Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-25T04:28:21.089Z Has data issue: false hasContentIssue false
  • English
  • Français

A European late starter: lessons from the history of reform in Irish health care

Published online by Cambridge University Press:  26 December 2017

Maev-Ann Wren Open the ORCID record for Maev-Ann Wren [Opens in a new window]  and
Sheelah Connolly
Maev-Ann Wren*
Affiliation:
The Economic and Social Research Institute, Whitaker Square, Sir John Rogerson’s Quay, Dublin, Ireland
Sheelah Connolly
Affiliation:
The Economic and Social Research Institute, Whitaker Square, Sir John Rogerson’s Quay, Dublin, Ireland
*
*Correspondence to: The Economic and Social Research Institute, Whitaker Square, Sir John Rogerson’s Quay, Dublin 2, Ireland. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care. The majority of the population pays out-of-pocket fees to access primary health care. Due to long waits for public hospital care, many purchase private health insurance, which facilitates faster access to public and private hospital services. The system has been the subject of much criticism and repeated reform attempts. Proposals in 2011 to develop a universal health care system, funded by Universal Health Insurance, were abandoned in 2015 largely due to cost concerns. Despite this experience, there remains strong political support for developing a universal health care system. By applying an historical institutionalist approach, the paper develops an understanding of why Ireland has been a European outlier. The aim of the paper is to identify and discuss issues that may arise in introducing a universal healthcare system to Ireland informed by an understanding of previous unsuccessful reform proposals. Challenges in system design faced by a late-starter country like Ireland, including overcoming stakeholder resistance, achieving clarity in the definition of universality and avoiding barriers to access, may be shared by countries whose universal systems have been compromised in the period of austerity.

Type
Articles
Information
Health Economics, Policy and Law , Volume 14 , Issue 3 , July 2019 , pp. 355 - 373
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amarach Research (2015), The Future of Ireland, Dublin, Ireland: OMD Ireland.Google Scholar
Bal, R. and Zuiderent-Jerak, T. (2011), ‘The practice of markets in Dutch health care: are we drinking from the same glass?’, Health Economics, Policy and Law, 6(1): 139–145.Google Scholar
Barrington, R. (1987), Health, Medicine and Politics in Ireland 1900–1970, Dublin: Institute of Public Administration.Google Scholar
Breen, R., Hannan, D., Rottman, D. and Whelan, C. (1990), Understanding Contemporary Ireland: State, Class and Development in the Republic of Ireland, Dublin: Gill and MacMillan.Google Scholar
Brick, A., Nolan, A., O’Reilly, J. and Smith, S. (2010), Resource Allocation, Financing and Sustainability in Health Care: Evidence for the Expert Group on Resource Allocation and Financing in the Health Sector, Dublin, Ireland: The Economic and Social Research Institute.Google Scholar
Browne, N. (1989), Against the Tide, Dublin: Gill and Macmillan.Google Scholar
Busse, R., Schreyögg, J. and Gericke, C. (2007), ‘Analyzing Changes in Health Financing Arrangements in High-Income Countries: A Comprehensive Framework Approach’. Health, Nutrition and Population (HNP) Discussion Paper, The World Bank.Google Scholar
Catholic Church (1963), Peace on Earth: Encyclical Letter of Pope John XXIII, London: Catholic Truth Society.Google Scholar
Central Statistics Office (2016), Ireland’s System of Health Accounts, Annual Results 2014, Dublin: Central Stastics Office.Google Scholar
