ESRI Conference: "Health Systems in the Era of Austerity"

At the conference a panel of Irish and international experts will examine national and international experiences, drawing on TCD research on the resilience of the Irish health system and on a joint ESRI/TCD/WHO 'rapid response' report on health system responses to the economic crisis. Contrasting lessons from Spain, Estonia and the wider WHO Europe region will also be presented. The background to the Conference is the impact on health systems of the current economic crisis which has led to large reductions in public health budgets in Ireland and across the EU. Across Europe, already stressed health systems are under huge pressure to maintain safe services and to do more with less. At the same time, they are expected to meet more complex, growing health needs while improving and reforming service delivery. The presentations at the Conference will explore how the economic crisis provides a unique opportunity to examine how different health systems are faring in recessionary times, and to draw out lessons for health policy coming from cross country comparisons. PROGRAMME 08.30 Registration and Coffee 08.55 Welcome: Professor Miriam Wiley,Economic and Social Research Institute Session 1: Chair, Professor Charles Normand, TCD 09.00 Key Themes for the Day: Resilience, Performance and Achieving Universal Health Care Dr Steve Thomas, Associate Professor, Centre for Health Policy and Management, TCD 09.30 The Experience of the Spanish Health System in the Financial Crisis Prof José R. Repullo, Head of the Academic Department of Health Planning and Economics, Spanish National School of Public Health / Institute for Health Carlos III, Madrid 10.00 Lessons from the Estonian Health System: Surviving Austerity Ms Triin Habicht, Head of Department of Health Care, Estonian Health Insurance Fund, Tallinn 10.30 Coffee Break Session 2: Chair, Professor Frances Ruane, ESRI 11.00 Reflections on Oslo II: Lessons Learned from Europe Dr Matt Jowett, Acting Head of Office, WHO Barcelona Office for Health Systems Strengthening 11.30 The Observatory Rapid Response for Ireland : Key Findings and Options Dr Anne Nolan, Research Officer, ESRI and Dr Sarah Thomson, Senior Research Fellow of the European Observatory on Health Systems and Deputy Director of the Observatory's LSE hub 12.15 Questions/Discussion 12.45 Closing Words: Department of Health Please find below short  summaries of the presentations at the Conference. Conference presentation slides will be available to download from our website on the day of the event. Members of the Media are invited to attend the Conference.  

"Resilience, Performance and Achieving Universal Health Care?" Dr Steve Thomas, Associate Professor, Centre for Health Policy and Management, TCD Dr Steve Thomas will detail findings from the research on how Ireland's health system is coping with austerity - how we are managing to provide much more care with fewer resources as well as showing on whom and where austerity is hitting hardest. He will present new quantitative findings on how tough decisions in health get made alongside a critique of progress on current government health reforms. The research findings are drawn from the HRB funded 'Resilience' project, of which Dr Thomas is the principal investigator.

"The Experience of the Spanish Health System in the Financial Crisis" Professor José R. Repullo, Head of the Academic Department of Health Planning and Economics, Spanish National School of Public Health / Institute for Health Carlos III, Madrid Prof José R. Repullo will outline the experience of the Spanish health system in the financial crisis. He notes that while there has been an expert consensus on how to reform the Spanish health system in the past to make it more efficient, in times of affluence and with major governance deficiencies, those reforms were never implemented. He discusses how the current austerity policies have some elements that could lend themselves to efficiency improvements but how some austerity policies also include mere cost-cutting elements. The paradox is that under the pressure of the crisis, the Spanish government has the clout to implement necessary reforms, but because of governance deficiencies, this opportunity is being lost. It will require good health policy, sufficient budgetary support, reasonable timeframes for appropriate downsizing, alliance with professionals and excellent leadership and management, to avoid a path of further deterioration in the Spanish National Health System.

