Health care in Ireland is delivered through public and private healthcare. The public health care system is governed by the Health Act 2004,[1] which established a new body to be responsible for providing health and personal social services to everyone living in Ireland – the Health Service Executive. The new national health service came into being officially on 1 January 2005; however the new structures are currently in the process of being established as the reform programme continues. In addition to the public-sector, there is also a large private healthcare market.
In 2019 Ireland spent €3,513 per capita on health, close to the European Union average,[2][3] of this spending approximately 79% was government expenditure.[4] In 2017 spending was the seventh highest in the OECD: $5,500 per head.[5]
Overcrowding has been an issue at hospitals in Ireland, with over 118,000 patients having to wait for a bed in 2019.[6]
History
In his Confessio Authoris, published posthumously by Jan Baptist van Helmont (a chemist from Brussels) in 1648, he noted that "The Irish nobility had in every family a domestic physician whose recommendation was not that he came from the College loaded with learning but that he was able to cure disorders; which knowledge they have from their ancestors by means of a book belonging to particular families that contains the marks of the several diseases, with the remedies attached; which remedies where vernacula the production of their own country - for this reason the Irish are better managed than the Italians who have a physician in every village".[7] According to John F. Fleetwood, there was little organisation of the medical practice in Ireland until at least the mid-19th century, and quackery was widespread in the 1700s.[7]
Healthcare system
Total health spending as a percentage of GDP for Ireland compared amongst various other first world nations from 2005 to 2008
All persons resident in Ireland are entitled to receive health care through the public health care system, which is managed by the Health Service Executive and funded by general taxation and subsidised fees for service. All maternity services and child care up to the age of six years are provided free of charge. Emergency care is provided at a cost of €100 for a visit to an Emergency Department (ED), if one has not attended a GP first.
The Medical Card – which entitles holders to free hospital care, GP visits, dental services, optical services, aural services, prescription drugs and medical appliances – is available to those receiving welfare payments, low earners, many retirees, and in certain other cases. The only medical conditions carrying automatic entitlement to a card are having thalidomide syndrome, having a surgical symphysiotomy, and children with cancer.[8] Many political parties support extending the availability of the Medical Card to eventually cover every resident in Ireland – they currently cover 31.9% of the population. Those on slightly higher incomes are eligible for a 'GP Visit Card' which entitles the holder to free general practitioner visits. Persons over 70 years who are not entitled to a medical GP visit card can instead receive an annual cash grant of €400 up to a certain income.
People who are not entitled to a Medical Card (i.e. 68.1% of the population) must pay fees for certain health care services. There is a €100 charge for those who attend an emergency department without a referral letter from a family doctor (a visit to which usually costs €45–75, though some practices offer rates as low as €25-35 for over-65s and students[9]). Hospital charges (for inpatients) are a flat fee of €80 per day up to a maximum of €800 in any twelve-month period, irrespective of the actual care received. Specialist assessments and diagnostic assessments (such as X-rays, laboratory tests, physiotherapy, etc.) are provided free of charge. If a person cannot afford to pay hospital charges, the HSE will provide the services free of charge. Under the Drugs Payment Scheme, prescription drugs, individuals and families are eligible for subsidies for approved prescription drugs, medicines, and certain appliances, and pay only a maximum of €80 per month per household. To qualify a patient must hold a Drugs Payment Scheme Card, for which everyone who does not hold a Medical Card is eligible.[10]
Everyone living in the country, and visitors to Ireland who hold a European Health Insurance Card, are entitled to use the public healthcare system. Under Common Travel Area (CTA) arrangements, British citizens do not require an EHIC card and can instead present their NHS number, NHS card, driving licence or other proof of residence within the CTA. Outpatient services are also provided without charge. The majority of patients on median incomes or above are required to pay subsidised hospital charges.
Hospitals
The Rotunda Hospital in Dublin is the world's oldest maternity hospital, founded in 1745. It is also one of its largest, dealing with over eight thousand births in 2007.
