Ireland: health system review

Abstract

The Health Systems in Transition (‎‎‎HiT)‎‎‎ profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Irish health system can be characterized as having been in a process of constant review and implementation of staged initiatives since the late 1990s. This process has culminated in major structural changes, made possible due to the economic growth that Ireland has enjoyed recently. The changes affect both the organization and orientation of the health care system. The reforms have revolved around the abolition of the former Health Boards and the creation of a single national body, the Health Service Executive (‎‎‎HSE)‎‎‎. The aim is to make the system more primary and community care driven, backed up by improved access to specialist, acute and long-stay services. Implementing such major change is challenging and it is too early to reach any definitive judgement on the success of these reforms, particularly as the pace of reform has varied across different sectors of the health system. Promoting equity within the health system is likely to remain a critical concern. Access to the primary care system tends to be pro-poor, in that services are free for this group, while the remaining 70% of the population who do not qualify for free primary care must pay the substantial cost of general practitioner (‎‎‎GP)‎‎‎ fees out of pocket. In contrast, in the secondary care sector, those who can afford private health insurance can avoid waiting for treatment. While much has been done to change the Irish health care system for the better since the late 1990s, major challenges remain, and none more so than primary care reform. The implementation of promised reforms is the key challenge, particularly now that the country, like most of the developed world, is likely to experience an economic downturn which will give the Government less room for manoeuvre in the near future.