The Health Service Executive (HSE) has said that the development of a new integrated model of care for patients based on enhanced services in the community would not necessarily be any cheaper than continuing with the existing hospital-based system of treatment.
However, the HSE said the community-based integrated model, which it is proposing, would produce significantly better results for patients.
A report on bed capacity in acute hospitals, which was published by the HSE yesterday, found that if the current model of hospital-based care continued that a total of 20,000 acute beds would be required in public hospitals by 2020 - an increase of some 8,000 beds.
However, it argued that if the community-based model was introduced the number of acute beds could be reduced by 4,000.
The report said that, given demographic changes, the demand for healthcare would increase by 60 per cent over the next 12 years.
The report by PA consulting group maintained that to deliver the additional 8,162 acute hospital beds would require a capital investment of over €4 billion, and additional revenue costs of almost €26 billion over 14 years.
It recommended that as an alternative a new integrated model of care should be implemented across the country.
This would involve reducing the average length of time patients spend in hospitals, which the report argued was excessively long, and increasing the number of people treated on a day-case basis.
The proposed new model would also see a reduction in the number of A&E admissions, with more patients treated in the community, in medical assessment units and in out-patient clinics.
The proposed system would also involve better planning for the discharge of patients, and ensuring that people were admitted on the day of their surgery rather than several days earlier.
It would also involve patients being treated in more appropriate settings. The report noted that 39 per cent of in-patients could be treated in an alternative to an acute hospital - many in their own home.
The review found that many of the proposed practices were already working well in some Irish hospitals, and that introducing them throughout the system could be done relatively quickly.
The HSE said the full implementation of an integrated health model of care would involve substantial changes in work practices.
HSE chief executive Prof Brendan Drumm said the current hospital-based system was unsustainable, and that modernising hospital practices was essential.
He said to develop a world-class health system "we have to replace outdated practices with modern ways of doing things that reflect the needs of patients".
Prof Drumm said the HSE had been rolling out parts of the proposed new model of care in some parts of the country for the last two years, and this would continue "aggressively".
The Department of Health said the report was a discussion document that would be considered with the social partners.
The Irish Hospital Consultants Association criticised the report, saying the HSE was a lone voice in suggesting that hospital services could survive with 4,000 few er beds.
The Irish Nurses Organisation said whatever structure was finally decided on, what were immediately required were extra beds.
The Irish Medical Organisation welcomed the report, and said it should form the basis for further debate on the health service in Ireland.