Council of the European Union (2006), Council Conclusions on Common Values and Principles in EU Health Systems, Brussels: Council of the European Union.Google Scholar
Crouch, C. (1993), Industrial Relations and European State Traditions, Oxford: Clarendon Press.Google Scholar
Dail Debates (2012), Speech by Minister of State, Roisin Shortall, in Motion of Confidence in the Minister for Health, Houses of the Oireachtas, Dáil Eireann Debate Volume 773 No. 2, http://oireachtasdebates.oireachtas.ie/debates. Accessed August 23rd 2016.Google Scholar
Dail Debates (2016), ‘Role of the Committee on the Future of Healthcare’, http://www.oireachtas.ie/parliament/oireachtasbusiness/committees_list/future-of-healthcare/role/ [20 August 2016].Google Scholar
Daly, M. (1981), Social and Economic History of Ireland, Dublin: The Educational Company.Google Scholar
Department of Health (2014), ‘The Path to Universal Healthcare: White Paper on Universal Health Insurance’. Dublin, Ireland: Department of Health.Google Scholar
Department of Health (2015), Statement by Minister Varadkar Following Cabinet Discussion on UHI. Dublin, Ireland: Department of Health.Google Scholar
Department of Health (2016), ‘Progress on the first year of our three-year Statement of Strategy 2015–2017’, Annual Report 2015. Dublin, Ireland: Department of Health.Google Scholar
Department of the Taoiseach (2011), Programme for Government 2011–2016, Dublin, Ireland: Department of the Taoiseach.Google Scholar
Department of the Taoiseach (2016), A Programme for a Partnership Government, Dublin, Ireland: Department of the Taoiseach.Google Scholar
Esping-Andersen, G. (1990), The Three Worlds of Welfare Capitalism, Cambridge: Polity Press.Google Scholar
Fine Gael (2009), ‘FairCare: Fine Gael Proposals to Reform the Health Service and Introduce Universal Health Insurance’. Fine Gael.Google Scholar
Fitzgerald, J. (2006), ‘Lessons From 20 Years of Cohesion’, in S. Mundschenk, M. H. Stierle, U. Stierle von Schütz and I. Traistaru (eds), Competitiveness and Growth in Europe: Lessons and Policy Implications of the Lisbon Strategy, Mannheim: ZEI, 66–100.Google Scholar
Foot, M. (1973), Aneurin Bevan; Volume II 1945–1960, London: Davis-Poynter.Google Scholar
Gallagher, M. and Marsh, M. (2016), How Ireland Voted 2016: The Election that Nobody Won, Basingstoke: Palgrave MacMillan.Google Scholar
Garvin, T. (1999), ‘Democratic Politics in Independent Ireland’, in J. Coakley and M. Gallagher (eds), Politics in the Republic of Ireland, London: Routledge, 311–323.Google Scholar
Goodey, C. (2015), ‘Why GPs oppose free care for children under 6’, http://nagp.ie/news-media/why-gps-oppose-free-care-for-children-under-6 [28 July 2016].Google Scholar
Houses of the Oireachtas Committee on the Future of Healthcare (2017), ‘Sláintecare Report’. Dublin, Ireland: Houses of the Oireachtas.Google Scholar
Hsiao, W. C., Knight, A. G., Kappel, S. and Done, N. (2011), ‘What other states can learn from Vermont’s bold experiment: embracing a single-payer health care financing system’, Health Affairs (Millwood), 30(7): 1232–1241.Google Scholar
Irish Medical Organisation (2010), ‘IMO Position Paper on Universal Health Coverage’. Dublin: IMO.Google Scholar
Kennedy, K., Giblin, T. and McHugh, D. (1988), The Economic Development of Ireland in the Twentieth Century, London: Routledge.Google Scholar
Kringos, D., Boerma, W., Bourgueil, Y., Cartier, T., Dedeu, T., Hasvold, T., Hutchinson, A., Lember, M., Oleszczyk, M., Rotar Pavlic, D., Svab, I., Tedeschi, P., Wilm, S., Wilson, A., Windak, A., Van der Zee, J. and Groenewegen, P. (2013), ‘The strength of primary care in Europe: an international comparative study’, British Journal of General Practice, 63(616): e742–e750.Google Scholar
Kutzin, J. (2012), ‘Anything goes on the path to universal health coverage? No’, Bulletin of the World Health Organization, 2012(90): 867–868.Google Scholar