Hospitals in Ireland generally offer a full range of healthcare including accident and emergency services. Many hospitals in Ireland, such as Connolly Hospital at Blanchardstown, are operated directly by the Health Service Executive. There are also hospitals run on a voluntary basis by organisations who receive public funding but operate with some degree of autonomy. Included in this latter group are teaching hospitals (such as University Hospital Galway) operated in conjunction with a university and hospitals with a long-standing religious ethos e.g. Tallaght University Hospital in Dublin. There are also many private hospitals. Ireland has a lower than OECD-average number of hospital beds according to the 2013 OECD Health at a Glance Report[11] The same report also noted that Ireland has fewer doctors (2.7 doctors per 1,000 population) and more nurses (12.2 nurses per 1,000 population) than average in other OECD countries. Consultants in the publicly funded hospitals are allowed to spend some of their time (typically 20%, though there is little supervision) on private practice.[5]
Waiting lists
Ireland has reduced its spending on health care by 6.6% since the onset of the Global Financial Crisis according to the OECD's 2013 Health Report. As a consequence, waiting times for treatment have increased.
According to the Euro health consumer index waiting times for emergency treatment, minor operations, and CT scans, in Irish hospitals in 2015 were the worst in Europe, though the Irish health system was ranked 21st out of 35 European countries.[12] The Health Service Executive accepted that it lacked the capacity to provide sufficiently accessible health services. It was working to ensure that no one had to wait more than 18 months for an outpatient appointment, or inpatient treatment. According to the index, reports by patients on waiting times were considerably more pessimistic than official Irish waiting-time statistics.[13] The Euro health consumer index 2018 report continues to rank the accessibility of Ireland's Health system as the worst in Europe, with the overall ranking as 22nd of 35.[14]
In 2007,[15] 76% of inpatients were admitted to hospital for operations immediately, 11% had to wait up to one month, 4% had to wait up to three months, 1% had to wait up to six months and 4% had to wait for over six months for operations. Waiting times at the National Rehabilitation Hospital, the only such facility in the country, can be one year. For outpatients, 23% were seen on time, 44% were seen within 30 minutes, 18% waited more than an hour and 7% waited two hours.
University Hospital Galway is one of Ireland's largest hospitals, dealing with over two hundred thousand patients in 2007.
In 2007,[15] for GP services, 31% were seen without an appointment, 38% received an appointment the same day, 28% received a next day appointment and 3% had to wait over two days to be seen.
The National Treatment Purchase Fund (NTPF) was set up in 2002 for those waiting over three months for an operation or procedure, and as a result over 135,000 patients on waiting lists have been treated so far. The NTPF involves the government paying for public patients to be treated for free in a private hospital in Ireland, or sometimes abroad if necessary. The NTPF has reduced waiting times for procedures to an average of between two and five months (the average in 2009 is 2.4 months), compared to between two and five years in 2002. There are cases where essential care is needed urgently but not made available by the HSE under their NTPF, and contrary to relevant judgements by the European Court of Justice.
HSE figures quoted in April 2012[16] show that at least 178,000 people in Ireland were on waiting lists to see specialists at an outpatient clinic, and that more than 300 patients had been waiting for over four years to be seen by a consultant after being referred by their GP.
Health centres provide a wide range of primary care and community services in towns and villages throughout Ireland, and are run by the HSE. Services available at these clinics include GP services, public health nurses, social work and child protection services, child health services, community welfare, disability services, older people services, chiropody, ophthalmic, speech therapy, addiction counselling and treatment, physiotherapy, occupational therapy, psychiatric services, and Home Help. These services are available for free, or at a subsidised rate.
