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Healthcare in the Republic of Ireland

6. Reform initiatives

Due to the high share of out-of-pocket payments under the existing health service system, the Republic of Ireland represents the only state within the EU, which does not provide universal healthcare based on the criteria by the WHO. The newly elected Irish government committed itself in March 2011 to reform the two-tier structure of national health service in response to public discontent with austerity measures from 2008 onwards. Since public funding of  health provision was reduced between 2009 and 2013 to meet payment obligations regarding the state’s budget deficit, citizens faced higher medical charges and extended waiting lists. In reaction to this development, the coalition government of Fine Gael and the Labour Party declared to introduce “a universal single-tiered health service, which guarantees access based on need, not income… through Universal Health Insurance.”  The published  government plan outlined in the 2014 document “The Path to UHC – The White Paper” foresaw introducing compulsory private health insurance based on managed competition between insurance companies to abolish the distinction between public and private patient status. Key features of the policy entailed mandatory health insurance for every citizen under free choice of insurer as well as entitlement to the same package of care, covering primary and acute hospital services. Further, patients should be charged in turn insurance premium irrespective of age or risk profile and additionally have the right to change their insurance membership on an annual basis. Those citizen, who are unable to afford the amount of premium would have qualified for subsidies to cover the required premium payments by a National Insurance fund.

The implementation of the proposed model of universal health insurance was supposed to be conducted by 2019. However, after a public consultation procedure regarding the reform initiatives the plan of universal health insurance was abandoned by the Irish administration in November 2015 due to projections that the envisaged system would be too costly and would still require the highest share of funds by general taxation. According to the state department of health, the implied costs of universal health insurance would have led to approximately 11 % higher expenditures than the existing system.  After the Irish parliamentary election of 2016 Fine Gael formed a minority government supported by independent parliamentarians and founded in June 2016 an all-party “Committee on the Future of Healthcare” following an initiative by the health department with the aim to identify an appropriate approach for establishing universal healthcare in Ireland. The committee was supported by an academic team from Trinity College Dublin to analyse submissions made within 30 public hearings in the course of the public consultation process. In May 2017 the committee published its final report entitled “Committee on the Future of Health, Sláintecare Report”, which specified universal healthcare based on the following definition:

"A universal healthcare system will provide population, promotive, preventative, primary,

curative, rehabilitative and palliative health and social care services to the entire population

of Ireland, ensuring timely access to quality, effective, integrated services on the basis of

clinical need."

The document entails a proposed ten-year plan for reforming the Irish health system towards universal healthcare. It consists of five sections, covering Population health profile, Entitlements and Access to Healthcare, Integrated care, Funding and Implementation. The report foresees the provision of health cards called Carta Sláinte to every citizen, granting access to primary care free of charges at specified local entities preferably outside of hospitals. This system is planned to be funded by taxation, requiring an increase of public health spending and further infrastructure investment of approximately 3 billion Euros. The submitted plan was debated twice in the parliament in 2017 and the Irish government decided to found an official implementation office to appoint a head of the organisation as well as to develop a drafted implementation plan by December 2017. However, as of June 2018 neither the document was published nor the lead to the office was appointed.