A rational solution to ballooning healthcare budgets has been talked about for 10 years

Sir, – In disputes pitting the leaders in our Government and healthcare system at odds with each other, two things seem clear. One is that everyone would rather see the problems solved, and the other is that real data can be cited to support either viewpoint.

This leads to an argumentative stalemate. If no one is shown to be “wrong”, no one will change their mind. A new approach is needed, and oddly it is one that has been proposed and anticipated for more than a decade.

A transition to a money-follows-the patient system of funding is surely long overdue. At present the incentives of taxpayers and healthcare providers are completely misaligned.

The State effectively grants a (very large, apparently) sum of money to a hospital as an annual budget. Arguably, then, the less work that gets done over that year, the better the hospital’s ultimate financial position will be.

A shift to a culture whereby each case or admission is reimbursed at a defined rate provides the opposite motivation. As a year ends, rather then slowing down as funds deplete, healthcarers would ramp up work to maximise that year’s revenue. This seems indisputably rational.

The big difficulty is in defining rates for each case. However, the private fees of the large insurers provide a platform to start that process. Artificial intelligence could help greatly.

In practical terms, a plan to allocate, say, 10 per cent of each hospital’s budget on this basis in 2028 could be followed by an increase of a further 10 per cent annually for five to six years.

My instinct is that, as many costs are fixed and incurred early – insurance, for example – a full transition would be unwise. But perhaps the present stand-off between those at the very top of the €30 billion system tells us that the time has come to try something different on this scale.

It would at least be impossible to have a situation where funding was consumed with no evident improvement in performance. – Yours, etc,

BRIAN O’BRIEN,

Kinsale,

Co Cork.