New ESRI research assesses the importance of Population-Based Resource Allocation for healthcare in Ireland

October 15, 2024

Health and Quality of Life
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A population-based resource allocation (PBRA) mechanism is due to be introduced for healthcare in Ireland for the first time. New ESRI research funded by the Department of Health examines the proposed PBRA mechanism and establishment of HSE Health Regions. The research provides evidence to inform the structure of PBRA using information from PBRA mechanisms used internationally and funding mechanisms in the Irish healthcare system.

The study highlights that implementing PBRA across the Irish healthcare system and devolving decision-making to new HSE Health Regions has the potential to significantly improve the efficient and equitable allocation of health and social care resources and advance integrated care pathways. PBRA has the potential to achieve some of the goals of Sláintecare and may allow for multi-year budgeting for healthcare.

Key findings

  • The PBRA formulae proposed by the Department of Health that use Health Region population size, age, sex, deprivation and rurality to allocate resources are commendable and align closely with PBRA implemented by international peer countries.
  • Due to the lack of universal healthcare in Ireland, and the importance of medical cards in accessing healthcare, additional adjustments for medical cards when allocating resources would be appropriate.
  • Only half of HSE expenditure is proposed to be included in PBRA initially, with important services such as general practitioner (GP) care, the Nursing Home Support Scheme, and Disability care not proposed to be included initially due to lack of data on these services. These exclusions may impede the full understanding of the actual resource needs of Health Regions.
  • Keeping GP care outside of the PBRA formula is unique in an international context and potentially problematic. GPs are a key provider of healthcare, but they also play a central role as gatekeepers to community and hospital care, and in helping to coordinate pathways of care for patients. Inclusion of GP care in future iterations of PBRA is recommended.
  • PBRA will take time to become embedded in the healthcare system, but transparency about how it works will be key to its acceptance and success. Clear evidence on how resources are being distributed and the use of an Advisory Group to oversee PBRA is recommended.

Brendan Walsh, an author of the report and Senior Research Officer at the ESRI said:

“Healthcare systems that distribute resources equitably and efficiently improve health and well-being. The Irish healthcare system lacks a systematic mechanism for doing this. The implementation of population-based resource allocation (PBRA) along with a devolution of decision-making to local leaders represents not merely a policy change but a fundamental shift towards a more equitable, efficient and needs-based distribution of healthcare resources.

Improvements to PBRA could be made by accounting for medical card rates across regions due to the importance of medical cards in accessing care. Currently it is proposed that almost half of all health spending, including spending on general practice and the Nursing Home Support Scheme will not initially be included in the PBRA system. Without these services, the resource allocation mechanism may not reflect a full understanding of the actual resource needs of Health Regions, which may exacerbate unequal resource distribution across regions and population groups.”