Peter Mathews (Dublin South, Independent) | Oireachtas source

I welcome the opportunity to continue to outline some of my thoughts. The HSE's Vote is moving into the Department of Health. It is extremely important that the financial measurement of what goes on in the health service and the delivery of the health needs of patients in all hospitals is done in a way that allows the activities of delivering the service to be costed. To date, it has been a bland form of budgeting with dollops of finance allocated to hospitals and so on. We have not had an activities measurement that can be applied consistently and uniformly across all units in the service. This would be extremely important in advance of the introduction of a universal health insurance system regardless of whether that system is to be a multi-insurance provider or a sole State provider.

At this stage it would be important for the Government and its advisers to revisit the overall concept of universal health insurance to see where the shortcomings are in other systems such as the Dutch model and so on. The United States also has multi-insurance participation, supposedly to provide competition that would produce cost efficiencies. However, that can also lead to over-delivery and over-costing of that delivery into a system of profit-based delivery taking away from the essence which should be patient and needs focused.

The framework for the accounting and financial measurement systems should be activities based. In other words those elements that go into delivering good health management at HSE locations should be properly set up on an integrated computer system to allow for budgeting, historical measurement and the comparison of activity-based accounting budgets with outcomes. It should be done in a way that makes sense and needs to be flexible enough to take account of different systems of delivery as they are developed.

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