Tuesday, November 17, 2009

A Healthy Recovery

IT article today indicates that an additional 10,000 full medical (GMS) cards are being issued per month. I would estimate that the number of people with voluntary PHI is currently falling at a third of this rate, i.e., ~ 3,000 per month. It's worth taking stock of these numbers and the effect they will be having on service demand and quality.

All public sectors are facing considerable funding cuts next month but I would urge caution in what is done in the public health sector. It's vital to recognise that this current trend in GMS coverage when budgets and labour remain fixed means a heavier work-load for each individual public health worker. When labour is fixed and funding is falling, as is widely expected in the near future, the situation is exacerbated. We need to think carefully about what broad brush-stokes will really mean. In other public sectors we might expect an increase in demand - more people might choose to finish school, there might be an increase in theft and property crime. But public education and justice are fundamentally different; their services are both less labour-intensive and less sensitive to demand (there aren't an additional 10,000 criminals being reprimanded or school-aged kids showing up each month!). Forthcoming policy needs to consider these facts and design an appropriate response that will ensure quality of service to the patient and fair conditions for staff.

Along with considered measures it now makes increasing sense to seriously revisit the issue of average length of in-patient stay. According to the ESRI's most recent 2007 national report, GMS medical card holders were discharged after an average of 7 days; about 3 days longer than non-GMS discharges. Of course there are a number of reasons why this is the case but to date we have no evidence on the matter.

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