L1- The Irish Health System
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129 Terms
Why is studying health systems and health services important?
Because:
Health is important in people’s lives.
Health services contribute to the improvement and maintenance of health.
There are uncertainties surrounding effectiveness, efficiency, equity and humanity in healthcare.
There is room for improvement.
Studying systems helps us predict the effects of change.
We can learn from other systems.
Health professionals and health services need to be accountable.
Healthcare costs consume a growing proportion of national budgets.
Healthcare is a large employer.
Healthcare forms part of a healthcare-industrial complex.
How does the WHO's 1948 statement describe health as a human right?
It states that the enjoyment of the highest attainable standard of health is a fundamental right of every human being, without distinction based on race, religion, political belief, economic condition or social condition.
What role can health systems and health services play in population health?
They are an influencing factor on the health and well-being of individuals and populations and can therefore be considered a structural determinant of health
What five major dimensions of a health system should be considered?
Affordability
Accessibility
Equitability
Quality
Efficiency
How did the WHO define a health system in 2000?
As all activities whose primary purpose is to improve health.
What does the broader WHO definition of a health system include?
All actors, institutions and resources that undertake health actions, where a health action is one whose primary intent is to improve health
What is meant by a “system”?
A set of things working together as parts of a mechanism or an interconnected network to achieve a specific outcome
“Adding years to life and life to years.” What are the 4 major goals of a health system?
To provide services efficiently and equitably.
To improve the health of the population.
To respond to the expectations of the population.
To ensure fairness of financial contribution.
What are the four broad functions of health systems?
Provide health services.
Generate resources for health- Raising money.
Finance health services- Paying for care.
Provide stewardship- Governing, regulating, policymaking and enforcement.
What are the three major levels of healthcare?
Primary, secondary and tertiary care
What is primary care?
Usually the first point of contact with the health system; it is generally community-based and provides general rather than highly specialised care; can act as the gatekeeper to other levels of the healthcare system.
What is Primary Health Care (PHC) associated with historically?
The Alma-Ata Declaration.
What is secondary care?
Specialised healthcare that may require referral from primary care.
What is tertiary care?
Highly specialised healthcare that may require referral from secondary care.
What 6 shortcomings of health systems are identified?
Inverse care
Impoverishing care
Fragmented/fragmenting care
Unsafe care
Misdirected care
Bureaucratic care/systems
In which sector are health services usually situated?
Usually the public sector.
What 2 other sectors contribute to health services?
Community and voluntary organisations
What consequence can accompany the large size of health services?
They can become bureaucratic.
What happened to medical practice in Europe from the mid-18th century?
A process of professionalisation of medical practice occurred with
Emergence of nation states
Increasing industrialisation
Colonialism
Were the motives behind this professionalisation necessarily altruistic?
No they were not necessarily rooted in altruism.
According to Foucault, what happened to the doctor's relationship with power?
The doctor acquired a foothold in different processes of power.
According to Foucault, what happened to the doctor's relationship with power?
The doctor acquired a foothold in different processes of power.
What four types of hospital/clinic effectively existed in Ireland during the 1700s/1800s?
Voluntary hospitals
County infirmaries
Fever hospitals
Dispensaries
Where were voluntary hospitals mostly located?
In urban centres.
What was the purpose of county infirmaries?
They were established in each county to serve the rural population.
Why were fever hospitals established?
In response to outbreaks of diseases such as TB and smallpox.
What services did dispensaries provide?
Outpatient services only, either at home or in small clinics.
What additional institution became part of healthcare after 1838?
Workhouse infirmaries.
What forms of care were important before the 19th century?
Traditional/folk remedies, described as lay care.
What was the regulatory status of medical care?
Medical care was unregulated.
What organisation was established to regulate medical practice in Ireland?
The Fraternity of Physicians of Trinity Hall.
Did establishing a regulatory body eliminate divisions between practitioners?
No. There were still factional differences between practitioners.
What institutions appeared during the 1700s?
Houses of industry.
When did the first hospitals emerge?
In the early 18th century.
