Our differing views on health and education

As of 2016 the Irish Government’s spending on higher education amounted to 1.9% of its total expenditure. That’s compared to a Eurozone average of 1.5%. Our total education spend was at 12.1% compared to a Eurozone average of 9.7%. At the same time we spent 19.2% of our budget on health compared to a Eurozone average of 15%.

It’s interesting to observe how these ‘overspends’ are perceived. The health service is routinely lambasted and portrayed as grossly inefficient, run by hordes of incompetent administrators and kept going by selfless, almost heroic frontline staff. Administrators and to a lesser extent, consultants, are the bad guys.

In the case of education, there isn’t as much consensus as to who the bad guys are. Teachers do get a bashing from time to time over their long holidays even though the evidence is that extending the school year has no positive benefits. Third level lecturers are often portrayed as doing five or six hours of work per week because many people (including families of lecturers!) still presume that all lecturers do is lecture. Universities are seen as little more than advanced secondary schools, not the complex multi-mission organisations that they have become. So there is a perception that there is plenty of scope for us all to work harder within the education sphere and this makes everyone, including politicians sceptical about our appeals for more funding. They can, for example, point to our frequent statements that although funding per student has been halved, we have managed to maintain quality.

The solutions to the health service’s problems are almost universally seen as involving some sort of fundamental restructuring of the system: far more emphasis on primary care, for example. Most people recognise, based on experience, that maintaining the status quo will just lead to more and more of the state’s funds being gobbled up by health without an improvement in quality.

In education, especially our third level system, the solutions to our ill-defined problems are nearly always portrayed (by us) as involving some mechanism for increasing the amount of money poured into the institutions. As mentioned above, campaigners frequently point out that the funding per student has halved over the last decade but it’s worth noting that if spending were to be restored to peak levels our spend on higher education would jump to 2.5 times the Eurozone average. That would be hard to justify even with our demographics. But the key point is that fundamental restructuring of our higher education system is never on the agenda. There are token efforts made from time to time but these inevitably amount to little more than exercises in merger mania.

I find our differing perspectives on health education very interesting. I think a key point is that the deficiencies of our health service are very visible and affect every family in the country while the higher education system remains shrouded in mystery. No one really knows what the core issues are. No one knows if we’re doing a good job or not. No one really knows if we are spending our money wisely. No one is quite sure if we are, in fact, prioritizing education at all. No one knows how much, or how little, our academic staff teach. So the conversation is controlled by the institutions but when people are in the dark they can become cynical and suspicious and just turn a deaf ear.

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10 thoughts on “Our differing views on health and education

  1. Not sure what you are basing your figures on Greg. The OECD:Education at a Glance 2018 report shows that third level expenditure per head in 2015 was 71% of what it was in 2010. The next largest cut was for Chile and Spain which was to 87%. The Eurozone countries on average increased by 15% over that period (OECD figure was 11%). Even our fellow PIGS Portugal and Italy increased spending per head by 4% and 1% respectively.
    Our spend per head at third level in 2015 in PPP terms was 86% of the EU average – we just don’t prioritise it. By comparison the equivalent figure for health (World Bank, 2014) is 8% higher than the EU average.

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  2. Yes, but still misleading/incomplete in my opinion – e.g. “…if spending were to be restored to peak levels our spend on higher education would jump to 2.5 times the Eurozone average. That would be hard to justify even with our demographics.” Even if we increased spend to 2010 levels AND increased it further to account for demographics we’d be 11% less than the OECD average.
    In any case per capita rather than total is particularly relevant with regard to the comparison between health and education – our younger population (and higher education participation rates) mean that we have a higher proportion of younger college goers and a lower percentage of elderly (generally the most expensive category with regard to health)

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  3. It’s precisely because of our demographics that we need to be a bit more forensic about this whole debate. You can’t just base the whole argument on per capita spending because you have to take into account the overall demands on the budget. But I’d like to know two things: correlation between spending on HE and quality of HE (Look at UK!) And correlation between spending on HE and economic (e.g. growth) and social (e.g. equity) outcomes.

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  4. Ok – well lets start at the total spend and the difference in perceptions. We spend higher than average proportions of our expenditure on health and education.First thing to look at is the baseline. DPER has a 2018 spending review (https://www.per.gov.ie/wp-content/uploads/24.-Comparative-Levels-and-Efficiency-of-Public-Expenditure.pdf) which notes that we spend about 5% less of GNI* than the eurozone average (43.6% versus 48.5%). So we spend less money overall, which will have a distorting effect on the figures. One of the more interesting pieces of analysis in the above report is where they look at our % (of GNI*) spending on various categories compared to the EU average, including making adjustments for our age profile (we have both the highest % of population under 20 and the lowest % of population over 65). Figure 9(p15) for example shows that our overall age adjusted spending has been lower than the EU average for most of the 2001-2015 period (the exception being 2007-2013 inclusive). If you drill into that further though you see that health spending has been above average in every one of those years – usually by 5% or more, while education has actually been below the average. (NB this age adjustment doesn’t account for Ireland having higher than average progression rates to third level)

    You pose the question as to the difference in perception.- I’d suggest it comes down to something relatively simple in principle (albeit not as easy to quantify in practice) – efficiency – do we have a good system relative to what we spend? Again the above report does some nice analysis. Interestingly, it chooses to ignore higher education – concentrating on primary and secondary level but concludes that we are slightly below average on spend, but achieve fairly well (using PISA scores and participation rates). Health is quite a different story – figures 19(p.25) and 22(p.28) are pretty stark – we’re spending nearly twice the average, and our outcomes are mid-table (healthy life years and non-communicable disease as the metrics). It is pretty hard therefore to escape the conclusion that we have significant structural problems in health compared to education. That, in my opinion, accords with the general public sentiment – which I’d also contend is reinforced by the continuing annual farce of the HSE coming in significantly over budget.

    Regarding your last ‘wish’ – I don’t know what metrics you’d use for quality of HE – staff student ratios perhaps? For HE spending, economic growth and equity, perhaps a bubble plot of HE spend (as % of GNI*) vs economic growth (GNI*) with Gini co-efficiencts for bubble size? I might have a look at that another time…..

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    1. Isn’t your last paragraph the nub of the issue. The only ‘metric’ we seem to have is international rankings and we know that they’re flawed in the extreme. If a university were to be given a chunk of money from the state, what is the best way for it to boost its rankings? Do a Manchester City and buy in a bunch of research heavy hitters who’ll have little or no impact on undergraduate teaching. Upgrading the equipment in undergrad labs will be low priority.

      The problem with HE is that we have no standardized testing. We have lots of standardized testing (e.g. literacy, basic arithmetic) at primary, and at secondary we have the Junior Cycle, the Leaving and international tests like PISA and TIMMS. But in higher education we only have crude proxies for quality like funding per student, or completion rates, or staff/student ratio.

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      1. Indeed! You may well be right about what various universities would do. If however, they were just pursuing rise in the rankings they’d actually get more impact in the main from hiring lots of high potential junior staff – which make a bigger dent in the staff student ratios. As the ranking categories are all in percentile terms, that would actually be where we could make the biggest climb for a given investment.

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    1. I’m not a great fun of expressing expenditure as a fraction of GDP especially for Ireland considering that our GDP is grossly inflated by multinationals.

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