No other area of public service provision arouses as much controversy in Ireland as health care. The media is filled with complaints about waste, inefficiency and poor service in public hospitals. On the other hand, policymakers and politicians with responsibility in this area point to progress being made, as evidenced by rationalization of care delivery, improved services and better outcomes.
The body responsible for the delivery of public health services in Ireland is the Health Services Executive (HSE), created in 2005 through the amalgamation of regional health boards that had previously run the system in a fragmented way. The HSE now has a budget of €17 billion, equal to 10% of GDP. During the period under review, it continued the task of rationalizing and streamlining the delivery of public health services, and has claimed significant success in many areas, notably cancer and primary health care. The rationalization of the health services sector has inevitably involved centralization of specialized facilities in a smaller number of “centers of excellence” as compared to the historical network of small-scale units dispersed in a large number of places throughout the country. Given the country’s low population density, it is inevitable that specialization along these lines entails longer travel times for some patients. This reorganization has provoked widespread protests and demonstrations in favor of maintaining a full range of services in small local hospitals.
Any evaluation of the Irish public health services today should bear in mind both the low starting point in the 1990s, and the exceptional growth in the population since that time, in particular the recent baby boom which has placed substantial pressure on maternity and pediatric services. Revelations of overcrowding, inefficiencies, waste, poor services, and extremely long waiting lists for access to specialized services continued unabated over the reference period and receive prominent press coverage. The gradual improvements in the overall delivery of health care and outcomes have received less publicity.
The Irish health care system is a two-tier system, with about half the population relying exclusively on the public health system and the other half enjoying additional services mainly paid for through private insurance policies. Thus, the system cannot be scored highly on the inclusiveness of public health care provision. Private health insurance is a way of avoiding the waiting lists typical of public hospitals. This generates inequalities in access to health care. But an increasing proportion of the population has found private health insurance too expensive, and has switched to exclusive reliance on the public health system. This has increased the strain on the system.
During the reference period, several problems received widespread publicity, notably in regard to the failure to diagnose cancers in public care patients and the recent revelation that an extraordinary number of X-rays were not properly dealt with in one of the largest hospitals in the country. In March 2010, the Health Information and Quality Authority (HIQA), the national body responsible for standards and safety in the health services, issued a statement saying that it believed as many as 57,000 backlogged X-rays remained unread. This is only one, albeit one of the worst, example of the grounds for concern regarding absolute standards as well as value for money in the Irish public health services.
On the other hand, the substantial increase in resources devoted to cancer screening under the National Cancer Control Program was judged to have resulted in significant progress in this area, according to a review published by HIQA in February 2010.
Undoubtedly severe problems of overcrowding persist in many public hospitals, despite the increase in resources made available. An unexpected source of this pressure has been the steady increase in population and the number of births, despite a resumption of emigration. The number of births registered in Ireland rose from 61,000 in 2005 to 75,000 in 2008, an increase of 28% for which no additional budgetary provision was made, as the birth rate was expected to fall. Despite these problems, the infant and maternal mortality rates have continued to decline and are today among the lowest in the world.