Republic of Ireland
Healthcare System & Market
Healthcare in the Republic of Ireland currently centres on a centrally-administered national health service financed mostly from general taxation, now known as the Health Service Executive (HSE). In this sense, Irish healthcare has historically had similarities with the British NHS, although it should be noted that in its existing form the HSE model is marked by a slightly larger reliance on mixed provision and funding. Like Britain, however, the Irish have historically encountered issues with waiting times, funding, centralisation, accountability, technological uptake and clinical outcomes in the HSE, at least when compared to some other universal healthcare nations on the continent. Ireland also has a complex multi-tier system of healthcare, in which people on lower or middle incomes sometimes struggle to access needed care while people with private voluntary health insurance get preferential access to care in state hospitals or to higher-quality treatment in the separate private hospital sector, similar to the privileged position the wealthy or insurance-holders have in the UK’s healthcare landscape. These problems have led to a feeling in the Irish population that their current healthcare system guarantees neither quality nor genuine equity.
Following a 2011 change of government to a coalition between the centre-right Fine Gael and the centre-left Labour Party, the Irish system is now in the midst of a radical and ambitious overhaul known as Universal Health Insurance (UHI), based on an amalgamation of plans put forward by both parties before the 2011 Irish election. UHI is essentially a plan to convert Ireland’s several-tier, centralised tax-financed system into a continental-style ‘Bismarckian’ social health insurance system with a main tier of universal compulsory health insurance and competing providers. Dr James Reilly, the current Minister of Health and a former GP and president of the Irish Medical Organisation, claimed that “The coalition Government has embarked upon one of the most radical programmes of healthcare reform since the formation of the UK’s NHS in 1948. Our goal is clear. To dismantle Ireland’s unfair and inefficient two-tier model of healthcare and replace it with a comprehensive system of Universal Health Insurance (UHI).”
Specifically, Reilly and the Irish government are citing the Dutch healthcare system as their model, which was itself overhauled as recently as 2006 and has been ranked number one among health systems by both the Commonwealth Fund and Euro Health Consumer Index (EHCI). Irish policymakers have spent recent years consulting with Dutch policymakers and health experts on the system. Insurer competition in Germany’s comparable healthcare system was also cited as an example in the Labour Party’s pre-election health plan. The plan is intended to be fully implemented by 2020.
If Ireland successfully completes this transition, this will be a significant event in Western health policy, as it will represent an example of a developed democracy with a long-established tax-financed healthcare system subsequently decentralising and switching over to the social insurance model. Therefore, Ireland’s bold reforms could serve as an interesting case study for the UK, especially in light of the relative comparability our cultures, public health profiles and to a large degree our existing systems. These reforms are also being pursued despite, or perhaps because of, the difficult fiscal and economic situation the Republic faces. Furthermore, the leading role that the Irish Labour Party - a social democratic party with close ties to our own UK Labour Party - has taken in calling for a decentralised and social insurance-based universal system is notable, demonstrating that the principles of social solidarity and universal free care need not necessarily entail support for a centralised public monopoly structure over a social insurance-based system.
Download the CIVITAS Irish Healthcare market report
Download the Republic of Ireland eHealth strategy 2015
Download the Electronic Health Record 2015 Strategy
Download the Knowledge and Information 2015 Strategy
Irish ECHAlliance Ecosystem