In 2012 a programme of developing 35 primary care centres was announced. By July 2017 only one was operational. 14 are to be constructed by public-private partnerships.[17]
General practitioners
Primary health care in Ireland is mostly provided by general practitioners (GPs), who generally operate as sole traders or in health centres with other GPs and sometimes nurses. Most GPs also offer house visits to their patients, with emergency "out-of-hours" GP services available in all parts of the country. GPs generally charge on a per-consultation fee basis, usually charging anything up to €65, depending on the region. People with Medical Cards or GP Visit Cards are exempt from charges. About 60% of the population have to pay up-front in cash.[5] Many GPs provide free services to those with hepatitis C and maternity and infant services. Those with private health insurance can, depending on their plan, have their GP costs paid or refunded, either fully or partially, by the insurance company. People can also claim tax relief for GP visit costs.
Prescription drugs and medical appliances are available to all for a small fee (medical card holders), reduced cost (Drugs Payment Scheme) or in certain circumstances free (under the Long Term Illness Scheme) to residents of Ireland. The Drugs Payment Scheme ensures that every household has to pay no more than €124 per calendar month for a month's supply of prescribed medicines and medical appliances,[18] to be cut to €114 from April 2020.[19] Some private health insurance plans provide partial reimbursement up to the Drugs Payment Scheme threshold.[20] Those who are entitled to a medical card pay a government levy for each item dispensed. The levy is €2.00 up to a maximum of €20 per family per calendar month. Those who are suffering from one of a list of 16 long-term illnesses do not have to pay for medicines or medical appliances related to their conditions.[21] Ireland has below-average use of generic medication according to the OECD, despite being a major exporter. The levy was reduced to €1.50 from April 2019 for medical card holders over the age of 70,[22] and will be further cut to €1 from April 2020.[19]
All immunisation vaccines for children are provided free of charge, in schools, health clinics and hospitals.
Recovering heroin addicts can receive methadone treatment free of charge under the Methadone Treatment Scheme.[23]
Information technology
The health service was said to have a ‘frail IT system’ and a ‘very-low level of cyber security maturity’ in a report by PricewaterhouseCoopers on ransomware attacks in 2021. Coombe Women & Infants University Hospital was targeted on 15 December 2021 forcing its IT services to be shut down.[24]
Other services
The HSE provide dental, optical (vision) and aural (hearing) health care. Medical Card holders and their dependents, Health Amendment Act Card holders and children get these services free. Other people can get these services free or at a reduced cost from the Treatment Benefit Scheme or private insurance. People who pay the full price to private practitioners can claim tax relief.[25]
The HSE also provide mental health services, and treatment and rehabilitation services for alcohol and drug addicts. The Irish healthcare system is often criticized for not providing sufficient services for those with mental health issues,[26] leading to a rapidly growing suicide rate,[27] and ineffective services delivered to young people.[28]
Payment schemes
Those and their dependants without a Medical Card or private health insurance can receive medical services free or at a subsidised rate from the Treatment Benefit Scheme, which takes into account the compulsory Social Insurance Fund (PRSI) contributions they have made. People can also claim tax relief on medical expenses not covered by the State or by private health insurance. Those with private health insurance are provided with tax credits, which are passed directly to the insurance company and lower the customer's premium.[citation needed]
Visitors to Ireland who hold a European Health Insurance Card do not have to pay for emergency treatment from a general practitioner or specialist, emergency dental, oral or aural treatment, inpatient or outpatient hospital treatment or prescription medicines. Those who need dialysis, oxygen therapy or other specialised treatments can arrange for them before their visit.[citation needed]
Performance
Ireland was ranked 19th out of 34 European countries on the Personalised Health Index in 2021. The use of telemedicine has grown exponentially during the COVID-19 pandemic in the Republic of Ireland and electronic prescriptions have been widely adopted. Ireland scores very poorly for Decision Support Systems in mHealth It was given high scores for legislation on Electronic Health Records but the use of electronic records across healthcare facilities was graded as poor. The problem was said to be lack of infrastructure and delays in implementing data-sharing policies.[29]
Satisfaction with the health service
A survey, commissioned by the HSE in 2007, found that patient satisfaction with the health service was quite high, with 90% of inpatients and 85% of outpatients saying they were satisfied with their treatment. In addition to this, 97% said they were satisfied with the care provided by their GP.[30]
The 2008 Health Consumer PowerhouseEuro Health Consumer Index report ranked Ireland's public healthcare system 11th out of 31 European countries.[31] This is an improvement on the 2007 report which ranked Ireland 16th out of 29 countries,[32] and a drastic improvement on the 2006 report, in which Ireland was ranked 26th out of 26 countries.[33]
The Health Service Executive (HSE) manages the delivery of the entire health service as a single national entity. There are four HSE administrative areas (HSE Dublin Mid-Leinster, HSE Dublin North-East, HSE South and HSE West), which are in turn divided into 32 Local Health Offices (LHOs). |It is Ireland's largest employer with over 100,000 workers; and has an annual budget of €16 billion, more than any other public sector organisation.
