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New Public Health Care System in the Republic of Ireland

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The Republic of Ireland has experienced a transformative change in health care over the last decade. What was once a two-tiered system (public and private) has now been transitioned into a “comprehensive, government funded public health care system” broken into two categories; those with medical cards and those without.

Prior to this time, Ireland had a system that produced long waiting lines, inequity of services based on income, and a lack of technological advances, much like the Beveridge system in the United Kingdom. In 2011, following a governmental change, the Republic of Ireland moved to a government plan largely funded by taxes. This transition moved what was once considered a Beveridge-like plan into a Bismarck-type plan where coverage is universal albeit the equitable part is for your own interpretation. The Irish spent years researching the Dutch health care system and tried to model their new system around that one. The transformation is said to be complete by 2020.

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A person must reside in Ireland for one year to gain access to the health care system via one of two avenues under the public system:

  • Individuals with medical cards
  • Individuals without medical cards

Medical card eligibility is based on weekly income, family size, savings, investments, and property levels. 30% of individuals qualify for medical cards which permits access to free general practitioner services, prescription drugs, hospital services, dental and vision services, maternity care, and some social services.

Individuals without cards are entitled to hospital services, prescription drugs, and maternity care but not general practitioner services. Additionally, individuals will likely need to pay a fee during hospital stays. These individuals may purchase voluntary insurance coverage (about 40%), via the private system, to help fill the gaps that the national system will not cover.

The system will cover anyone who resides in Ireland for after one year so coverage is nationwide but access to care continues to be an issue. This is likely due to the higher than average ratio of physicians to patients due to the centralized hiring process. Ireland has also seen a decrease in health care professionals in recent years as well as an increase in the cost of care.

The system allows more access to care for those with medical cards but the wait time is decreased for those with additional private coverage which presents an interesting issue. Those with medical cards get more care with longer wait time and those with higher income can essentially pay for a reduction in wait times. I wonder if a study will be done on which approach improves health outcomes when all other variances can be accounted for.

The traditional Bismarck model aims to provide choice, reduced wait time, high quality and low costs while being challenged with wanting to increase costs due to increased amounts of expensive care.

Overall, I think the transition has left Ireland with issues that still need to be addressed. Ireland has provided choice and some advancements in technology. It has solved the issue of coverage for all but still needs significant work on access to care and the cost of care. Not unlike the United States, they have to find ways to improve the overall health of its population, which making care less expensive and more efficient.


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