Is Ireland’s diagnostics scheme a good model for queue-busting?
Queues for accessing publicly-funded health care are a feature of almost every country that has an NHS system. In most of these countries they have worsened since Covid. There is one very notable exception to this.
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Before 2021, the Republic of Ireland had some of the longest waiting times in the world for access to diagnostics. Those without PMI (the poorer half of the country) would sometimes have to wait four years to access imaging services in public hospitals. Many would end up going to A&E just to get a scan.
But then in 2021 the HSE (Ireland’s NHS) introduced a new scheme called ‘GP Access to Community Diagnostics’, under which anyone could be referred directly to private outpatient imaging providers by their GP. This opened up the private outpatient imaging sector to the poorer half of the country (those without PMI), who previously would have had to pay out of pocket to access it.
All three of Ireland’s major private imaging providers – Alliance Medical, Affidea and Medica Ireland – are involved in the scheme. Caroline Byrne, managing director at Medica Ireland, tells us: “It wasn’t hugely publicised to say ‘free scans for everybody’. But obviously all GPs were informed. There wasn’t a massive stampede. In 2021 138,000 scans were provided under the scheme, and this did grow to 253k in 2022, so awareness did get out.”
The scheme seems to have been a success. An academic study released in June 2023 stated: “GPs reported that the initiative had led to a large proportion of cases being managed solely in general practice, with an 81% reduction in referrals to acute hospital settings and a 58% reduction in referrals to secondary care clinics. GPs felt imaging studies improved patient care in 86% of cases, but increased GP workload in 58% of cases.
“GPs felt enhancing access to diagnostics improved patient care by expediting diagnosis, decision-making, and treatment and by reducing hospital referrals.”
Byrne tells us that MRI would have been the big driver, since that is the modality which had the longest waiting lists. She also says that there’s still a bit of work to be done on the efficacy of the initiative.
One slightly negative side effect was that waiting times for outpatient sector imaging did increase a bit – but only from three weeks to four weeks.
While the increase in GP workload may require some remedying, overall it seems this is a win-win, for both the public system and private providers. Other NHS countries introducing their own schemes to improve access to diagnostics, such as the UK, could learn a lot from this.
We would welcome your thoughts on this story. Email your views to Martin De Benito Gellner or call 0207 183 3779.
