• Spending overview
• Policy overview
• Diseases overview

Spending overview

Total expenditure on healthcare as a percentage of GDP stood at an estimated 7.6% in 2008, up from 7% in 2000, according to the OECD. Up to 2008 public expenditure on healthcare rose rapidly, but then stabilised in 2009 owing to severe fiscal pressures. Over three-quarters of total healthcare expenditure is accounted for by public spending, approximately 10% less than in the UK, but similar to levels in France and Germany.

Taxation provides 78% of the funding for health expenditure. About 11% is accounted for by private health insurance, and the remaining 11% represents out-of-pocket payments, notably on pharmaceuticals and visits to general practitioners (GPs). This hybrid system of funding had until the 1990s helped to keep Ireland's healthcare costs under control. However, that changed during the extended boom years (1995-2007) as rising wages and inadequate controls resulted in soaring public spending on health, although much of this extra funding was absorbed by administrative costs. Consequently, the public believes that the system is not delivering adequate services. As public spending faces significant cuts over the forecast period, resources and numbers employed in the public healthcare system will go sharply into reverse. This raises the prospect of reduced capacity and lower levels of service provision.

Policy overview

Ireland's public health service faces a lengthening list of problems and challenges, including long waiting lists for non-urgent hospital treatment for those without private health insurance and poor acute hospital provision outside the east of the country. Government health strategy over the past decade has focused on improving health outcomes by, for example, implementing national strategies to tackle both cardiovascular disease and cancer, the two main causes of premature death. More recently, greater emphasis has been placed on developing the country's health infrastructure and reforming health service structures in order to ensure that resources are used more efficiently. The cornerstone of the government's health services reform programme is the HSE, a centralised body responsible for managing service delivery nationally, in order to reduce fragmentation and overlap. The HSE came into being on January 1st 2005, although the old network of 32 local and regional health authorities retained autonomy for a six-month transition period. The process of improving health infrastructure has nonetheless been difficult and controversies have been many. There have been mounting calls for major reform of Ireland's system of private health insurance, after the decision in late 2006 of the second-largest provider, BUPA, to withdraw from the Irish market.

The chronically bad state of the public finances has led to cuts in pay for all public sector workers with those on the highest salaries experiencing the biggest reductions in most cases. This has led to some industrial action by medical staff and is expected to have some negative impact on service provision in 2010, if not beyond.

Only a small number of private hospitals operate independently of the state. Unusually, large public hospitals treat both public and private patients. Around one-third of hospital beds are financed by private insurance.

Diseases overview

In 2008 a survey conducted for Health Promotion Unit of the Department of Health and Children found that among adults aged 18 to 44, 41% of men were overweight and 16% were obese. Among women of the same age group, 24% were overweight and 17% obese. These figures are unsurprising, given that 22% of the population admitted to being physically inactive and a further 24% to taking insufficient levels of exercise, while there is widespread over-consumption of foods high in fats and sugars, according to the survey. Health risks from bad diet and insufficient exercise are compounded by 80% for men and 71% for women who suffered high levels of cholesterol going untreated.

Ireland prohibited smoking in the workplace in 2004, thereby banning smoking in all indoor public places, with only a small number of exceptions, such as hotel rooms. The measure received wide support, including that of many smokers, and has led many smokers to cut down.