Suchergebnisse

We considered two basic questions, 'Is it possible to implement Social Health Insurance in Ireland?', and 'How can this be done?'. Can Social Health Insurance be implemented in Ireland? Our answer is a very definite yes. Furthermore, there would be many opportunities, while working towards this end, to improve the performance of our health care system. How can it be implemented? This process will need to be actively managed. There are many difficulties in the Irish health services, but also many opportunities. The greatest strengths are the talented, well-trained and very committed staff. Getting and keeping the support of these staff, for the necessary changes in service delivery, will be critical. Ireland has the capacity to make these changes, but without high quality management, a detailed focussed plan for change, and political support, little will happen. Each step in the change needs to be planned to maintain services, improve service delivery, improve service accountability, and improve service governance. Each sector of the service will need someone to lead the change, and mind that service during the change. Primary care remains under-developed. The HSE plan to develop primary care teams (PCT) has not succeeded. There are several established PCTs which work well. In other areas there are informal arrangements for collaboration, which work well. Overall, there are many useful lessons to learn from the experience so far. Future developments will need to place general practice at the centre of primary care. The mechanisms for doing this will vary from place to place, but need to be developed urgently. Acute hospitals face a crisis of governance. Maurice Hayes' (1) recent report on Tallaght hospital gives an idea of the scale of the changes needed. Tallaght is, we believe, not atypical, and is reputed to be by no means the worst governed hospital in the system. This, alone, should provide a pressing motive for change. Redesigning Irish hospitals to a new mission of supporting primary care, of supporting ...

Countries with social health insurance (SHI) systems display some common defining characteristics - pluralism of actors and strong medical associations - that, in dealing with crisis times, may allow for common learnings. This paper analyses health system responses during the COVID-19 pandemic in eight countries representative of SHI systems in Europe (Austria, Belgium, France, Germany, Luxembourg, the Netherlands, Slovenia and Switzerland). Data collection and analysis builds on the methodology and content in the COVID-19 Health System Response Monitor (HSRM) up to November 2020. We find that SHI funds were, in general, neither foreseen as major stakeholders in crisis management, nor were they represented in crisis management teams. Further, responsibilities in some countries shifted from SHI funds to federal governments. The overall organisation and governance of SHI systems shaped how countries responded to the challenges of the pandemic. For instance, coordinated ambulatory care often helped avoid overburdening hospitals. Decentralisation among local authorities may however represent challenges with the coordination of policies, i.e. coordination costs. At the same time, bottom-up self-organisation of ambulatory care providers is supported by decentralised structures. Providers also increasingly used teleconsultations, which may remain part of standard practice. It is recommended to involve SHI funds actively in crisis management and in preparing for future crisis to increase health system resilience.