The Minister for Health has responsibility for setting overall policy with regard to the health service.
Private health insurance
Private health insurance is available to the population for those who want it. Vhi Healthcare (which is a semi-state company), Laya Healthcare, and Irish Life Health provide health insurance, among other services. On 2 July 2012, GloHealth entered the market to become Ireland's fourth private health insurer.
In 2005, 47.6% of people were covered by private health insurance. The regulatory body for private health insurance is the Health Insurance Authority. In 2015 the proportion of people buying private health insurance had fallen to 40%, but this is still the highest proportion of any European country.[34] The average annual cost of basic health insurance was €1,850 in 2017. Only 13% of the total Irish expenditure on healthcare was attributed to private insurance.[5]
Noël Browne attempted to introduce free state-funded healthcare for all mothers and children aged under 16 in 1948, but was defeated by Irish Medical Organisation and the Catholic Church, which objected to the expansion of "socialized medicine", so healthcare continued to be delivered by family doctors and in religious and charitable hospitals. The state concentrated on public health measures, and built hospitals which were still run by the church. Private hospitals benefit from tax reliefs and this has encouraged private for-profit operators into the system.
Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.
Two-tier healthcare is a situation in which a basic government-provided healthcare system provides basic care, and a secondary tier of care exists for those who can pay for additional, better quality or faster access. Most countries have both publicly and privately funded healthcare, but the degree to which it creates a quality differential depends on the way the two systems are managed, funded, and regulated.
Healthcare in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together with smaller private sector and voluntary provision. As a result of each country having different policies and priorities, a variety of differences have developed between these systems since devolution.
The Swedish health care system is mainly government-funded, universal for all citizens and decentralized, although private health care also exists. The health care system in Sweden is financed primarily through taxes levied by county councils and municipalities. A total of 21 councils are in charge with primary and hospital care within the country.
The National Health Service (NHS) is the publicly funded healthcare system in England, and one of the four National Health Service systems in the United Kingdom. It is the second largest single-payer healthcare system in the world after the Brazilian Sistema Único de Saúde. Primarily funded by the government from general taxation, and overseen by the Department of Health and Social Care, the NHS provides healthcare to all legal English residents and residents from other regions of the UK, with most services free at the point of use for most people. The NHS also conducts research through the National Institute for Health and Care Research (NIHR).
Healthcare in the Netherlands is differentiated along three dimensions (1) level (2) physical versus mental and (3) short term versus long term care.
Healthcare in England is mainly provided by the National Health Service (NHS), a public body that provides healthcare to all permanent residents in England, that is free at the point of use. The body is one of four forming the UK National Health Service, as health is a devolved matter; there are differences with the provisions for healthcare elsewhere in the United Kingdom, and in England it is overseen by NHS England. Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing and able to pay.
