Sir, – Introduction by the CSO of a modified version of gross national income (GNI) to minimise distortions caused by multinational activities should have a profound impact on planning and performance measurement in Ireland. The CSO estimates that modified GNI for 2016 was only about 69 per cent of gross domestic product (GDP). On this basis, the ratio of government debt to modified GNI was an unsustainable 106 per cent in 2016, as compared with a more moderate 73 per cent based on GDP.
Drilling down into the economy using modified GNI reveals many other unfavourable ratios. For example, according to the OECD, the ratio of Ireland’s health expenditure to GDP was 7.8 per cent in 2016 and we ranked 24th highest of 35 countries.
If modified GNI is used instead of GDP, this ratio jumps to 11.4 per cent, and our cost ranking rises to third place behind the US and Switzerland and ahead of highly regarded German, Swedish and French services.
As anyone who uses our health service knows, this ranking makes little sense and prompts fundamental questions about the sector’s costs, efficiency, case mix and underlying demographics. – Yours, etc,
BRIAN FLANAGAN,
Blackrock,
Co Dublin.