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Brief analytical summaries or syntheses #4

Reforming health sector resource allocation and financing in Ireland


This report from the Expert Group on Resource Allocation and Financing in the Health Sector examines how the health system can be changed to support core objectives of the health reform program. The report presents 34 recommendations grouped under seven guiding principles.


Like most other developed countries, Ireland is grappling with the challenges of providing health care for it's population at a cost it can afford. This report shows how these challenges are set in a context of:

  • a growing and aging population;
  • rising individual expectations in relation to healthcare provision;
  • rising incidence of chronic disease;
  • greater provision of first-line care in the community;
  • the need for people to be involved in the management of their own health alongside health professionals.

The response to these issues across developed countries has been to:

  • develop new integrated care models that focus on prevention and chronic disease management;
  • fund multidisciplinary care teams;
  • ensure equitable access to affordable health services.

Analysis and results

The Expert Group found that the Irish system of healthcare resource allocation is not as coherent as it could be, as there is no framework to allow decisions to be taken in an integrated way and link with the overarching goals of the healthcare system.

The Expert Group also noted that many of the reimbursement systems for providers and the payment systems for users of health care run contrary to healthcare policies. Few incentives are in place to support the provision of primary care in the community.

The Group found that the current financing system lacks transparency and contributes to serious inequalities in access to care. The system does not take users’ ability to pay into consideration and enables individuals who can afford private insurance faster access to care.

In relation to the sustainability of the healthcare system, the Group noted a potential for cost reductions. If Irish hospitals were to become as efficient as the best international norms, considerable cost savings could be made.


In terms of the stated objectives of policy, changes could be made to the current system of resource allocation in order to:

  1. promote equity and fairness;

  2. support quality of service;

  3. generate clear accountability;

  4. facilitate a greater focus on the patient.

The Expert Group concluded that the current means of resource allocation does not support policy objectives of high-quality, easily accessible and safe care that is delivered cost-effectively. The process of decision-making must become more transparent at every level and there must be greater clarity in governance. The concept of integrated care should be mainstreamed to strengthen the connection between policies and actions.

Implications and recommendations

The Expert Group issued 34 recommendations in relation to resource allocation, grouped under seven guiding principles.

Guiding principles

  1. There should be a transparent resource allocation model based on population health needs.

  2. The resource allocation model should support local implementation of national priorities based on nationally set clinical accountability and governance standards.

  3. The resource allocation model should support the delivery of safe, sustainable, cost-effective, evidence-based care in the most appropriate setting, whether public or private.

  4. The resource allocation model should promote the integration of care within and across hospital, primary and community/continuing care sectors at local level.

  5. Financial incentives should align as far as possible across all actors (including users and providers) in the system, consistent with promoting health and wellbeing and in line with nationally determined priorities.

  6. The methods of financing health care should be as effective and equitable as possible.

  7. All aspects of the healthcare system should be as sustainable as possible.

Potential barriers to implementation

  • Society
    Public support for an integrated model of care cannot be taken for granted and resistance to change must be expected.
  • Service providers
    Providers must change the way they deliver care; this may involve the professional moving to the patient rather than the patient moving to the professional.
  • Training
    Medical training must move towards a shared, integrated care model. Medical students have to be taught about the costs of interventions, drugs, etc.
  • Governance
    Governance in the health system needs to develop so that there is a clear line of accountability linking Clinical Directors in hospitals to care professionals in the primary and social care sectors. Structures within the hospital sector need to link financial and care decision-making so that managers and clinicians can work effectively together to provide safe, high-quality, cost-effective health care.
  • Institutions
    The integrated medical models involve the delivery of more care in the community rather than in hospitals. Consequently, some resistance to change can be expected from certain healthcare professionals.


Report of the Expert Group on resource allocation and financing in the health sector. Ce lien s'ouvrira dans une nouvelle fenêtre.

Gouvernement du Québec
© Gouvernement du Québec, 2018