Financing healthcare systems

Providing services for people with dementia is costly and governments in both NI and ROI are faced with questions about how best to use limited resources in ways that are equitable and cost-effective to finance healthcare systems and support people with dementia and their family carers. Alzheimer associations have been at the forefront of debates on the financing of healthcare systems, and a number of their publications are included below. This section also includes an economic analysis of the cost of care for people with dementia on the boundary between home care and residential care within the HSE & Genio Dementia Programme, and a paper documenting the results of a national survey undertaken by the Dementia Services and Information Development Centre (DSIDC) to gather information on specialist care units for people with dementia.

The £20 Billion Question - an inquiry into improving lives through cost effective dementia services

Sharp, S., Saunders, T., O’Brien, N.
All Party Parliamentary Group

This report commissioned by the Alzheimer’s Society (UK) begins by setting the scene for provision of services in a challenging financial climate, making reference to the reduction in NI’s central funding and the likely impact on community care.

The report makes nine recommendations highlighting the need for: better collaboration and integration across dementia care and support systems; sharing expertise between different sectors; early intervention; improved co-ordination, increased use of key workers; better access to training; an increase in rates of diagnosis; better support for carers; sharing of best practice.

The Dementia Tax

Alzheimer’s Society
Alzheimer’s Society (UK)

This report was produced by the Alzheimer’s Society (UK) to inform the debate on the funding of care and support for people with dementia.

The report, which follows the Society’s first Dementia Tax report (2008), suggests that people with dementia face the highest costs of care of any group and have to pay the most towards their care to the extent that the authors consider this a ‘Dementia Tax.’ Almost 4,000 people either living with dementia (411) or caring for someone with dementia were surveyed (1% of this population resided in NI). The report primarily focuses on England but has influenced policy development in Wales and NI. Key indicators of a better funding and charging system of care are suggested: people with dementia living at home for longer with better social contact; less people going into hospital and shorter hospital stays; more choice in relation to care at home and in formal care environments; the provision of specialist dementia care in care homes. The report also calls on the government to ensure an open public debate is held on the Dilnot Report (2011), with greater clarity and scrutiny of this report, recognition of the contribution of families to providing care, changes to care regulation, and creating better systems to reward and retain care staff. 

Getting Personal? Making Personal Budgets Work

Lakey, L., Saunders, T.
Alzheimer’s Society (UK)

This report from the Alzheimer’s Society (UK) focuses on the use of personal budgets to meet the government’s personalisation agenda.

It suggests personal budgets offer many benefits for people with dementia and carers but that they are not suitable for everyone, so that other options must be available. Considerable burden was associated with accessing and using direct payments, and attitudes and understandings of health and social care professionals were identified as a barrier. There is a limited market range of services available and insufficient funding was highlighted. Criteria for eligibility were found to be problematic with many people not becoming eligible until a situation reached crisis point.

The report recommends full involvement of people with dementia and their carers in the personal budgets agenda, that personal budgets must not be seen as a cure-all for the social care system, that the market should be fully developed to deliver a range of different types of dementia services, that the personal budgets system should be adapted to meet the particular needs of people with dementia and their carers, that timely and appropriate information for people with dementia and their carers must be provided as well as awareness raising and training for health and social care professionals, and that the system must ensure an improved evidence base on dementia, including pilot sites to evaluate effective models of provision and accurate data on current use of personal budgets.

An Economic Perspective of Dementia Care in Ireland: Maximising Benefits and Maintaining Cost Efficiency

Alzheimer Society of Ireland

Trepel (2010) examines the international evidence on dementia in relation to prevention, care and cure and considers how the evidence can be used to inform decisions about spending on dementia that will maximise benefits to society and at the same time maximise optimal cost efficiency, and in par

ticular the implications for ROI. He concludes that investing in services and interventions to support carers is essential to achieving cost-effectiveness in dementia care. 

Financing Dementia: What money is available, what does dementia need and will the required resources be received?

Alzheimer Society of Ireland

In a later report, Trepel (2012) examines the different ways in which healthcare systems can be financed and resources distributed to those in need of healthcare.

He describes the unique public-private mix of financing health care in ROI, the two-tiered system of healthcare that has evolved, and the implications that this has for dementia care in ROI. Trepel (2010) highlights the absence of a clear budget line for dementia care. With increasing age dependency ratios meaning that fewer resources will be available in the future, he argues that the Irish government needs to make a financial commitment to dementia, guided by the principles of social solidarity, social sustainability and interdependency. To meet the needs of people with dementia and their carers and promote their quality of life, he argues that the “social contract” paid for during the productive years needs to be demonstrably upheld and contractual responsibility of private health insurers recognised.