Kutzin, J. (2013), ‘Health financing for universal coverage and health system performance: concepts and implications for policy’. Bulletin of the World Health Organization, World Health Organization, 91(8): 602–611.Google Scholar
The Labour Party (2011), Labour’s Plan for Fair Health Care, Dublin: The Labour Party.Google Scholar
Leahy, P. (2017), ‘FG and FF insist recommendations on healthcare be amended’. The Irish Times, 29 May 2017. https://www.irishtimes.com/news/politics/fg-and-ff-insist-recommendations-on-healthcare-be-amended-1.3099576 [30 May 2017].Google Scholar
Loughlin, E. (2016a), ‘Labour minister Kathleen Lynch says Fine Gael stalled free GP care plans’. Irish Examiner, 6 January 2016. http://www.irishexaminer.com/ireland/labour-minister-kathleen-lynch-says-fine-gael-stalled-free-gp-care-plans-374549.html [5 May 2016]Google Scholar
Loughlin, L. (2016b), ‘Legislation by consensus will be better: Regina Doherty’. Irish Examiner, 9 May 2016. http://www.irishexaminer.com/ireland/legislation-by-consensus-will-be-better-regina-doherty-398331.html [10 May 2016].Google Scholar
Lu, J. and Hsiao, W. C. (2003), ‘Does universal health insurance make health care unaffordable? Lessons from Taiwan’, Health Affairs, 22(3): 77–88.Google Scholar
Lynch, F. (2014), Letter to Mr David Moloney, Assistant Secretary, Department of Public Expenditure and Reform. Released under Freedom of Information, Dublin, Ireland: Department of Health.Google Scholar
Mair, P. (1999), ‘Party competition and the changing party system’, in J. Coakley and M. Gallagher (eds), Politics in the Republic of Ireland, London: Routledge, 127–151.Google Scholar
Mathauer, I. and Nicolle, E. (2011), ‘A global overview of health insurance administrative costs: what are the reasons for variations found?’, Health Policy, 102(2–3): 235–246.Google Scholar
Mikkers, M. and Ryan, P. (2014), ‘“Managed competition” for Ireland? The single versus multiple payer debate’, BMC Health Services Research, 14(1): 442.Google Scholar
MillwardBrown (2016), Health Insurance Authority – A review of private health insurance in Ireland, The Health Insurance Authority, http://www.hia.ie/publication/consumer-surveys [21 August 2017]Google Scholar
O’Connell, T., Rasanathan, K. and Chopra, M. (2014), ‘What does universal health coverage mean?’, Lancet, 383: 277–279.Google Scholar
O’Connor, N. (2017), ‘Harris considers leasing maternity hospital land in U-turn on controversy’. Irish Independent, 1 May 2017. https://www.independent.ie/irish-news/health/harris-considers-leasing-maternity-hospital-land-in-uturn-on-controversy-35668350.html [2 May 2017]Google Scholar
O’Connor, N. and O’Regan, E. (2017), ‘Varadkar and Harris insist tax reliefs here to stay’. Irish Independent, 7 April 2017. https://www.independent.ie/irish-news/politics/varadkar-and-harris-insist-tax-reliefs-here-to-stay-35601938.html [8 April 2017].Google Scholar
O’Regan, E. (2014), ‘Opposition grows to plan for universal healthcare’. Irish Independent, 7 April 2014.Google Scholar
O’Reilly, D., O’Dowd, T., Galway, K. J., Murphy, A. W., O’Neill, C., Shryane, E., Steele, K., Bury, G., Gilliland, A. and Kelly, A. (2007), ‘Consultation charges in Ireland deter a large proportion of patients from seeing the GP: results of a cross-sectional survey’, European Journal of General Practice, 13(4): 231–236.Google Scholar
Pierson, P. and Skocpol, T. (2002), ‘Historical Institutionalism in Contemporary Political Science’, in I. Katznelson and H.V. Milner (eds), Political Science: State of the Discipline, New York: W.W. Norton, 693–721.Google Scholar
Prosser, T. (2010), ‘EU Competition Law and Public Services’, in E. Mossialos, G. Permanand, R. Baetan and T. Hervey (eds), Health Systems Governance in Europe: The Role of European Union Law and Policy, Cambridge University Press, 315–336.Google Scholar
