The Irish healthcare system is undergoing substantial reform with a commitment to implement new Regional Health Areas and a Population-Based Resource Allocation (PBRA) by 2024. PBRA is a funding model for health planning that seeks to distribute available healthcare resources according to population need to promote efficiency and equity in both health outcomes and distribution of resources. This Spending Review contributes to the evidence required to support decision-making on the most appropriate PBRA model to implement.

Background

• Population-Based Resource Allocation (PBRA) is a funding model for health planning that seeks to distribute available healthcare resources according to population need to promote efficiency and equity in both health outcomes and distribution of resources.
• The Irish healthcare system is undergoing substantial reform with a commitment to implement new Regional Health Areas (RHAs) and a PBRA funding model by 2024.
• RHAs will be regional divisions within the Health Service Executive (HSE) with the objective of aligning hospital and community care services and promoting innovation, integrated care, efficiency, clinical and corporate governance and accountability.
• This paper builds upon the review by Johnston et al., (2021) which examined PBRAs across six countries and highlighted the importance of objectives, impacts, and outcomes.
• This work, however, focusses more on the practical nature of implementing PRBAs in an Irish context, with consideration given to methodology and data used.
• This Spending Review contributes to the evidence required to support decision-making on the most appropriate PBRA model to implement.

Methods

• This paper reviews methodological literature on PBRA formulae identified through reference mining of relevant literature. In addition, a sample of PBRA formulae are selected for investigation into how they are constructed by reviewing policy and technical documents.
• The selection of jurisdictions was based on three criteria: high-income countries, availability of documents in English, and similarities in health system funding models to Ireland.
• The selected jurisdictions are Alberta, Canada; England; New South Wales, Australia; New Zealand; Northern Ireland; and Scotland.
• Informed by the findings of the literature review, potential Irish data sources are considered, and statistical profiles of the new RHAs are presented with regard to relevant variables.

Findings

• While no two PBRA models are the same, some common variables (such as area population, age - structure, and socioeconomic status), methodology, and data used are observed.
• The CSO Census of Population and the Department of Health’s ‘Healthy Ireland’ Surveys’ were found to be the most useful and reliable data sources for the purposes of designing a PBRA in Ireland.
• The ability of Ireland to pursue a best practice approach is constrained by the lack of a fit for purpose unique health identifier and the inability to match utilisation and cost to other characteristics of people or groups (e.g., socioeconomic status).
• However, this paper provides data on the likely drivers of healthcare need in the Irish context. Work is ongoing with regard to estimating relationships between need variables and utilisation/expenditure, given data constraints, in order to inform the development of a PBRA model.