The absence of a dedicated fraud unit in the Health Service Executive to track €14 billion in annual spending has been criticised in an OECD report.

The report on wasteful spending on health says there is little evidence to support charges imposed on patients for visits to emergency departments in Ireland and other countries.

It also highlights high levels of adverse outcomes in many countries, pointing out that one in 10 patients in OECD countries is unnecessarily harmed during care. Ireland, for example, has the highest rate of post-operative sepsis for abdominal surgeries, at 3 per cent, according to the report.

Almost 5 per cent of births in Ireland involve obstetric trauma following delivery using forceps or vacuum extraction, while one in 200 hip and knee surgeries performed leads to a pulmonary embolism or deep vein thrombosis, it says.

Over 20 per cent of spending on private health insurance in Ireland goes on administration, it points out.

The report says it is alarming that at a time when public budgets are under pressure worldwide, one-fifth of health expenditure “likely” makes no or minimal contribution to good health outcomes.

“Governments could spend significantly less on health care and still improve patients’ health. Efforts to improve the efficiency of health spending at the margin are no longer good enough.”

Extremely corrupt

A third of citizens in OECD countries consider the health sector to be corrupt or even extremely corrupt, according to the report.

The authors say health services should stop doing things that do not bring value, such as unnecessary surgeries and clinical procedures. They should also swap to cheaper alternatives where they exist, such as generic drugs, or ensure patients are treated out of hospital when they do not need to be there.

One in three babies is delivered by caesarean section, the report points out, when medical indications suggest C-section rates should be 15 per cent at most.

The study questions the use of expensive technologies such as robotic surgery, especially for prostate cancer, and points out that an Irish study raised questions about the poor quality of studies examining clinical effectiveness.