Healthcare in Turkey consists of a mix of public and private health services. Turkey introduced universal health care in 2003. Known as Universal Health Insurance Genel Sağlık Sigortası, it is funded by a tax surcharge on employers, currently at 5%. Public-sector funding covers approximately 75.2% of health expenditures.
Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, specific healthcare precincts are responsible for providing healthcare to their residents as of 2023.
The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "best overall health care" in the world. In 2017, France spent 11.3% of GDP on health care, or US$5,370 per capita, a figure higher than the average spent by rich countries, though similar to Germany (10.6%) and Canada (10%), but much less than in the US. Approximately 77% of health expenditures are covered by government-funded agencies.
Italy's healthcare system is consistently ranked among the best in the world. The Italian healthcare system employs a Beveridge model, and operates on the assumption that health care is a human right that should be provided to everyone regardless of their ability to pay. Life expectancy is the 4th highest among OECD countries and the world's 8th highest according to the WHO. Healthcare spending accounted for 9.7% of GDP in 2020.
Health care in Poland is insurance based, delivered through a publicly funded health care system called the Narodowy Fundusz Zdrowia, which is free for all the citizens of Poland provided they fall into the "insured" category. According to Article 68 of the Polish Constitution everyone has a right to have access to health care. Citizens are granted equal access to the publicly funded healthcare system. In particular, the government is obliged to provide free health care to young children, pregnant women, disabled people, and the elderly. However, private health care use is very extensive in Poland. Patients who are uninsured have to pay the full cost of medical services. According to a study conducted by CBOS in 2016, out of 84% patients taking part in the survey, 40% declared use of both private and public health services, 37% use only public health care, and 7% use only private health services. 77% of all responders declared using private health care is caused by long waiting for public health care services.
Healthcare in Slovenia is organised primarily through the Health Insurance Institute of Slovenia. In 2015, healthcare expenditures accounted for 8.10% of GDP. The Slovenian healthcare system was ranked 15th in the Euro health consumer index 2015. The country ranked second in the 2012 Euro Hepatitis Index.
Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance. The United States spends more on healthcare than any other country, both in absolute terms and as a percentage of GDP; however, this expenditure does not necessarily translate into better overall health outcomes compared to other developed nations. Coverage varies widely across the population, with certain groups, such as the elderly and low-income individuals, receiving more comprehensive care through government programs such as Medicaid and Medicare.
Healthcare in Belgium is composed of three parts. Firstly, there is a primarily publicly funded healthcare and social security service run by the federal government, which organises and regulates healthcare; independent private/public practitioners, university/semi-private hospitals and care institutions. There are a few private hospitals. Secondly is the insurance coverage provided for patients. Finally, industry coverage; which covers the production and distribution of healthcare products for research and development. The primary aspect of this research is done in universities and hospitals.
The Norwegian Health Economics Administration is the Norwegian Directorate for Health and Social Affairs external agency, and annually administers around NOK 35 billion. Helfo's responsibilities include making payments from the National Insurance scheme to healthcare providers, suppliers and service providers, as well as individual refunds of expenses incurred by private individuals relating to medicines, dental healthcare and health services abroad. Helfo's societal mission is to safeguard the rights of stakeholders in the health sector and private individuals and to provide information and guidance concerning health services.
Examples of health care systems of the world, sorted by continent, are as follows.
As of 2019 Lithuanian life expectancy at birth was 76.0 and the infant mortality rate was 2.99 per 1,000 births. This is below the EU and OECD average.
Government-guaranteed health care for all citizens of a country, often called universal health care, is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at broadly extending access to health care and setting minimum standards. Most implement universal health care through legislation, regulation, and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis.
Healthcare in San Marino is provided through a universal health care system, as well as private healthcare to complement it. San Marino's healthcare system is consistently rated as one of the top three in Europe.
↑ "Outcomes in EHCI 2015"(PDF). Health Consumer Powerhouse. 26 January 2016. Archived from the original(PDF) on 6 June 2017. Retrieved 27 January 2016.
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