Healthcare in the Republic of Ireland
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Health care in Ireland is two-tier: public and private sectors exist. The public health care system is governed by the Health Act 2004,[1] which established a new body to be responsible for providing health and personal social services to everyone living in Ireland – the Health Service Executive. The new national health service came into being officially on 1 January 2005; however the new structures are currently in the process of being established as the reform programme continues. In addition to the public-sector, there is also a large private healthcare market.
In 2010 Ireland spent €2,862 per capita on health, compared to a European Union average of €2,172 per capita,[2] of this spending approximately 79% was government expenditure.[3]
Health care system
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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. A person may be required to pay a subsidised fee for certain health care received; this depends on income, age, illness or disability. All maternity services and child care up to the age of six months are provided free of charge. Emergency care is provided at a cost of €100 for a visit to the Accident and Emergency department.
Everyone living in the country, and visitors to Ireland who hold a European Health Insurance Card, are entitled to free maintenance and treatment in public beds in Health Service Executive and voluntary hospitals, UK and CTA (Common Travel Area) 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 for free. However the majority of patients on median incomes or above, are required to pay subsidised hospital charges.
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, those with certain long-term or severe illnesses and in certain other cases. Many political parties support extending the availability of the Medical Card to eventually cover everyone resident in Ireland – they currently cover 31.9% of the population. Those on slightly higher incomes are eligible for a GP Visit Card which entitles the holder to free general practitioner visits. For persons over 70 years who are not entitled to a medical card or GP visit card they instead receive an annual cash grant of €400 up to a certain income.
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 A&E charge for those who attend an accident and 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[4]). Hospital charges (for inpatients) are a flat fee of €75 per day up to a maximum of €750 in any twelve-month period, irrespective of the actual care received. Specialist assessments and diagnostic assessments (such as X-rays, laboratory tests, physiotherapy, etc.) are provided for free. If a person cannot afford to pay hospital charges, the HSE will provide the services free of charge.
Hospitals and health outcomes
Many hospitals in Ireland, such as Connolly Hospital at Blanchardstown, are operated directly by the HSE. There are also hospitals run under a voluntary basis by organisations who receive public funding but operate with some degree of autonomy. Included in this latter group are teaching hospitals (such as University Hospital Galway) operated in conjunction with a university and hospitals with a long-standing religious ethos e.g. Adelaide and Meath Hospital in Dublin. There are also many private hospitals. Ireland has a lower than OECD-average number of hospital beds according to the 2013 OECD Health at a Glance Report[5] The same report also noted that Ireland has fewer doctors (2.7 doctors per 1,000 population) and more nurses (12.2 nurses per 1,000 population) than average in other OECD countries.
Hospitals in Ireland generally offer a full range of healthcare including accident and emergency services. There have been dramatic reductions in mortality from the three principal causes of death in Ireland - heart disease, cancer and stroke - in recent years[6] age-standardised mortality rate for heart disease has fallen by 59% between 1990-2011 and now stands just above the OECD rate at 136 deaths per 100,000 population per annum. Similarly the age-standardised mortality rate for stroke has fallen by 51% in the same period to below the OECD average (61 deaths from stroke per 100,000 population per annum). Deaths from cancer have fallen by 21% between 1990-2011 to 217 per 100,000.
Waiting lists
Ireland has reduced its spending on healthcare by 6.6% since the onset of the Global Financial Crisis according to the OECD's 2013 Health Report. As a result, waiting times for treatment have been noted to increase.
