The €22.5bn health budget needs to get bigger every year because of increased demand from population growth, ageing, and the rising cost of cutting-edge medication, a leading health economist has said.
Dr Brian Turner, economist and senior lecturer at Cork University Business School, delivered the Doolin Memorial Lecture and warned that difficult decisions lie ahead around health budgeting.
“We may need to have a mature conversation about how we are going to fund health services in the future,” he said.
“If we want to maintain the improvements in life expectancy, improvements in quality of life, that we’ve seen in recent years, that comes with a cost.”
It has emerged that Department of Health secretary-general Robert Watt had warned that the health service’s budget was “not credible” just days before Budget 2024 was announced.
Dr Turner said wider costs including the move to universal healthcare, offering free access to GPs, and other changes need to be factored into the budget.
“We should see increasing budgets, it should be as natural as the changing of the seasons that we see an increasing of health budgets every year,” he said.
“So as long as that happens, and we want to keep getting the new drugs, more effective surgical procedures and we have a growing and ageing population, it’s going to cost more every year for the foreseeable future.”
These are positive changes, he said, adding: “We need to be aware of all the costs and wider costs we need to pay, and we need to be willing to pay those costs.”
Funding is needed for changes including the move to free access to GPs and other changes which benefit individuals greatly, he said.
Dr Turner’s comments come in the wake of political controversy around this year’s health budget.
Reports of disputes between Health Minister Stephen Donnelly and Minister for Public Expenditure and Reform Paschal Donohoe have been played down by both men but many sectors were left feeling aggrieved and fearful.
HSE chief executive Bernard Gloster has also warned the budget is not adequate, and has already brought in a recruitment freeze to help tackle spiralling costs.
Dr Turner suggested creative ways to reduce costs will be needed, such as tackling the growing problem of resistance to antibiotics.
“This has consequences in terms of healthcare costs, because as antibiotics become less and less effective, more and more people are going to be sicker for longer and the second or third line treatments are quite considerably more expensive,” he said.
One approach could involve governments working with the private sector in various ways, possibly similar to how vaccines against covid-19 were developed.
Pharmaceutical companies, he said, tend to focus more on high-cost specialist drugs such as those for cystic fibrosis or certain cancers rather than antibiotics.
“We need more government investment in this, not just in Ireland but globally,” he said, pointing to a University of Oxford study which indicated 1.2m deaths directly linked to antimicrobial resistance in 2019.
Dr Turner gave the Doolin Memorial Lecture hosted by the Irish Medical Organisation at the Royal College of Surgeons Ireland in Dublin.