Ireland, Yeats famously said, is ‘no country for old men’ (and probably not women), but a greying population means it will quickly need to think up new ways of paying for health care. In the October 2021 budget, Health Minister Stephen Donnelly announced €21billion in funding which represented, the Government briefed, the biggest ever investment in Ireland’s health and social care services. Of this, €36.5million was devoted to measures to achieve “safe, quality, and patient-centred care”.
But how can this commitment to care that is centred around patients fit alongside stretched health budgets after covid – and an Ireland quickly growing older? For a place much of the world thinks of as the “old country”, Ireland in recent decades has been remarkably young. Birth rates stayed high until the late 1980s, much later than elsewhere in Europe. Mass emigration in the 1960s and 1970s meant many Irish-born people are growing old in Britain, America, or Australia instead.
“When we look at ageing populations, what the demographics are like, solving our health care challenges can’t just be solved with a bottomless pit of money,” says Dr Maeve McGrath, head of health care innovation at Roche Ireland. “What we have to look at is making sure the medicines being delivered, and the treatments, are showing value for a patient, and to do that we’ve got to look at what we’re actually measuring,” she says. Many health care systems are funded on a transactional model, where hospitals get reimbursed based on the numbers of hip or knee replacements they do.
And health care providers may make different decisions if they were instead reimbursed on patients’ outcomes: how quickly they could return to work, or reported a higher quality of life or mobility, say. In Ireland, “we’re not very far on implementing this, and we’re not capturing outcomes on a widespread basis, or not in a way that would be needed to inform those types of
decisions,” says McGrath. “It’s about capturing the right data, and first of all determining what is the right data,” she says.
And a system that is more based on reimbursing value or patient-care based outcomes, not activity, could make use of blockchain, to let different health care providers pass information securely about a single patient’s health outcomes. “This is five or 10 years away,” says John
Lee Allen, a surgeon turned managing partner of RYSE Asset Management. Even just an integrated Resident Assessment Instrument (RAI) for nursing home residents, a way of looking at their care requirements and signposting where their needs are best met, “it’s been talked about for a long number of years but we haven’t yet seen it in operation,” says Tadhg Daly, chief executive of Nursing Homes Ireland.
“What we need ultimately is an integrated system, because the resident in a nursing home is a patient of a GP, and probably has been in hospital before,” he says. It’s a longstanding pain point that a blockchain distributed ledger might finally have some ability to mitigate.
Similarly, a shift to metaverse-based care could finally help implement the e-health goal of patients having unique health identifiers. Ireland in particular is an outlier because in the postwar period, it never moved to a system of universal access to health care, based either on insurance or tax like the NHS, says Dr Sara Burke, research assistant professor at Trinity College Dublin’s school of medicine. This was a result both of the lack of wartime devastation like in the rest of Europe, and also the role of the Catholic Church’s low enthusiasm for major health care reform under personages like Archbishop John Charles McQuaid.
On the one hand, this means there’s currently less portability of individual health records compared with in the NHS. But it also means Ireland has “an opportunity here to leapfrog, and do some of the newer things first and not be patching them into legacy type systems,” says McGrath. And with a recent spurt of bold leadership from the HSE’s Digital Transformation Group, we could see Ireland “transform from that digital health laggard to a digital health leader,” she says.