Rosenau, P. V. and Lako, C. J. (2008), ‘An experiment with regulated competition and individual mandates for universal health care: the new Dutch health insurance system’, Journal of Health Politics, Policy and Law, 33(6): 1031–1055.Google Scholar
Ruane, F. (2010), ‘Report of the expert group on resource allocation and financing in the health sector’. Dublin, Ireland: Department of Health and Children.Google Scholar
Ryan, P., Thomas, S. and Normand, C. (2009), ‘Translating Dutch: challenges and opportunities in reforming health financing in Ireland’, Irish Journal of Medical Science, 178(3): 245–248.Google Scholar
Skocpol, T. (1979), States and Social Revolutions : A Comparative Analysis of France, Russia and China, Cambridge: Cambridge University Press.Google Scholar
Skocpol, T. (2008), ‘Bringing the state back in: retrospect and prospect’, Scandinavian Political Studies, 31(2): 109–124.Google Scholar
Smith, S. and Normand, C. (2011), ‘Equity in health care: the Irish perspective’, Health Economics, Policy and Law, 6: 205–217.Google Scholar
Taylor, M. G. (1987), ‘Health Insurance and Canadian Public Policy – the seven decisions that created the Canadian heath insurance system and their outcomes’. Toronto, Ontario, The Institute of Public Administration of Canada/McGill-Queen’s University Press.Google Scholar
Thomas, S., Normand, C. and Smith, S. (2006), Social Health Insurance:Options for Ireland, Dublin: The Adelaide Hospital Society.Google Scholar
Thomas, S., Normand, C. and Smith, S. (2008), Social Health Insurance: Further Options for Ireland, Dublin: The Adelaide Hospital Society.Google Scholar
Thomas, S., Ryan, P. and Normand, C. (2010), Effective Foundations for the Financing and Organisation of Social Health Insurance in Ireland, Dublin, Ireland: The Adelaide Hospital Society.Google Scholar
Thomson, S., Jowett, M., Mladovsky, P., Evetovits, T., Figueras, J., Nolan, A. and Normand, C. (2012), Health System Responses to Financial Pressures in Ireland: Policy Options in an International Context, Brussels, Belgium: World Health Organisation and European Observatory on Health Systems and Policies.Google Scholar
Thomson, S., Busse, R., Crivelli, L., van de Ven, W. and Van de Voorde, C. (2013), ‘Statutory health insurance competition in Europe: a four-country comparison’, Health Policy, 109(3): 209–225.Google Scholar
Thomson, S., Foubister, T. and Mossialos, E. (2009), Financing Health Care in the European Union: Challenges and Policy Response, Denmark: World Health Organisation.Google Scholar
Tussing, A. D. and Wren, M. (2006), How Ireland Cares: The Case for Health Care Reform, Dublin: New Island.Google Scholar
Whyte, J. H. (1980), Church and State in Modern Ireland 1923–1979, 2nd edn, Dublin: Gill and Macmillan.Google Scholar
World Health Organization (WHO) (2010), ‘The world health report: health systems financing: the path to universal coverage’. Geneva: WHO Press, World Health Organization.Google Scholar
Wren, M. (2003), Unhealthy State – Anatomy of a Sick Society, Dublin: New Island.Google Scholar
Wren, M. and Connolly, S. (2016), ‘Challenges in achieving universal healthcare in Ireland’, Dublin: Economic and Social Research Institute Budget Perspectives, 2017(1): 1–28.Google Scholar
Wren, M., Connolly, S. and Cunningham, N. (2015), ‘An examination of the potential costs of Universal Health Insurance in Ireland’, Research Series Dublin: Economic and Social Research Institute.Google Scholar
Wren, M., Connolly, S. and Cunningham, N. (2016), ‘An approach to estimating the effects of financing system change on Irish healthcare expenditure’, Journal of the Statistical and Social Inquiry Society of Ireland, XLV: 1–15.Google Scholar