"Lessons from the Estonian Health System: Surviving Austerity" Ms Triin Habicht, Head of Department of Health Care, Estonian Health Insurance Fund, Tallinn. In her presentation to the ESRI/TCD conference on 'Health Systems in the Era of Austerity', Ms Triin Habicht will draw out lessons for health systems from the Estonian experience with austerity. In contrast to many EU countries, the Estonian health system was relatively well prepared for the financial crisis. In particular, the establishment of a legal requirement to accumulate reserves for the health insurance fund was the consequence of the previous crisis in the late 1990s and enabled the fund to overcome a short term fall of revenues.

"Reflections on Oslo II: Lessons Learned from Europe" Dr Matt Jowett, Acting Head of Office, WHO Barcelona Office for Health Systems Strengthening. The World Health Organization (WHO) is working with many European countries to help them to understand both the impact of the financial crisis on population health, and also on health systems. In his presentation, Dr Matt Jowett will outline some clear messages that have emerged from the evidence prepared for the WHO Oslo II Ministerial Conference on health systems and the economic crisis held in April 2013. First, wherever possible it is advisable to absorb budget reductions through efficiency savings rather than passing the cost onto the patient, especially given the higher needs typically observed during financial crises. Second, it is important to maintain a focus on the long-term challenges facing health systems, in particular tackling chronic diseases.

"The Observatory Rapid Response Report for Ireland: Key Findings and Options" Dr Anne Nolan, Research Officer, Economic and Social Research Institute, Dublin. Dr Sarah Thomson, Senior Research Fellow, European Observatory on Health Systems and Policies; Deputy Director of LSE Observatory Hub. The presentation by Dr Anne Nolan and Dr Sarah Thomson will discuss the findings of the report 'Health system responses to financial pressures in Ireland: policy options in international context'. They show how the Irish health system is experiencing unprecedented reductions in public spending. Cuts to the health budget are compounded by underlying upward cost pressures, some caused by weaknesses in the health system (high salaries, high drug prices, poorly developed primary care, means-tested benefits), and some caused by factors beyond the health system's control (population growth, economic recession). So far, cuts in public spending on health have been mainly achieved through reduced pay for staff, improved efficiency in service delivery and, to a lesser extent, increases in the financial burden falling on users. Although there is scope to make substantial additional savings through efficiency gains, they warn that these cannot be made within the required timeframe without damaging patient care, unless high salaries and the high price of other inputs are seriously addressed. They conclude by noting that while the Government's commitment to establish universal access to primary care is an important step, this will require additional funding.

Note to Editors: 1. This half-day Conference, jointly organised by the Centre for Health Policy and Management, TCD and the Economic and Social Research Institute (ESRI), will take place on Tuesday 18 June 2013 at the ESRI. It is funded by the Health Research Board, through its Knowledge Exchange and Dissemination Scheme (KEDS), and the ESRI/TCD/European Observatory. 2. The aims of the conference are: • To showcase the Observatory Rapid Response report for Ireland and the Resilience project work. • To highlight the key findings from the Oslo II Ministerial Conference on Health Systems and the Economic Crisis, April 2013. • To draw lessons from specific country case studies (Estonia, Spain) for Ireland. • To encourage knowledge exchange around cutting budgets, maintaining services and achieving transformation. 3. The Rapid Response Report, produced by the European Observatory on Health Systems and Health Policies and partners, reviewed the main policy options available to the Irish government in responding to the effects of the financial crisis on the Irish health system. It assessed the response of the Irish health system to budget cuts in recent years and explored future options in light of relevant international evidence drawn from experiences in European and OECD countries facing similar challenges. The report may be accessed on our website. 4. The Resilience Project ("Resilience of the Irish Health System: Surviving and utilising the economic contraction") is a three year research programme funded by the HRB, headed by the Centre for Health Policy and Management, TCD, assessing how the Irish health system is performing during the economic crisis. The research is developing guidelines on how the Irish health system might both withstand and benefit from the current economic crisis and providing strategies to strengthen the Irish health system in anticipation of future crises. Further details on the TCD Resilience Project may be found at: http://www.medicine.tcd.ie/resilience4health/overview/ 5. Members of the media are invited to attend this conference. For further information please visit the ESRI website.