Primary Care and Community Services
The statistics presented in this section represent a selective view of a very diverse range of services. The primary care sector includes General Practitioner (GP) care, long-stay care, community mental health and disability services, dental treatment, public health nursing, children in care, preventative services such as immunisation and food-safety inspections, and reimbursement services such as the drug payment and long term illness schemes.
The section begins by presenting a high level assessment of access to treatment for health problems. This is derived from the harmonised EU Survey on Income and Living Conditions (EU-SILC) and displays the percentages of respondents reporting an unmet need for a medical examination/health treatment classified by income quintile. In this histogram, Ireland is compared with the EU average across 5 income categories (see Figure 4.1). The picture which emerges is of significantly lower unmet need in Ireland compared with the EU as a whole. For Ireland, the fact that the second highest income quintile has the second highest level of unmet need may be a reflection of the means-tested system for medical card eligibility.
Data on the numbers of people covered by medical cards and on the so-called “demand led schemes” such as the drugs payment scheme and the long term illness scheme demonstrate both volume and population-based rate increases for the most recent years. This is in contrast with the earlier years of the decade which witnessed a declining proportion of the population eligible for a medical card. The demand led schemes have shown consistent growth with, for example, more than a 70% increase since 2000 in the numbers availing of the drugs payment scheme. The number of prescription items dispensed under the General Medical Services (GMS) is now more than 50 million items annually compared with just over 20 million in 1999 (see Figure 4.2). Between 2008 and 2009, the number of medical cards increased by over 9% to reach nearly 1.5 million, representing 33% of the population. General Practitioner visit cards increased by almost 15% to nearly 100,000 over the same period.
The ways in which health service utilisation is distributed across the various community-based services is shown in Table 4.1. These results come from a Health Module carried out by the Central Statistics Office in 2010. They show that 88% of respondents had a health consultation of some kind or other and that 74% of respondents reported at least one visit to their GP during the previous 12 months. They also generally show higher consultation rates with age, higher rates for women than men, and higher rates for medical card holders. Figure 4.2 shows GP consultation rates classified by age and medical card status.
Data on the numbers of people covered by medical cards and on the so-called “demand led schemes” such as the drugs payment scheme and the long term illness scheme demonstrate both volume and population-based rate increases for the most recent years (see Table 4.2). This is in contrast with the earlier years of the decade which witnessed a declining proportion of the population eligible for a medical card. However, numbers of medical cards and numbers availing of the drug payments scheme and the long term illness scheme have all increased by over a third over the past ten years. As a measure of both the increased utilisation and increased cost of primary care reimbursements, Figure 4.3 displays the year on year percentage increase in numbers of prescription items and the average cost per item.
Table 4.3 reports on children in care. A notable feature has been the positive trend toward higher rates of foster care provision which have increased from 77% in 2000 to 89% in 2009.
Table 4.4 summarises the results of the Long Stay Survey which covers all public, voluntary and private long stay accommodation. The most striking feature of this data, in terms of trends, is that the age distribution of residents is significantly older than 10 years ago. 47% of all residents are now over the age of 85 years compared with 39% in 2001 (see Figure 4.4). This is the continuation of a longer term trend over recent decades and reflects both significant increases in life expectancy as well as improved provision of home care supports.
Immunisation rates are set out in Table 4.5 and show significantly improved uptake rates over the period since 2001.
Data on people with a physical and/or sensory disability is set out in Table 4.6. This is based on the numbers of people registered with the National Physical and Sensory Disability Database (NPSDD) and shows a slight decline in numbers between 2009 and 2010. The registration target for the NPSDD remains at 45,000. The data show that of the 25,190 persons registered in 2010, 57% had a physical disability only; 21% had a single form of sensory disability (i.e. either hearing, visual, or primary speech and language); the remaining 22% had multiple disabilities.
People in receipt of intellectual disability services are recorded on the National Intellectual Disability Database (NIDD) (see Table 4.7). Since 2001, the numbers of persons availing of day services who are day attendees has increased by 15% and the numbers who are full time residents has decreased by 1.7%. Data are also displayed by level of disability but the figures are difficult to interpret given the relatively high proportion of cases where the level of disability has not been verified.
This section concludes with Table 4.8 on food safety. The inspection of food establishments is an important activity of the Food Safety Authority of Ireland and contributes to public health by raising national food safety standards. Data show a very marked improvement in food safety since 2001. While the numbers of premises inspected has increased by 10%, the percentage of premises displaying food safety infringements has decreased from over 55% to 20%.