What did Edwin Chadwick, 1800–1890 believe about population health and productivity?
He believed that a healthier population would work harder and cost less to support.
What major report did Chadwick produce?
Report into the Sanitary Conditions of the Labouring Population of Great Britain (1842.)
What did Chadwick's report demonstrate about life expectancy?
Life expectancy was much lower in towns than in the countryside
What 3 improvements resulted from Chadwicks work?
Improvements in:
Housing
Working conditions
Sanitation
How many workhouses were built between 1838 and 1851; Under what system were the workhouses established?
163; The Poor Law.
How was Poor Law assistance financed?
Through a rate paid by property owners to help people in need.
When did the Famine period occur?
1845–1849.
What happened to the existing system during the Famine; What financial problem affected the system during the Famine?
collapsed under the pressure created by enormous levels of disease and destitution
Many landlords became bankrupt, undermining a source of funding.
What important development occurred in 1860?
Nursing orders of religious sisters began working in workhouses; They helped improve the standard of care
What happened to workhouses in 1862?
They were opened to non-destitute sick persons.
What were conditions like in workhouses?
Poor, including:
Unplastered walls
Straw mattresses
No running water/sanitation
How were workhouses perceived socially and Why was there stigma associated with workhouses?
They were shunned by “respectable people”; Because of their association with the Poor Law
What major legislation concerning doctors was introduced in 1858?
The Medical Registration Act.
What did the Medical Registration Act create?
A common medical register for Great Britain and Ireland to identify people qualified to practise as doctors.
What organisation was established to supervise medical education and professional practice?
The General Medical Council.The General Medical Council.The General Medical Council.
Approximately how many registered doctors were there in Ireland; What proportion of these doctors worked as dispensary/workhouse medical officers?
2,200; Approximately half.
Where did most people at the beginning of the 1900s experience birth and death?
At home.
What was the government's health responsibility largely limited to in the 1900s? 2
Providing a safety net for the poor.
Controlling outbreaks of certain infectious diseases.
How were hospitals commonly regarded in the 1900s?
As places of last resort, particularly for people with untreatable illnesses and for the poor; people who could afford it preffered treatment at home- they had a desire to keep their distance from poor people and “their infections.”
What advances took place during the 1900s?
Medicine's capacity to combat human illness changed rapidly.
That medical care based on need rather than ability to pay should be considered a right of all citizens.
What did the 1911 Health Insurance Bill propose?
An insurance scheme.
What 3 types of costs was the insurance system intended to average across a person's life and across the community?
Illness
Childbirth
Unemployment
What 3 social protection was the proposed insurance scheme intended to provide?
Protection from poverty and dependence on the Poor Law; became a major cornerstone of the UK welfare state.
Was the scheme accepted in Ireland?
No. It was rejected in Ireland.
Ireland was a largely agricultural society.
There was a lack of insurance-scheme structure/administration and fear of cost.
There was a lack of political will because attention was focused on Home Rule.
What major political context influenced healthcare development from 1930 onward?
The establishment of the Irish State
How did the emphasis of healthcare policy change from 1930 onward?
It moved towards providing health services for all.
What happened when voluntary hospitals entered crisis from 1930 onward?
The Irish Hospitals Sweepstakes was created, with the State becoming involved in distributing funds.
What happened to healthcare infrastructure during the 1930s?
There was an extensive building programme
What did the TB Act 1945 allow?
It gave powers to acquire land and directly build new sanatoria.
What did the 1947 Health Act reflect?
A recognised need to reorganise health services and focus on primary care.
What were Dr Noel Browne's 2 major health objectives as Minister for Health?
Eradication of TB.
Free health services for mothers and children.
What opposition did Noel Browne encounter?
Opposition from the Catholic Church to increasing state intervention
What happened under the 1953 Health Act?
A modified version of the proposed reforms was introduced, with complex eligibility criteria and the introduction of VHI.
What major organisational reform followed the 1970 Health Act?
The establishment of Health Boards.
What did Taoiseach John Costello reportedly tell Dr Noel Browne regarding doctors and bishops?
