Healthcare in the Republic of Ireland


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



The Irish health care system is a socialized, universal, public health care system and is governed by the Health Act 2004, 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 large public-sector, there is also a large private healthcare market.

Health Care System
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 child health and maternity services are provided free of charge as is emergency care.

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. Outpatient services are also provided for free. However some people, mostly high-income earners, may have 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, all persons aged 70 or over, 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.

People who do not qualify for a Medical Card, 68.1% of the population, must pay for certain health care services at a subsidised rate. Hospital charges (for inpatients) cost €66 per day up to a maximum of €660 per year, though the actual care received is free. Those who do not qualify for the exemptions can also be charged €66 (only once per year) for a visit to an outpatient department or an accident and emergency department if the patient has not been referred by a family doctor. 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
See also: List of hospitals in Ireland

Many hospitals in Ireland, such as James Connolly Memorial Hospital at Blanchardstown, are operated directly by the HSE. There are also hospitals run under a voluntary basis by organisations. Some are teaching hospitals (such as University College Hospital Galway) operated in conjunction with a university. There are also many private hospitals.

Hospitals in Ireland generally offer a full range of healthcare including accident and emergency services.

Waiting lists
The public health system, despite having billions spent on it in recent years, has some problems. An ongoing issue is the "waiting lists" for those requiring, in some cases, serious operations.

In 2007, 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.

For outpatients, 23% were seen on time, 44% were seen within 30 minutes, 18% waited more than an hour and 7% waited two hours.

The National Treatment Purchase Fund was set up in 2002 for those waiting over three months for an operation or procedure, and as a result over 100,000 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 to five months, compared to between two and five years in 2002.

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 there being 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 €50. 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.

Waiting times
In 2007, 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.

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, €90 per month for prescribed drugs, medicines and medical appliances. Those who hold Medical Cards, suffering from long-term illnesses, or who have Hepatitis C, do not have to pay anything for medicines or appliances.

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.

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.

The HSE also provide mental health services, and treatment and rehabilitation services for alcohol and drug addicts.

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 compulsary 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.

The 2007 Health Consumer Powerhouse Euro Health Consumer Index report ranked Ireland's public health system 16th out of 29 European countries. This is a drastic improvement on the 2006 EHCI report, in which Ireland was ranked 26th out of 26 European countries.

Health Service Executive
The Health Service Excecutive (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 €12 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 and Children
The Minister for Health and Children 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 owned by the government), Quinn Healthcare, and Vivas Health provide health insurance, among other services. In 2005, 47.6% of people were covered by private health insurance.

Private health insurance, by law, uses Community Rating, Open Enrolment (Lifetime Cover) and Risk Equalisation, and this means that everyone with private insurance pays the same premium regardless of age, gender or health profile. The only exceptions are children and students, whose premiums cannot be more than 50% of the adult rate, group schemes can also get a discount of 10%, and some pensioners may also receive a discount. This legislation results in low prices and encourages competition between the insurers. The law also states that no one can be refused health insurance cover if they want it, and no one can be refused the chance to renew a health insurance policy.

The regulatory body for private health insurance is the Health Insurance Authority.

Health Statistics
In 2005 :


 * 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 smokers, even though the legal age to buy tobacco is 18.
 * 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.