Towards the development of a resource allocation model for primary, continuing and community care in the health services. Volume 2: Technical Report
This study was conducted by a research team lead by Professor Anthony Staines at DCU and was commissioned by the HRB and HSE. The report of this study proposes a resource allocation model for the Irish health services based on the principle that each Irish resident should be provided with access to health services funded from general taxation and in proportion to their need for those services.
The question posed by the study was: 'Given the national spend on the health services, and existing allocation between services, how should the budget for each service be divided between Primary, Continuing and Community Care (PCCC) areas in order to support access to services in rough proportion to the need for these services in each area?' The current system does not allocate resources in a way that addresses this question. There is no single correct way to allocate resources, and there is no perfect model.
What is required is a model that is comprehensible to non-specialists; is acceptable to practitioners, politicians and the general public; is flexible and is robust in the sense that small changes in the model and in the data will lead to small changes in resource allocation. Currently, while many services are provided to Local Health Organisations (LHO) populations, they are either delivered outside the LHO, or they are provided by the voluntary sector or other providers. Therefore, it is difficult to ascertain exactly how resources are allocated between care groups at LHO level. Budgets do not reflect service provision to the population at LHO level and there is no truly systematic approach to resource allocation.
This study proposes a new model, which would operate at LHO level; a model in which resource allocation is driven by LHO populations and is weighted by age and gender-specific estimated need. Need was estimated using as proxy age and gender-specific estimates of national GP and PCCC utilisation. The new model proposes to allocate money ' not staff, facilities or equipment' to specified areas (LHO's for the purposes of this study) in which the managerial responsibility for ensuring that services are provided to the resident population of that area actually resides. This does not imply that services would have to be physically located within a particular LHO catchment area; neither does it imply that services would have to be provided by agencies either directly or indirectly managed by the relevant LHO managers. The severe limitations of existing health information systems mean that any Irish model developed at present will necessarily be very crude. This report makes a number of specific recommendations aimed at bringing Irish health information systems into line with the necessary international standards. Work is underway to improve the recording and reporting of HSE expenditure in these systems, and there are significant improvements each year, but they are not yet completely consistent in the classification of expenditure. According as this is done, it will be possible to refine and improve resource allocation.
In the current economic environment, where budgets are shrinking, the implementation of a resource allocation model will be difficult. This report suggests adopting a phased approach to implementing the resource allocation strategy i.e. one where the development of the financial system is agreed as a priority action. This study emphasises that an overly rapid implementation of any resource allocation system would be likely to cause severe damage to the delivery of healthcare to the Irish population.