Ireland

While health reforms in 1970 gave way to several pillars of its modern system (such as general taxation as a source of funding and access to healthcare as a public entitlement), it was the 2004 Health Act that shaped the most recent system. The 2004 Health Act was an overhaul of the previously unsuccessful system of “Health Boards,” and took effect the following year. The policy change gave the HSE central authority to run the nation’s public health program with money from the state. The new system sought to establish strong primary and community care as a starting point for patients, and in the process increase accessibility to more specialized care. Now, a patient looking for an appointment will typically meet with a local General Practitioner, who refers him or her to a consultant to find a specialist.

Under the HSE, all residents are granted healthcare coverage in two categories. Category One coverage provides complete coverage, where applicants are given a “Medical Card” that covers all ordinary medical and hospital costs. Individuals qualify for a Medical Card if their total income falls below a certain threshold, and the card normally covers the applicant and his or her spouse and children. Residents are also automatically eligible for a Medical Card if they are over 70. Category Two includes anyone else, and grants coverage for all in-patient hospital services, and all out-patient services with an annual maximum of a few hundred euros. Accident and emergency department expenses can be covered if referred by a doctor.

The biggest criticism of the public system is the lengthy wait time for free services. In an effort to cut down on waiting, nearly half of Irish residents turn to the voluntary private health insurance (PHI) market. However, it is interesting to note that the number of participants in PHI has been on the decline since the start of the global financial crisis. Private insurance participation peaked in 2008, with about 51% of the population carrying a plan. Since then there has been a marked downward trend, with about 44% of the population subscribed to a private plan in December 2014. A driving factor of this decline was the introduction of a health insurance levy in 2009 – a response from the government to the contracting economy. The levy sought to subsidize private insurers with disproportionately older, higher-risk participants. As a consequence, an upward pressure was placed on health insurance premiums, and fewer residents (namely young people) could afford plans. With fewer young, low-risk residents buying private health insurance to offset the cost of expensive older participants, PHI premiums continued to rise, and even fewer could purchase plans.