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Neither area was deemed appropriate to be initially funded through the prospective funding model, which was detailed in Money Follows the Patient: Policy Paper on Hospital Financing, published in 2013.
Regarding emergency services, the paper said this was because these services differ fundamentally from inpatient and day case services. It stated that emergency services are, by their nature, something which must be maintained at a certain level, regardless of actual demand. Funding outpatients through ABF was also thought to be too complex. However, it was suggested that both matters would be kept under review.
“The policy paper stated that emergency departments were going to stay on the block grant,” Ms Maureen Cronin, HSE Assistant Chief Financial Officer (ACFO), told MI.
“And I have asked the Department to change that. We will move in time to outpatients and emergency, because to leave emergency in the block was going to be such a disincentive and so wrong. For example, one of the early challenges you have in an ABF system is, it incentivises hospital admission because they get paid for an inpatient and a day case. Now an awful lot of our clinical effort is to avoid hospital admission. We want hospital avoidance.”
Ms Cronin said she recently met with Clinical Lead of the National Clinical Programme for Emergency Medicine Dr Gerry McCarthy, who expressed concern about the issue. Dr McCarthy asked if hospitals could be disadvantaged if emergency medicine consultants and their teams did not admit patients.
“What I will say is that this system is early [in development]; there are lots of issues and problems to be resolved yet,” outlined Ms Cronin. She stressed that all would done to ensure that the system would not prioritise patients who are more commercially attractive, which is one of the inherent risks within an ABF system.
From 2016, hospital budgets have been separated into ABF and non-ABF (eg, pay costs) for the first time, with agreed ABF activity targets and fixed ABF budgets for inpatient and day case work, and transition payments to maintain financial stability.
See feature, pages 4-5