Impact of Policy on Primary Healthcare in Ireland - Case Study Example

Impact of policy on primary healthcare in Ireland Did ten years of health policy expressed as health strategy improve primary healthcare in Ireland?Ireland’s health system is hybrid system that combines elements of the United States’ private system and the United Kingdom’s public system (Rebele 2004, p. 1). According to Rebele (2004), all citizens are eligible to basic health care under Ireland’s health system regardless of ability to pay. During the past 10 years, three policy documents guided health care in Ireland: the strategic health plan for the period 2000 to 2005, period 2005 to 2007, and period 2008 to 2010. Let us assess the impact of policy on the delivery of primary healthcare. . 2000 to 2005. In Ireland’s health strategy for 2000 to 2005, the strategy articulated is that the strategic aims and objectives of the 2000 to 2005 health strategy has been guided by the five principles of the Ottawa Charter (Department of Health and Children 2000, p. 38). The Ottawa Charter refers to the agreements achieved in 1986 during the World Health Organization’s first international conference on health promotion held in Ottawa, Canada. The Ottawa Charter called for action on five areas: building healthy public policy, reorienting health services, creating supportive environments, strengthening community action, and developing personal skills (Department of Health and Children 2000, p. 11). In implementing the principles of the Ottawa charter, the Ireland’s Department of Health and Children defined that the priority aims of the 2000-2005 health strategy (2000, p. 11) cover the empowerment of communities to take control and improve their health collectively. 2005-2007. In the health strategy for 2005-2007, the priority mission articulated was to enhance health and well-being through the placement of health as the centre of government policy and the promotion of a “whole of government” approach to health (Department of Health and Children 2005, p. 7). It is not clear why the strategy for 2005-2007 involved a fewer number of years compared to the strategy document for the period 2000-2005. Further, it is also not clear why the mission statement seems too general and too broad such that the articulated statement of mission for the specific period is valid for all times, thereby useless in guiding the direction of work of health service professionals for the specific period. The 2005-2007 health strategy defined that the key health priorities were those related to the organizational and systems streamlining of government units and tasks related to health (Department of Health and Children 2005, p. 13). In other words, the key priorities of the 2005-2007 health strategy are those related to improving the systems of the Department and improving the ways through which the Department can address better Ireland’s health concerns. The health mission statements for 2005-2007 focused on strengthening organizational structures and legal/accountability frameworks, ensuring health care quality, and providing policy and legal frameworks. 2008-2010. Ireland’s health strategy for 2008 to 2010 defined the mission of the Department of Health and Children as that of improving the health and well-being of the people in Ireland “in a manner that promotes better health for everyone, fair access, responsive and appropriate care delivery, and high performance” (Department of Health and Children 2008, p. 6). The health strategy document for 2008 to 2010 defined its “high level objectives” as focused on primary health care or the provision of “broad spectrum of integrated, locally-based, and accessible services (Department of Health 2008, p. 7). The articulation of high level objectives in the health strategy are very significant because the articulation identifies what the health priorities of Ireland are and makes Ireland’s health strategies better directed compared to the 2000-2005 health strategy in which priorities have not been adequately articulated relative to the Ottawa charter. According to McAuliffe and Vaerenbergh (2006, p. 1), guiding the changes in the strategies adopted by the Irish health system were changes in the planning and system models, the approach adopted to make the changes, and the tools adopted to assess capacity and development of action. Further, the inputs from partners (McAuliffe and Vaerenbergh 2006, p. 7) were also instrumental in modifying the approaches and strategies adopted for advancing health services in Ireland. Citing international agreements on definitions based on the Alma-Ata Declaration of 1978, World Health Organization (1998, p. 3) defined primary health care as the provision of health care “made accessible at a cost a country and community can afford, with methods that are practical, scientifically sound and socially accessible”. According to the World Health Organization (1998, p. 3), the Alma-Declaration emphasized “everyone should have access to primary health care and everyone should be involved in it”. Further, according to the World Health Organization (1998, p. 3), the primary health care approach consists of five key elements: equity, community involvement, intersectorality, appropriateness of technology and affordable costs”. Based on this definition of primary health care of the World Health Organization, we assess primary health care in Ireland based primarily on citizen’s access to health services and equity or equality of access to such health services. Sinn Fein, an advocacy group based in Dublin, complained that Ireland’s health services are very far from providing equal access to health in Ireland (2006, p. 2-5). Towards addressing equal access to health in Ireland, the Sinn Fein advocacy group recommended the following proposals (Sinn Fein 2006, p. 3-6): 1. Universal medical care for all under-18s as a transitional measure towards a fully-universal access to health; 2. Establishment of primary care centres on an accelerated basis; 3. Implementation of enhanced provision of essential nursing home beds, community care facilities, and home care. 4. Provision of primary health care services on an all-Ireland basis. 