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Performance improvement and health cost reductionHealth care expenditure in Ireland has reached 9.5% of GDP (2009 data). This figure is similar to the UK and is in line with most other European countries apart from France and the Netherlands which are higher at over 11%. In most western societies health spending is rising faster than economic growth, a trend that was first observed in the 1970s and has continued unchecked. The spending on health in the US at 18% is almost twice as high as Europe and has now reached crisis point. This represents $7960 per capita compared with the OECD average $3223. Yet despite this massive investment the US cannot guarantee access to healthcare for all its population. With the global down turn there is an increasing impetus for all countries to contain their health spend. Healthcare is barely covering its costs. Resources are finite and without properly planned containment, rationing may become necessary. It is imperative that the health professions set down the priorities for medical care rather than having a solution imposed on them and their patients.