According to the Euro health consumer index waiting times for emergency treatment, minor operations, and CT scans, in Irish hospitals in 2015 were the worst in Europe, though the Irish health system was ranked 21st out of 35 European countries.[7] The Health Service Executive accepted that it lacked capacity to provide sufficiently accessible health services. It was working to ensure that no one had to wait more than 18 months for an outpatient appointment, or inpatient treatment. According to the index reports by patients on waiting times were considerably more pessimistic than official Irish waiting-time statistics.[8]
In 2007,[9] 76% of inpatients were admitted to hospital for operations immediately, 11% had to wait up to one month, 4% had to wait up to three months, 1% had to wait up to six months and 4% had to wait for over six months for operations. Waiting times at the National Rehabilitation Hospital, the only such facility in the country, can be one year. For outpatients, 23% were seen on time, 44% were seen within 30 minutes, 18% waited more than an hour and 7% waited two hours.
In 2007,[9] for GP services, 31% were seen without an appointment, 38% received a same day appointment, 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 (with the average in 2009 being 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 he HSE under their NTPF, and contrary to relevant judgements by the European Court of Justice.
HSE figures quoted in April 2012[10] show that at least 178,000 people in Ireland are on waiting lists to see specialists at an outpatient clinic and that more than 300 patients have been waiting for over four years to be seen by a consultant after being referred by their GP.
Health centres
Health centres provide a wide range of primary care and community services in towns and villages throughout Ireland, and are run by the HSE. Services available at these clinics include GP services, public health nurses, social work and child protection services, child health services, community welfare, disability services, older people services, chiropody, ophthalmic, speech therapy, addiction counselling and treatment, physiotherapy, occupational therapy, psychiatric services, Home Help and more. These services are available for free or at a subsidised rate.
General practitioners
Primary healthcare 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 €60. People with Medical Cards or GP Visit Cards are exempt from charges. Many GPs also provide services to those with Hepatitis C and maternity and infant services for free. Those with private health insurance can, depending on their plan, get their GP costs paid for or refunded ("cash back"), 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 free or at a reduced cost. The Drugs Payment Scheme ensures that every household only has to pay, maximum, €144 per calendar month for up to a maximum of one month's supply of prescribed drugs, medicines and medical appliances.[11] Some private health insurance plans provide partial reimbursement up to the Drugs Payment Scheme threshold.[12] Those who hold Medical Cards, suffering from long-term illnesses do not have to pay anything for medicines or appliances [citation needed]. Ireland has below average use of generic medication according to the OECD, despite being a major exporter.
All immunisation vaccines for children are provided free of charge, and are provided in schools, health clinics or hospitals.
Recovering heroin addicts are able to get methadone treatment for free under the Methadone Treatment Scheme.[13]
Other services
The HSE provide dental, optical (vision) and aural (hearing) health care. Medical Card holders and their dependants, Health Amendment Act Card holders and children get these services for free. Other people can get these services for free or at a reduced cost from the Treatment Benefit Scheme and/or private insurance, or claim tax relief after paying the full cost with a private practitioner.[14]
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 lacking in sufficient services for those with mental health issues[15] due to the rapidly growing suicide rate[16] and ineffective services delivered to young people.[17]
Payment schemes
Those without a Medical Card or private health insurance are able to receive medical services for free or at a subsidised rate from the Treatment Benefit Scheme – as are their dependants – which brings into account the compulsory Social Insurance Fund (PRSI) contributions they have made. People can also claim tax-relief on medical expenses that are not covered by the State or by private health insurance. Those with private health insurance also get tax credits, which are passed directly on to the insurance company and lower the customer's premium.
Visitors to Ireland who hold a European Health Insurance Card do not have to pay anything 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 such treatments, can arrange for it before their visit.
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.[18]
The 2008 Health Consumer Powerhouse Euro Health Consumer Index report ranked Ireland's public healthcare system 11th out of 31 European countries.[19] This is an improvement on the 2007 report which ranked the Ireland 16th out of 29 countries,[20] and a drastic improvement on the 2006 report, in which Ireland was ranked 26th out of 26 countries.[21]
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).
The HSE 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.
The HSE's organisational structure is divided into three main areas:
- Health and Personal Social Services, which in turn is divided into three service delivery units:
- The National Hospitals Office (NHO), which manages acute hospital and ambulance services.