5. Legislation of statutory rights to equality in health care. 6. Establishment of a fully resourced Child and Adolescent mental health services throughout Ireland. The proposals may be worth looking into. In addition, the Public Health Alliance (2007, p. 4-5) supports or complements the perspective taken by the Sinn Fein proposal. Addressing the Sinn Fein proposals is a problem because Ireland only spends 8.7% of its GDP on health, a figure that is lower among the OECD countries compared to the US spending of 16% and Switzerland’s 10.7%. Yet, Ireland has 3.2 physicians per 1,000 people, a figure that is higher than Australia, United States, United Kingdom and Canada (OECD 2010, p. 2). One way of interpreting the data is that it can be argued that Ireland has been managing its health sector efficiently because it is able to have a higher number of physicians relative to its population considering that it spending a low percentage of its budget on health services. Of course, it can also be viably argued that Ireland is not focusing on health services enough because only a low percentage of its GDP is spent on health services. Ireland has more physicians per population compared to the United States who has been keen on privatisation as a strategy for better health (OECD 2010, p. 2). The Irish government has provided a new funding of Euro 52 million for primary health care since 2002 but this may not be substantial as total health funding remains small compared to the other OECD countries. (Department of Health and Children 2010). These indicate that Ireland could do more so its citizens can have greater access to health services. With regard to equality in access to health services, the Public Health Alliance (2007, p. 4-5) revealed that mortality rates in the lowest occupational class of Ireland are 100-200% higher than the rates in the highest occupational class. Assuming that all the data of the Public Health Alliance is correct, the data indicate that primary health care in Ireland have to be improved as equality of access is one of the core values of primary health care (World Health Organization, 1998, p. 3). A possible explanation to the situation why access to health services continues to be unequal in Ireland is that mechanisms are lacking to involve communities deeper in planning for the delivery of primary care services (Harvey 2007, p. 16). “Community involvement” is one important key element of what the World Health Organization considers as primary health care (1998, p. 3). Harvey also complained (2007, p. 9) that the earlier focus on health prevention, health promotion and social responsibility probably led to a situation where people spent less time in hospitals leading to the closure of hospitals and decommissioning of hospital beds. This matter must be investigated further as it is ridiculous because primary care is never intended to lead to the closure of tertiary hospitals nor to the decommissioning of hospital beds. Thus, assessing the impact of Ireland’s health care policy focused on primary health care would require more data than what are immediately available from the government archives. However, we have adequate indications that allow us to say that health access in Ireland has been unequal and relatively inaccessible to the poor and even across sectors. This implies that primary healthcare in Ireland is weak in terms of access and equity, two important principles in primary health care. The primary health care system is Ireland also is also devoid of intersectorality because not all sectors have adequate access to health services. Unfortunately, we do not have adequate data to confirm that a number of people in Ireland cannot afford health services and the technologies for healthcare deliveries are “appropriate”. As mentioned, appropriateness of health technology is also one of the criteria for a good primary health care (World Health Organization 1998, p. 3). So far, we have discussed the negative aspects of Ireland’s primary health care services. We must know, however, that Ireland’s primary health care have something to be proud. In 2000, life expectancy at birth in Ireland was 67.5 years old for males and 71.7 years old for females (WHO 2000, p. 176). From that time, life expectancy in Ireland improved to 78 years old for males and 82 years old for females in 2008 (WHO 2010, p. 50). Thus, from a “global” viewpoint, health in Ireland improved such that Irish citizens today have life expectancies 10 year longer than those in 2000. This figure is an important proof that not all is bad in Ireland’s primary health care as all citizens have fundamental access to longer lives which is a main result of Ireland’s primary health care system. In conclusion, Irish health policy has evolved significantly during the last ten years but available data indicate that the Irish primary healthcare has continued to be both inadequate and unequal even with the significant improvement in life expectancies that can be assumed to have resulted from policy. A more comprehensive assessment of health policy or strategies must take place to identify the specific factors responsible for the failure of policy to produce results consistent with avowed goals, particularly with regard to equality of access to health even with significantly improving life expectancies. Meanwhile, as a middle class person accessing health services in the country, my experience largely involve middle-class experiences. I am contented with Ireland’s health services and I am unable to empathize adequately with those who may be left out in Ireland’s health service system. From my vantage point, what I can see is that the health service system must just have to improve its service access systems. For example, this can take the form increasing health services to areas and sectors believed to be disadvantaged in Ireland society. Reference List Barry, J., Darker, C., Thomas, D., Allwright, S., and O’Dowd, T., 2010. Primary medical care in Irish prisons. BMC Health Services Research, 10 (74), 1-6. Department of Health and Children, 2000. The National Health Promotion Strategy 2000-2005. Government of Ireland: Department of Health Children. Department of Health and Children, 2005. Statement of Strategy, 2005-2007. Government of Ireland: Department of Health and Children. Department of Health and Children, 2005. Statement of Strategy, 2008-2010. Government of Ireland: Department of Health and Children. 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