Dr. Conor Keegan:

Thank you, Chairman.

I would like to thank the committee for the opportunity to present on our research. I am here in my capacity as a research officer at the ESRI. I am an economist by training and I am a PhD in the area of in the area of health economics. I am the lead author of the ESRI working paper, An Examination of Activity in Public and Private Hospitals in Ireland 2015, which was published last October and which the Joint Committee on Health has invited me to discuss. The analysis was undertaken as part of the ESRI-Department of Health research programme in healthcare reform, which has the broader objective of projecting demand for and expenditure on healthcare services in Ireland. The working paper was prepared in light of the independent review group's work examining the implications of the Sláintecare proposal to remove private practice from public hospitals.

While the ESRI did not provide any direct input to the deliberations of the review group, the working paper was subsequently cited as part of the review group's final published report in August 2019. The ESRI working paper examines the extent of private activity in public hospitals and provides an overview of service delivery across public and private hospitals in Ireland in 2015. The analysis expands on research undertaken and findings presented as part of the ESRI research series report, Projections of Demand for Health Care in Ireland 2015-2030, the first report from the Hippocrates Model published in October 2017. The report contained new analysis of private hospital activity, which had not been previously published for the Irish healthcare system. The working paper expands on that analysis by examining the extent to which care in public hospitals was delivered on a public or private basis.

In 2015, nearly 1.5 million day patients, those admitted and discharged on the same day for elective, that is, scheduled treatment, and nearly 4.2 million inpatient bed days relating to either elective or emergency care were recorded across the public and private hospital system in Ireland. The public hospital system delivered the majority of this care.

In 2015, approximately seven out of ten day patient cases, and more than eight out of 10 inpatient bed days were estimated to have taken place in public hospitals. Some 16% of cases in public hospitals were treated privately.

Looking at private care across the hospital system, more than 75% of all private day patient activity was recorded in private hospitals. In contrast, we estimate that less than half of all private inpatient bed days were recorded in private hospitals. These findings suggest that the private hospital system is primarily specialised in the delivery of elective care, with all day patient care being elective by definition.

In considering the removal of private care from public hospitals, it is important to note that most private inpatient activity in public hospitals are emergency inpatients arriving through hospital emergency departments. Elective private inpatient activity accounts for less than 4% of total inpatient bed days in public hospitals in 2015.

It is unclear, therefore, whether the types of private emergency inpatients currently treated in public hospitals could access the care they require in private hospitals. Traditionally private hospitals have not provided many of the more urgent and complex treatments associated with emergency care that are available in public hospitals. Data on public and private activity in public hospitals were available from the hospital inpatient enquiry, HIPE, scheme managed by the healthcare pricing office. HIPE collects detailed clinical and administrative data on discharges from and deaths in acute public hospitals nationally. However, we did not have access to comparable routinely collected administrative data on private hospital activity.

To try to fill this gap, private hospital activity profiles were estimated using aggregate information on health insurance claims provided by the health insurance market regulator, the Health Insurance Authority. We would have liked to extend this analysis further, for example, to compare public and private activity at the level of diagnoses and procedures or to compare the roles of the two types of hospitals with respect to elect and emergency inpatient care. Data limitations meant this depth of analysis was not possible. The absence of good quality data creates difficulty for both researchers and policy makers to inform important policy proposals, such as the one being discussed this morning, with evidence.

The full working paper has been circulated to the committee and is available on the ESRI website.