Ireland has published the first examination of the factors affecting patients getting onto public hospital waiting lists and getting off waiting lists.

It says that the public hospital system here prioritises access to specialised care, based on need and not on ability to pay and because of this, waiting lists exist.

Not surprisingly, waiting lists for planned surgery rise, when the number of patients referred for specialist consultation or treatment, is greater than the number of patients treated and removed from the list.

That is basic maths.

The study from the Department of Health says that it is not easy to compare countries with each other but it does make an attempt.

What it finds is very interesting – Ireland does not have factors which cause high demand and a large number of patients needing to get onto waiting lists, compared with other countries.

What it means is that Ireland has a relatively young population, with a low amount of people with chronic conditions.

So we should not have such terrible waiting lists.

It warns that one factor which may be bigger in the future is the growing number of people aged 65 years and older.

The study says that getting people off waiting lists and out the other side is a problem in Ireland.

This is because we have one of the lowest levels of acute hospital beds, based on our population, well below the EU22 average.

Also, we have a much lower number of doctors working in hospitals and a lower share of surgeries done on a day basis.

The availability of high tech equipment, like CT scanners, MRI units and PET scanners is also a factor.

In this study, Ireland has below the average, for each of these high tech pieces of equipment, in the 22 EU countries we were compared with.

The bottom line then from this study is that the age and health profile of the Irish population should not really be leading to such large waiting lists.

But the system is heavily constrained, due to a shortage of beds and specialists and important diagnostic equipment, compared to other European countries.

• Waiting lists for elective care increase when the number of patients referred for specialist consultation/treatment (the inflow) is greater than the number of patients assessed or treated and removed from the list (the outflow).
• The determinants of the inflow to a waiting list for elective care (i.e., demand for care) within any country are health status, medical technology, severity thresholds and user cost sharing.
• The determinants of the outflow from a waiting list for elective care (i.e., supply of care) within any health system are public capacity, private capacity, productivity, and provider payment mechanisms.
• It would be desirable to be able to compare the relative size of inflows onto and outflows from waiting list in Ireland to that of other countries. However, readily available collated data on inflows onto and outflows from hospital waiting lists for OECD countries is not available. International Comparison of Determinants of Inflows and Outflows
• It is important to note that there are limitations to making international comparisons across countries due to data on health systems varying in definitions and/or data collection methods, and variation in the structure of health systems.
• A review of relevant inflow determinant indicators for 2019 suggests that Ireland does not have high demand drivers to generate inflows onto waiting lists relative to average EU/ OECD countries. Notably, Ireland’s population is relatively young and has a low share with chronic conditions. However, high annual rates of growth in the 65+ population suggests Ireland might have relatively high rates of growth in inflows.
• A review of relevant outflow determinant indicators for 2019 suggests that Ireland is unlikely to have high outflows relative to population. Ireland’s stock of acute care beds per 1,000 (2.7) is in the 2nd lowest quintile 1, below the OECD average (3.5) and the EU22 average (3.6). Ireland’s physicians working in hospitals per 1,000 (1.8) is in the 2nd lowest quintile, below the OECD average (2.1) and the EU22 average (2.2).
• Ireland has a mixed performance on gauges of productivity as proxied by hospital discharges per hospital doctor, the share of certain surgeries performed as day cases, and for avoidable hospital admissions.