- Primary, Community and Continuing Care (PCCC), which delivers health and personal social services in the community and other settings.
- Population Health, which promotes and protects the health of the entire population.
- Support Services, which enables the HSE to function efficiently and cost effectively.
- Reform and Innovation, which drives the HSE's strategic and corporate planning processes.
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 to avail of it. Vhi Healthcare (which is part-owned by the government), Laya Healthcare, and Aviva provide health insurance, among other services. Quote Devil were set up in 2006 to provide health insurance amongst other insurance types. 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.[22]
The Hospital Saturday Fund (HSF) is also available to give customers cash towards a range of every day health care costs.
Health statistics
- 47.6% of Ireland's population were covered by private health insurance, and 31.9% of the population were covered by Medical Cards.
- 23.8% of the population over 16 had a "chronic illness or health problem".
- 19.6% of the population over 16 had "limited activity", of which 6.6% were "strongly limited" and 13.0% were "limited".
- 47.2% of the population over 16 described their health as "very good", 35.7% as "good", 13.5% as "fair" and only 3.6% as "bad" or "very bad".
- 24.9% of the population over 16 were classed as smokers.
- There were 53 publicly funded acute hospitals, with a total of 12,094 in-patient beds available and 1,253-day beds available.
- The average length of an in-patient stay in hospital was 6.6 days.
See also
- Health care system
- Maev-Ann Wren, analyst and critic of Irish healthcare provision
References
- ^ "Health Act 2004". Irish Statute Book. Office of the Attorney General. Retrieved 5 October 2010.
- ^ http://www.rte.ie/news/2012/1116/345998-health-OECD-European-union accessed December 10th 2013
- ^ WHO Statistical Information System
- ^ http://www.inchicoredoctors.ie/
- ^ http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf accessed December 2013
- ^ http://www.dohc.ie/press/releases/2011/2011219.html accessed December 10th 2013
- ^ "Irish emergency care waiting times rated worst in Europe". Irish Times. 26 January 2016. Retrieved 30 January 2016.
- ^ "Numbers awaiting outpatient assessment unacceptable - HSE". RTE. 26 January 2016. Retrieved 30 January 2016.
- ^ a b Health Service Executive – Insight 07
- ^ http://www.thejournal.ie/hse-178000-waiting-to-see-a-consultant-at-an-outpatient-clinic-409073-Apr2012/
- ^ http://www.citizensinformation.ie/en/health/entitlement_to_health_services/drugs_payment_scheme.html
- ^ http://www.hia.ie/ci/comparison/step3?231¤t=231/
- ^ http://www.dohc.ie/publications/fulltext/primary_care_new_direction/appendix1.html
- ^ http://www.citizensinformation.ie/en/money_and_tax/tax/income_tax_credits_and_reliefs/taxation_and_medical_expenses.html
- ^ McNamara, McNicholas, Ford, Paul, Gavin, Coyne, Cullen, O'Connor, Ramperti, Dooley, Barry, Singh (2002). "Early Intervention in the Real World-Transition from child and adolescent to adult mental health services in the Republic of Ireland: an investigation of process and operational practice". Early Intervention in Psychiatry. 53 (9): 466–468.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Hegarty, K (2014). "Suicide in Ireland". The Furrow. 22 (8): 291–297.
- ^ Illback, Bates (2011). "Transforming youth mental health services and supports in Ireland". Early Intervention in Psychiatry. 5 (1): 22–27.
- ^ BreakingNews.ie – Survey finds widespread satisfaction with health service
- ^ Health Power House – EHCI 2008
- ^ Health Power House – EHCI 2007
- ^ Health Power House – EHCI 2006
- ^ "Outcomes in EHCI 2015" (PDF). Health Consumer Powerhouse. 26 January 2016. Retrieved 27 January 2016.
- ^ Statistical Yearbook 2007 – Social Inclusion
- ^ Statistical Yearbook 2007 – Health and Social Condititons