Academic journal article Journal of the Statistical and Social Inquiry Society of Ireland

An Approach to Estimating the Effects of Financing System Change on Irish Healthcare Expenditure

Academic journal article Journal of the Statistical and Social Inquiry Society of Ireland

An Approach to Estimating the Effects of Financing System Change on Irish Healthcare Expenditure

Article excerpt

Abstract: The Irish healthcare system is a complex mix of public and private. The system is predominantly tax-financed (in 2013, 77 per cent of healthcare financing came from general taxation revenues); however, private health insurance and out-of-pocket payments are also used to finance significant amounts of healthcare expenditure. There are a number of different eligibility categories for public healthcare services in Ireland. Those in Category I (full medical cardholders) are entitled to free public health services but pay a co-charge for prescription items. Those in Category II are entitled to subsidised public hospital services and prescription medicines, but pay the full cost of other services including General Practitioner (GP) care. In October 2005, the GP visit card was introduced; GP visit cardholders have the same entitlements to free GP care as Category I individuals, but the same entitlements to all other public health services (including prescription medicines) as Category II individuals. Eligibility for a full medical/GP visit card is assessed primarily on the basis of an income means test, with a higher threshold applying to the GP visit card. A significant proportion of the population (42 per cent in 2014 (Department of Health, 2015a)), hold private health insurance, which mainly provides cover for private or semi-private acute hospital services.

Keywords: healthcare expenditure, Ireland

JELs: H51, I18

1. INTRODUCTION

The Irish healthcare system is a complex mix of public and private. The system is predominantly tax-financed (in 2013, 77 per cent of healthcare financing came from general taxation revenues); however, private health insurance and out-of-pocket payments are also used to finance significant amounts of healthcare expenditure. There are a number of different eligibility categories for public healthcare services in Ireland. Those in Category I (full medical cardholders) are entitled to free public health services but pay a co-charge for prescription items. Those in Category II are entitled to subsidised public hospital services and prescription medicines, but pay the full cost of other services including General Practitioner (GP) care. In October 2005, the GP visit card was introduced; GP visit cardholders have the same entitlements to free GP care as Category I individuals, but the same entitlements to all other public health services (including prescription medicines) as Category II individuals. Eligibility for a full medical/GP visit card is assessed primarily on the basis of an income means test, with a higher threshold applying to the GP visit card. A significant proportion of the population (42 per cent in 2014 (Department of Health, 2015a)), hold private health insurance, which mainly provides cover for private or semi-private acute hospital services.

This complex system has been the subject of much criticism, frequently with respect to barriers to and inequities in access to care. In particular, the use of direct out-of-pocket payments to finance GP care by the majority of the population who do not qualify for free GP care is unusual in a European context (Evetovits et al., 2012). In addition, the role of private health insurance in facilitating faster access to public hospital services for those with PHI over those without PHI but with equivalent health needs has also been highlighted (Ruane, 2010, Smith, 2010).

Recognising and responding to these issues, in 2011 a newly elected coalition government committed to far-reaching healthcare reform for Ireland, which included the development of a universal, single-tier health service, which guarantees access to medical care based on need, not income (Department of the Taoiseach, 2011). The proposals also committed to a change to the manner in which Irish healthcare is financed, with the introduction of Universal Health Insurance (UHI). Some three years later, a White Paper was published which proposed how this reform might be achieved (Department of Health, 2014). …

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