Health insurance in Ireland : issues and challenges

Over the past decade or so the context in which Irelands complex mix of public and private health care operates has changed radically, as the numbers purchasing health insurance have soared and the nature of the insurance market has changed in response to EU regulations. This has widened the divide between those with and without health insurance, and called into question the public-private structure on which Ireland has relied for many years. Almost half the Irish population now pay for private health insurance, one of the highest levels of coverage in the OECD. This is despite the fact that hospital care is what private health insurance mostly covers, and everyone has entitlement to public hospital care from the state. The insured can avail of private health care, but much of this private care is actually delivered in public hospitals. The resulting two-tier system is now widely regarded as problematic from an equity perspective, but there are also serious efficiency issues arising from the incentive structures embedded in this particularly close intertwining of public and private.