Sir, – Paul Goldrick-Kelly and Tom Healy criticise the use of gross national income (GNI) rather than gross domestic product (GDP) as the denominator when comparing Irish health expenditure with that of other countries on the grounds that all income counted in GDP is taxable ("Where is the evidence we overspend on health?", Opinion & Analysis, May 23rd). For most countries the GDP-GNI difference is small, but it is large (about 20 per cent) for Ireland. Not all of this difference, which is largely income accruing to non-residents, is taxable at the same rate as that of residents.
Leaving this aside, recent CSO estimates for 2013 tell a very different story. In 2013 total current health expenditure in Ireland was 10.2 per cent of GDP compared with an OECD average of 9 per cent. Health spending in Ireland was 12.4 per cent of GNI.
Of course, this does not prove that there is overspending on health, but account should also be taken of Ireland’s relatively young population. In 2011, 11.1 per cent were aged over 65, compared with 14.9 per cent in the OECD as a whole and over 20 per cent in Italy and Germany.
Based on these facts, there is little basis for saying that we underspend on health.
Overall, we should wonder why such high levels of expenditure seem to produce such dissatisfaction with the health service.
But maybe we should pay more attention to the very favourable trends in health outcomes, notably life expectancy, which seem to get relatively little attention. – Yours, etc,
JOHN SHEEHAN,
Rathfarnham,
Dublin 14.
Sir, – I suggest that Patrick Goldrick-Healy of the Nevin Research Institute did not look far enough to answer their question. They consider well the GDP and value for money aspects.
But surely the central question is whether the present levels of health, education and welfare spending, which account for around 80 per cent of public spending, are sustainable. They depend on massive annual budget deficits and massive neglect of public infrastructure maintenance and development. Instead of using the present low cost of money for the latter purpose, our politicians are using it for the former.
That is irresponsible, highly dangerous and unsustainable. – Yours, etc,
JOSEPH FOYLE,
Ranelagh,
Dublin 6.
Sir, – I am a senior citizen and have just read a review of the dreadful state of the health service and how ill-prepared it is for our future needs. I was prepared to pay and did pay my water charges, as did 900,000 householders in the county. Now the health service must compete with all other services for shrinking funds. Politicians, hang your heads in shame. – Yours, etc,
MARGARET MURRAY,
Dublin 9.