Healthcare in the Republic of Ireland
Life in Ireland |
---|
Culture |
Economy |
General |
|
Society |
Politics |
Policies |
Health care in Ireland is delivered through public and private healthcare. The public
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
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
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
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
Hospitals in Ireland generally offer a full range of healthcare including
Waiting lists
Ireland has reduced its spending on health care by 6.6% since the onset of the
According to the
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
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.
Drugs
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
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
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
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 Powerhouse Euro 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]
Health Service Executive
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.
Minister for Health
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]
History and reform
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.
The
The British
See also
- Health care system
- Health in Ireland
- Maev-Ann Wren, analyst and critic of Irish healthcare provision
- Mental health in Ireland
References
- ^ "Health Act 2004". Irish Statute Book. Office of the Attorney General. Retrieved 5 October 2010.
- ^ "Ireland: Country Health Profile 2021". OECD. 13 December 2021. Retrieved 30 January 2022.
- OCLC 1276861968.
- ^ "GHO | By theme". Who.int. Retrieved 27 March 2017.
- ^ a b c d "Health care in Ireland leaves much to be desired". The Economist. 21 March 2019. Retrieved 24 March 2019.
- ^ Meskill, Tommy (2 January 2020). "2019 worst year ever for hospital overcrowding - INMO". RTE News. Retrieved 18 April 2020.
- ^ a b Fleetwood 1990.
- ^ "Am I eligible [for a Medical Card]?". Ireland's Health Service. Retrieved 25 September 2017.
- ^ "Inchicore Family Doctors | Primary Care Centre". Inchicoredoctors.ie. Retrieved 27 March 2017.
- ^ "Your Guide to the Drugs Payment Scheme - Ireland's Health Service".
- ^ "Archived copy" (PDF). Archived from the original (PDF) on 6 December 2013. Retrieved 11 December 2013.
{{cite web}}
: CS1 maint: archived copy as title (link) - ^ "Irish emergency care waiting times rated worst in Europe". The Irish Times. 26 January 2016. Retrieved 30 January 2016.
- ^ "Numbers awaiting outpatient assessment unacceptable - HSE". RTE. 26 January 2016. Retrieved 30 January 2016.
- ^ "Euro Health Consumer Index 2018" (PDF). Health Consumer Powerhouse. Retrieved 11 July 2019.
- ^ HSE.ie. 2007. Archived(PDF) from the original on 10 April 2019. Retrieved 10 April 2019.
- ^ "HSE: 178,000 waiting to see a consultant at an outpatient clinic". Thejournal.ie. 6 April 2012. Retrieved 27 March 2017.
- ^ "Here's what stage 35 primary care centres announced for 20 counties in 2012 are currently in". The Journal. 22 July 2017. Retrieved 25 May 2018.
- ^ "Drugs Payment Scheme". Citizensinformation.ie. 25 October 2016. Retrieved 27 March 2017.
- ^ a b Cullen, Paul (8 October 2019). "Health budget rises to a record €17.4 billion in Budget 2020". The Irish Times.
- ^ "Health Insurance Comparison | HIA: Health Insurance Authority". Hia.ie. Retrieved 27 March 2017.
- ^ "Prescriptions - government schemes explained". Hickeys Pharmacies.
- ^ "Prescription charges for medical card holders". Citizens' Information. 29 January 2019. Retrieved 24 March 2019.
- ^ "Primary Care – Appendix 1". Archived from the original on 7 April 2014. Retrieved 6 April 2014.
- ^ "Irish health sector hit by second ransomware attack in a year". Building Better Healthcare. 5 January 2022. Retrieved 18 February 2022.
- ^ "Taxation and medical expenses". Citizensinformation.ie. Retrieved 27 March 2017.
- S2CID 22029714.
- ^ Hegarty, K (2014). "Suicide in Ireland". The Furrow. 22 (8): 291–297.
- S2CID 36929935.
- ^ "Ireland performs poorly on international index of personalised healthcare". Irish Medical Times. 9 September 2021. Retrieved 17 November 2022.
- ^ "Survey finds widespread satisfaction with health service". BreakingNews.ie. 28 September 2007. Retrieved 27 March 2017.
- ^ "Irish healthcare system winesses improvement in European health consumer ranking" (PDF). Healthpowerhouse.com. Archived from the original (PDF) on 3 March 2016. Retrieved 27 March 2017.
- ^ "Omslag_EHCI_2007_cover02" (PDF). Healthpowerhouse.com. Archived from the original (PDF) on 19 March 2017. Retrieved 27 March 2017.
- ^ "Euro Health Consumer Index 2006" (PDF). Healthpowerhouse.com. Archived from the original (PDF) on 22 February 2011. Retrieved 27 March 2017.
- ^ "Outcomes in EHCI 2015" (PDF). Health Consumer Powerhouse. 26 January 2016. Archived from the original (PDF) on 6 June 2017. Retrieved 27 January 2016.
- ^ a b Ní Fhallúin, Maebh (16 February 2019). "Opinion: Is public healthcare in Ireland failing because we've chosen the path to failure?". The Journal. Retrieved 18 February 2019.
Sources
- Fleetwood, Dr. John F. (1 September 1990). "Irish Quacks and Quackery". Dublin Historical Record. 43 (2). Dublin: JSTOR 30100953.