An Ireland Worth Working For by Tom Healy

Author:Tom Healy [Healy, Tom]
Language: eng
Format: epub
ISBN: 9781848407251
Published: 0101-01-01T00:00:00+00:00

A plan for healthcare

Health of mind and body is a fundamental human right. Access to health services on the basis of need rather than ability to pay is a vital human need and right. The 1919 Democratic Programme asserted that ‘it shall be the duty of the Republic of Ireland to take such measures as will safeguard the health of the people and ensure the physical as well as the moral well-being of the Nation’. The views of the Report of Oireachtas Committee on the Future of Healthcare (Houses of the Oireachtas, 2017a) are significant, especially in its statement of first principles, which calls for ‘a vision and a plan for re-orienting the health service towards a high quality integrated system providing care on the basis of need and not ability to pay.’

The report (hereafter referred to as the Sláintecare Report) marks an important milestone as it represents a broad political consensus on the need to move away from a two-tier system of health provision in the Republic of Ireland to one based on need and funded mainly or almost entirely from public sources. Given the historical legacy of failure to deliver sufficient reform in the way healthcare is managed and funded, a political momentum to achieve a publicly funded, single healthcare system within a decade is to be welcomed. However, two significant matters need to be addressed: (i) There are areas of healthcare resource allocation and usage where improvements in performance could be achieved and further cost savings effected. Key examples of this include education in healthy living and investment in primary and comprehensive healthcare facilities; and (ii) any significant and continuing increase in health spending will require additional revenue. A working paper published by the NERI (Goldrick-Kelly and Healy, 2018) builds on the work of the Sláintecare Report while addressing these two areas.

Significant strides forward in healthcare and in health outcomes have been achieved over recent decades. Life expectancy has risen significantly while the Republic of Ireland is now above the European Union average on this measure (Figure 23). However, the close tie between social class background and health has not narrowed and there is a clear correlation between social class and health status (Figure 24).

In any jurisdiction, the provision of a quality and efficient health service entails the outlay of anything between 5 and 15 per cent of GDP, depending on many factors, including the level of development of a country. How expenditure for health is funded is a matter of societal and political choice. In common with most European countries the level of subvention from the state accounts for the bulk of expenditure in the Republic of Ireland. The Republic of Ireland has an unusual funding arrangement for the following reasons:

– The extent of out-of-pocket and private health insurance expenditure is greater than in other EU states.

– User charges have increased significantly in recent years (e.g. prescription re-imbursement limits, charges per item for medical-card holders and other charges have risen as a result of cutbacks in public spending on health).

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