Health care in the Republic of Ireland


 * "Health care in Ireland" redirects here. For health care in Northern Ireland, see Health and Care NI

Health care in the Republic of Ireland is governed by the Health Act 2004, which established a new body to govern the national health service in the Republic of Ireland, the Health Service Executive. The new health service came into being officially on 1 January, 2005; however the new structures are in the process of being established. Hospital care is free to all, while citizens (and their dependants, be they adult or child) who earn below a certain limit, or in some other circumstances, are entitled to receive some more services (such as dental, aural and oral care, prescription drugs and GP visits) for free, via a 'medical card'.

Minister for Health & Children
The Minister for Health & Children has responsibility for setting overall policy with regard to the health service.

Health Service Executive
The Health Service Excecutive (HSE) manages the delivery of the entire health service as a single national entity. Currently the HSE is continuing to manage the health service under the Health Act 1970 structures. The Health Boards no longer exist as corporate entities, however the structures which existed remain as divisions of the HSE until a plan of reorganisation is complete. Each former health board area operates as a division of the HSE and the former chief executive officer of each health board is now known as a chief officer for the HSE region. There is in the region of 120,000 staff working for the HSE

When the HSE reorganisation plan is completed, there will be three main directorates:
 * The National Hospitals Office, which will manage the hospitals service under a number of hospital networks.
 * The Primary, Community, and Continuing Care Directorate, which will be in charge of the community care service. This will be in turn divided into four Regional Health Offices.
 * The National Shared Services Centre.

Delivery
The delivery of health care in Ireland is currently a major concern of national politics, health care is typically delivered in a mix of private and public systems. The health care system is often criticised for being ad-hoc and fragmentary in nature and not taking advantage of economies of scope.

Health insurance is available to the population for those who want to avail of it. Vhi Healthcare and BUPA Ireland, and VIVAS Health a third player provide health insurance. The provision of health insurance has been controversial in Ireland for a number of years and more so recently, because "risk equalisation" has not been implemented, and it is claimed this would go to some length in creating more even profit margins and risk management between the two main competitors. Although, it is also claimed that Vhi Healthcare is simply trying to strengthen and maintain its market dominance by using risk equalisation to extract large payments from its main competitor BUPA Ireland.

Free primary healthcare is provided under the General Medical Services (GMS) scheme for those who earn below a certain income, and for all over the age of seventy irrespective of income. A medical card is provided by the HSE to those entitled to participate in the scheme. This system of health provision is often criticised as it is reactive rather than preventive in treating patients. Many parties want to extend the medical card scheme to eventually cover the entire population.

A significant proportion of the population is covered by either health insurance or the General Medical Services, whilst many employed people pay the health contribution under the Pay Related Social Insurance system that is administered by the state and gives few benefits.

Primary healthcare
Primary healthcare in Ireland is provided by general practitioners (GPs) who generally operate as sole traders or in practices with up to two other GPs and sometimes practice nurses. GPs generally charge on a per consultation fee basis. People with Medical cards are exempt from charges.

Because of the sole trader nature of GP practice in Ireland this is often criticised as not bringing together various other medical disciplines that can be easily dispensed in the community and complement each other such as baby, child and dental care which even in very small towns or villages may use different facilities and not be near each other.

Hospitals
See also: List of hospitals in Ireland

Hospitals in Ireland generally exist as voluntary organisations (operated by trusts or foundations), though some, such as James Connolly Memorial Hospital at Blanchardstown, are operated directly by the Health Service Executive. Some are teaching hospitals operated in conjunction with a university.

Hospitals in Ireland generally offer a full range of healthcare including accident and emergency services. One ongoing dispute is a proposal that some local hospitals will in the future only offer certain services while major hospitals will offer the full range. This is a matter of much political debate in Ireland.