Projected private hospital expenditure in Ireland, 2018–2035: What role for demographics, cost, and Sláintecare?

Abstract

Despite private hospitals occupying an important role in the delivery of acute hospital care in Ireland, an understanding of future spending pressures on these services is limited.Particularly, a key dimension of Ireland's ambitious roadmap for healthcare reform (Sláintecare) seeks to remove private practice from public hospitals. However, to date, there has been no examination of how this reform could impact private hospital demand and expenditure, and ultimately, the capacity to treat public patients. Using previously unavailable administrative health insurer data and a healthcare macro-simulation projection model, we project real (volume-based) and nominal expenditure on private hospital services over the medium-term (2018-2035). We develop a number of projection scenarios that vary assumptions in relation to population growth and ageing, healthy ageing, and the future cost of care delivery. Additionally, by developing profiles of private activity in public hospitals, we examine how the removal of private practice from public hospitals could impact on demand and expenditure in private hospitals over time.Findings from this analysis have implications for capital investment and workforce planning in private hospitals, and failure to meet future demand could have implications for access to care in public hospitals. Moreover, should private practice be ended in public hospitals, most complex private in-patient and emergency care is likely to remain within the public hospitals with limited capacity benefits for the public system.

The National Development Plan in 2023: priorities and capacity

“…The authors further note that most private patients in public hospital under the current system would likely become public patients under the proposed reform. Later work found that an increase in activity in private hospitals arising from the removal of private activity from public hospitals would have implications for capital investment and workforce requirements in private hospitals (Keegan et al, 2021). If the private hospital system fails to increase supply along with demand this could have implications for the public hospital system; for example, the National Treatment Purchase Fund purchases spare capacity in the private hospital system to treat people who have been on the public waiting lists for a long time.…”