Maxwell economics professor advises the Irish on their health care system

Maxwell economics professor advises the Irish on their health care systemDecember 04, 2001Cynthia J. Moritzcjmoritz@syr.edu

When the Irish want an authority on their health care system, one of the people they turn to is an American-A. Dale Tussing, professor of economics in the Maxwell School. Tussing spoke at two conferences in Ireland this fall on how to fix the country’s two-tiered system of health care.

“There aren’t very many health economists in Ireland,” Tussing says, “so if they want that perspective, they must go outside the country.” His expertise in the Irish system comes from making numerous trips to Ireland since the 1970s and living there in the ’70s and ’80s. He was research professor of economics at the Economic and Social Research Institute in Dublin in 1975-76 and 1979-81. While living in Ireland he published journal articles about financing both the health care and education systems there.

One conference Tussing spoke at this fall was the annual general meeting of the Irish Pharmaceutical Health Association. The other was entitled “The Great Health Debate,” and was sponsored by the Adelaide Hospital Society. Other speakers included Liz McManus and Maev-Ann Wren, the two women who are largely responsible for the currrent health-care debate. Two years ago McManus, the Irish Labour Party spokesperson on health, issued a document about reforming the health care system, which she had asked Tussing to review. Wren wrote a series of articles for The Irish Times, “An Unhealthy State,” in which she analyzed the crisis in the Irish health care system. Tussing’s keynote speech was called “Confronting the Hard Issues: The Way Forward to Reform.”

Tussing sees two major problems with the Irish health care system. First is its hybrid nature, in which tax money goes to subsidize care to which everyone is entitled but many people buy private insurance. Private patients often get more prompt care and access to the top specialists because while physicians earn a salary for treating public patients, they get a fee per patient on top of that for private patients. Tussing says doctors should be paid in the same way for every patient, thus eliminating the incentive to give different levels of care to the two groups.

A second problem is lack of modernization in general practitioners’ practices. While Irish doctors receive a good education and are skilled, half of the GPs are in solo practices without clerical or nursing help, which means they must everything themselves, including taking temperatures, giving shots and keep records. Many don’t have computers, and so are not in close touch with other physicians. This leads to a high rate of referrals to specialists because GPs are unsure of their diagnoses. After making such a referral, the GP usually doesn’t hear the result. Tussing would like to see many more group GP practices created, along with getting doctors in touch with district nurses and nurse-midwives.

Tussing believes there will be reform in the Irish health care system, but is not sure whether it will be fundamental or cosmetic. The government recently announced a large increase in health-care spending, but didn’t say what it would be used for. Tussing predicts health care will be a big issue in the next national election, which will probably be held in the spring.

While he maintains his interest in the Irish health care system, Tussing has gone on to other areas of study. Currently, his research is focused on the economic aspects of Caesarean sections, exploring the non-medical factors that play a role in determining whether a woman gives birth through C-section.