The Irish health system and the crisis: a case study in the struggle for the capacity of the Social State

Abstract

Ireland’s health care system is a weak Beveridgean system with no entitlement to free care and substantial acute waiting lists. Just under half the population has voluntary private health insurance and there is a two-tier access to acute care with dual practice consultants. Ireland experienced a multifaceted and severe economic crisis from 2008. From late 2010 until late 2013, the government was forced into a Troika bailout of €85 billion. The health sector was given a fairly free hand in the initial Memorandum of Understanding although there was substantial dialogue between the Irish government and the Troika on overspending, competition, the safety net system and high pharmaceutical costs. Yet, in reality, Ireland imposed its own austerity package cutting on health resources and shifting costs onto families and private households. This caused a negative impact on the financial protection of households, acute hospital waiting lists and the health status of the population, albeit alongside some efficiencies. Nevertheless, there is hope for a better health care system with the cross-party development of the Sláintecare Plan to bring Universal Health care over a ten year period through expanded entitlements and system overhaul. Despite opposition from vested interests this is slowly being implemented.