Costello did not want to fight either group individually and especially did not want to fight the doctors and bishops together
What argument did the Catholic bishops make concerning state provision for children's healthcare?
They argued that the State should not relieve what they characterised as the 10% of necessitous or negligent parents by infringing the rights of the other 90% of parents to provide for their children's health.
What healthcare was already available to the poorest third of the population?
Free care from dispensary doctors
How did the 1953 Health Act compare with the extended service proposed previously?
It was a severely modified version.
How was eligibility for services determined in the 1953 Health Act?
Through complex eligibility criteria based on income which varied across services
What major insurance development accompanied the 1953 Act?
The introduction of Voluntary Health Insurance (VHI).
What major legislation shaped healthcare in the 1970s?
The Health Act 1970.
What cour changes came in under the Health Act 1970?
medical card eligibility was simplified and expanded.
A two-tier framework of eligibility for public services
There was a process of hospital improvement and expansion of bed capacity
Regional Health Boards were established
What international economic/political ideology formed part of the context of healthcare in the 1980s?
New conservatism/neoliberal economic reforms.
What two international political-economic approaches are specifically named?
Reaganomics and Thatcherism.
What happened to privatisation during this period?
It grew.
What remained influential in Ireland and what happened to the Irish economy?
The Church; the Irish economy contracted
How did economic contraction affect Medical Card demand?
It increased the number of people needing Medical Cards; Cutbacks/austerity also followed
What development occurred in the private hospital sector?
Ireland's first fully profit-driven hospitals opened.
The Mater Private
The Blackrock Clinic
What 3 health/social-policy issues are specifically associated with Ireland in this period (1980s)?
Response to the AIDS crisis
Contraception
The David Norris case
What did the Health Amendment Act 1991 do?
It extended free hospital care to the entire population, effectively introducing universal access.
Did universal access eliminate the two-tier system?
No; Because public hospital consultants retained rights to:
Earn private fee income within public hospitals.
Work simultaneously in public and private hospitals.
What major reform occurred in the 2000s?
Formation of the Health Service Executive (HSE); Health boards were replaced by a centralised structure
What major economic event occurred in 2008?
Recession
What policy response followed the recession?
Austerity.
By how much does the slide state that the health budget was cut during the recession?
22%.
What 3 workforce measures followed the recession?
Hiring freeze.
Pay agreements.
Resulting impacts on staffing levels.
Why did the financial crisis significantly disturb the health system?
It produced:
Constrained resources due to the collapse in taxation.
Service cuts/reductions.
Loss of morale through lower pay and service cuts
How does the O'Toole quotation describe the Irish health system?
As “a mass of contradictions.”
What contradiction regarding public hospital care is highlighted?
In theory, everyone is entitled to free public hospital care, while Department of Health policy encouraged people, where possible, to take responsibility for their own health and healthcare costs.
What replaced Quality and Fairness: a health system for you (2001) in 2005?
Health Service Executive
What is the HSE?
HSE is a large, multi-level national organisation containing national directorates alongside seven Hospital Groups and nine geographically organised Community Healthcare Organisations
What happened to many health services under the HSE?
They were centralised including Cancer Control.
What fundamental problem drives healthcare reform?
Demand outstrips resources everywhere
How can healthcare systems respond to the mismatch between demand and resources? 4
Increase efficiency.
Encourage more cost-effective care.
Manage demand better → It should ensure that the most severely ill have greater access to care.
Manage public expectations → Through debate and awareness of the system's limitations.
What 11 factors create the need for healthcare reform?
Budgets
Waiting lists and inequitable access
Lack of integration
Capacity
Accountability and reporting
Prioritisation
An ageing/changing population
Dependence
Chronic illness
New technologies
Consumerism and patient empowerment
What are three broad models of health-system financing? How is Ireland characterised in relation to these models?
State financing through general taxation eg The NHS in Britain.
State financing through social insurance eg Most of Europe.
Private finance/voluntary insurance eg The United States.
Ireland is a hybrid of the British and American models.