Ireland grapples with public vs private healthcare

 

In Ireland, the demand for private health insurance is relatively high comparatively, and this influences debate on how healthcare is provided in the country.

Sláintecare is the Irish Government’s 10-year strategy to reform the Irish healthcare system. It aims to address deficiencies in the healthcare sector and pledges to tackle the two-tier nature of the system, where wealthier patients can skip lengthy public waiting lists for procedures by going private. The proposed reforms outlined by Sláintecare (including the phased elimination of private care from public hospitals) are ambitious but so far, the strategy has foundered due to disagreements on what to do, when, and how to pay for it.

An independent research paper commissioned by the independent regulator for private health insurance, The Health Insurance Authority (HIA) titled ‘The Irish Healthcare System’ has now been published. This research paper provides a historical and comparative view of Irish healthcare which, the HIA hopes, will raise awareness among the public, providers, insurers and policymakers about the current and proposed systems.

Some of the key points in the paper include:

  • Privately insured patients in Ireland may be treated in private hospitals or in public hospitals. This can create incentives for practitioners to treat some patients over others given the different reimbursement mechanisms for public and private patients.
  • The removal of private practice from Irish public hospitals would represent a significant shift from the current model. If implemented successfully, the increase in capacity of public hospitals will be challenging, not only from the point of view of raising the required funding, but also in terms of recruitment and retention of staff, particularly given the shortages of suitably qualified staff internationally.
  • The removal of private practice from public hospitals will have a significant impact on the overall structure of the Irish healthcare system and private health insurance market.
  • Most consultants employed in Irish public hospitals have private practices, so they may be forced to choose between public and private hospitals (unless they will be permitted to have separate contracts with public and private hospitals).
  • Privately insured patients would no longer have the option of being treated in public hospitals, increasing the pressure on capacity demand of private hospitals but they will still have entitlement to be treated as public patients.
  • The removal of private practice from public hospitals would potentially affect demand in private hospitals. The Private Hospitals Association says that its member hospitals care for 400,000 patients per annum.
  • There may be a reduction in demand for private health insurance if investment in the public hospital system leads to shorter waiting times and greater confidence surrounding access and services in public hospitals.
  • Ultimately, the success of Sláintecare and the resulting impact on the private health insurance market, will depend on how well funded it is.

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