Kieran Murphy, MSc Digital Health, BSc Nursing, discusses Ireland’s lack of access to preventative care, calling for action from policy makers.
Ireland is seen as having an ideal eco-system to capitalize on the digital health market due to its strong base in medical technologies, ICT, pharmaceuticals, bio-pharmaceutical/ technology, high caliber universities and the graduates they produce.
The COVID-19 pandemic highlighted the severe deficiencies within the Irish healthcare system, but it also demonstrated and purely acted as the catalyst for the rapid introduction of many new health technology solutions. But how do we continue to triumph to meet the healthcare challenges of the post-pandemic era and capitalize on the populations’ digital leapfrogging development?
Ireland’s population is growing, with the most significant growth in the older age groups. An aging society living longer with increased health conditions will put more strain on a heavily burdened healthcare system.
It is estimated that by 2024, Ireland will have a total population of 943,000 over the age of 50 that will be affected by a chronic condition of one or more.
This will have a significant impact on services in the acute sector, with readmissions to hospitals and increased emergency department visits certain.
The impact on health service utilization is particularly evident in the acute sector, with chronic diseases accounting for 40% of admissions and 75% of bed days. An ageing population, with high levels of risk factors for chronic disease, presents a challenging future for the healthcare services in Ireland.
During the pandemic, many private companies answered Ireland’s call and deployed remote monitoring solutions for patients to clear the emergency departments and wards, so the hospital’s resources could be realigned, with the impending waves of patients needing to be centralized and closely monitored.
The rapid adoption of these innovations demonstrates what the healthcare system is capable of implementing in a short time.
Within the Irish homecare market, many clients are suffering from chronic conditions and would benefit from remote monitoring and digital health technologies. Most home support in Ireland is provided by private providers.
Private homecare company, Connected Health, has taken inspiration from the Irish government’s ‘Sláintecare’ reforms, as well as the Health Service Executive (HSE) digital transformation teams’ ‘Stay Left, Shift Left’ strategy to utilize increased digital technology within the broader healthcare sector and have invested in healthcare innovations that will improve patient outcomes, keep them well and keep them at home.
The HSE must be commended in their efforts to transform healthcare but assistance is now needed from the policy makers to amend and update current policies to assist with the transformation to unleash its true capabilities.
Connected Health believes that updating these policies and creating new ways of paying and reimbursement will make healthcare more accessible to all. They also believe that by removing these roadblocks, it will pave the way to achieve a main aim of the HSE’s digital transformation strategy, to make Ireland a Digital Health leader in Europe by 2025.
Irish Healthcare initiatives to go from digital laggard to digital leader
The HSE is changing the way healthcare is being delivered in Ireland and has recognised and undertaken complex projects to implement critical infrastructure that will be crucial to its success, such as the national electronic health record and unique health identifier projects. The Government has also realised the need for change and in 2017 published “The Sláintecare report” by the Oireachtas Committee on the Future of Healthcare in Ireland.
It is aimed to reform and transform how we deliver healthcare in Ireland and abolish the current two-tier, public/ private system, building towards equal access to services for every citizen based on patient need and not their ability to pay. By putting people at the centre of the health system and developing primary and community health services, the Department of Health and HSE are working together to provide new models of care that allow people to stay healthy in their homes and communities for as long as possible. The aim is to deliver the Sláintecare vision of one universal health service for all, providing the right care, in the right place, at the right time. The current plans of Sláintecare are focusing on prevention and shifting care from acute hospitals into the community and closer to people’s homes and has led to the HSE strategy “stay left, shift left”.
‘Stay left, Shift left’
The strategy is based on partnering with innovative companies, universities and individuals to utilise the power of digital applications, data and technology, in order to improve quality of life and quality of care, while reducing the cost of care. The concept of ‘Stay Left’ is to use technology to keep people well in their homes, and allow people with chronic conditions to manage themselves in the best way possible at home. ‘Shift left’ is about finding technologies that help people move as quickly as possible from the acute setting to a community setting and finally, to a home setting.
Tax Reliefs and Reimbursement
There are many tax reliefs, incentives and reimbursement options when choosing to follow the “traditional model” of care in Ireland as briefly outlined in following paragraphs and table below. Clients and their families can avail of the following schemes to make care more affordable:
Within the public system, a citizen will still have to pay for healthcare unless they have a medical card, meaning certain health services will be free of charge. Medical cards are given to individuals who have an income below a certain level or who have a long-term illness and is means tested.
Employ a Carer “HK1 Form”
For those looking to stay at home but require a carer for extra assistance can seek an allowance to pay for a carer. Clients can fill out a HK1 form where the payer can receive 20-40% tax relief depending on their income or the income of the person paying the bill.
People looking for nursing home care can avail of the Government Nursing Home Support Scheme called the Fair Deal. The Fair Deal scheme offers financial support to people who need long term nursing home care. This scheme is operated by the Health Service Executive (HSE). Based on a financial assessment, the client will contribute to the weekly cost of care and the HSE will pay the balance. However, the amount that the client pays will vary from person to person.
Private funding means that an individual covers the full cost of nursing home care without any public assistance. The client can claim tax relief on Nursing Home fees paid. This can be claimed at their highest rate of tax. The amount of relief can be claimed at 20 – 40%, depending on the amount of income tax paid by the payer.
|Medical card||N/A||State pays|
|Employing a carer “HK1”||20 – 40%||Maximum € 75,000|
|Fair Deal||20 – 40 % return on balance paid by client||Financial means test|
|Private funding||20 – 40%|
Age is a significant driver of service utilization within the acute sector in Ireland with individuals aged 65 years and over accounting for the vast majority of overnight hospital stays. The over-reliance on the provision of hospital-based care, is unsustainable and we need to continue to progress the aim of shifting care to the community.
The use of technology to move people as quickly as possible to a community or home setting is a space that needs careful consideration but is essential to transform the traditional healthcare model.
In Ireland at present, companies who have viable solutions to assist with the concept of treating people in their homes need assistance from the government and policy makers to assist with reimbursement pathways in order to focus on the stakeholders to adopting their solutions to truly disrupt the home and healthcare sector.
Reimbursement and funding is a major obstacle to digital health transformation and adoption and will need to be addressed by Government to make Ireland a real digital health leader by 2025.