irish essay on the health system

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Maresso A, Mladovsky P, Thomson S, et al., editors. Economic crisis, health systems and health in Europe: Country experience [Internet]. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2015. (Observatory Studies Series, No. 41.)

Cover of Economic crisis, health systems and health in Europe

Economic crisis, health systems and health in Europe: Country experience [Internet].

5 the impact of the crisis on the health system and health in ireland.

Anne Nolan , Sarah Barry , Sara Burke , and Stephen Thomas .

Introduction

The collapse of Ireland's overexposed banking and construction sectors at the onset of the global financial crisis precipitated a sovereign debt crisis that required a Financial Support Programme from the Troika. In parallel to sharply rising unemployment and declining household incomes, the terms of the country's international loan agreement required deep cuts to public sector spending, including the health sector, and incentivized reforms aimed at achieving greater efficiency and cost savings.

Public expenditure on health has fallen by about 9% since its historical peak in 2008, requiring several efficiencies to be achieved through lowering unit costs, particularly in pharmaceuticals and human resources, increasing productivity, laying the ground for a hospital payment system where "money follows the patient" and reallocating services across levels of care. To a large extent, the economic crisis helped to highlight the need for health system reform, and nowhere is this better exemplified than by the government's commitment to radically expand population coverage through a staged introduction of universal health insurance, starting with population-wide entitlement to free primary care services by 2015. A primary challenge will be to implement the major health financing reform associated with a new universal insurance system within the context of continued budgetary constraints. In addition, while there may be potential to develop longer-term real efficiency gains, most of the main cost-cutting measures already have been employed and care must be taken not to erode the health system's operational capacity, quality of services or access to care.

1. The nature and magnitude of the financial and economic crisis

1.1. the origins and immediate effects of the crisis.

As a small open economy, Ireland was particularly exposed to, and affected by, the global financial and economic crisis. Domestically, access to cheap credit and inadequate government oversight of the financial sector led to the development of an unsustainable property bubble. When the global financial crisis hit in 2008, this contributed to an internal banking collapse and the collapse of the construction sector. In response, private bank debt was effectively converted into sovereign debt following the bank guarantee scheme announced in September 2008. On the revenue side, the tax base had become increasingly dependent on pro-cyclical consumption taxes (Thomas, Ryan & Normand, 2010 ); the widening gap between revenues and expenditure was reflected in a sharply increasing debt to GDP ratio (Thomas et al., 2012 ). In addition, between 2008 and 2011 Ireland's gross national product fell by nearly 20% (CSO, 2012b ).

1.2. Government responses to the crisis

In 2008 and 2009, several budgets sought to address the impact of the economic crisis (Thomas & Burke, 2012 ). However, borrowing costs continued to rise: in November 2010, yields on the benchmark 9-year Irish Government bond reached 9% (Carswell, 2012 ). In November 2010, after continued deterioration in key economic indicators and increasingly unaffordable borrowing costs, Ireland accepted a Programme of Financial Support from the Troika worth €85 billion for the period 2010–2013. Despite a return to the bond markets in 2013, the economic outlook remained bleak, with low growth forecasts nationally and internationally (Duffy & Timoney, 2013 ), continued high unemployment of nearly 14% in 2012 (CSO, 2013b ) and a large, albeit slightly falling, debt/GDP ratio of approximately 120% (Department of Public Expenditure and Reform, 2012b ; Duffy & Timoney, 2013 ; see also Table 5.1 ).

Demographic and economic indicators in Ireland, 2000–2012.

1.3. Broader consequences

The Irish rate of unemployment increased sharply during the crisis, from under 5% at the end of 2007 to just under 14% at the end of 2012 (CSO, 2013b ). Rates of unemployment among the younger population were higher still, at over 30% for males aged 15–24 years in 2012, while at the end of that year, long-term unemployment (defined as out of work for more than a year) accounted for nearly 60% of total unemployment (CSO, 2013b ).

Household incomes and poverty rates also were affected, with household incomes falling by over 12% in nominal terms, the “at risk of poverty” rate increasing from 14.4 to 16.0% and the proportion of the population experiencing two or more types of enforced deprivation (e.g. without heating in the last year, unable to afford a hot meal, etc.) increasing from 13.8 to 24.5% over the period 2008 to 2012 (CSO, 2013c ). Inflation in health prices has consistently exceeded that of overall prices, and given the heavy reliance on OOP payments in the Irish health system (see section 3.2 ), this has created an additional burden on households. In particular, sharp increases in PHI premiums, in combination with deteriorating household finances, have been reflected in increasing numbers cancelling their PHI cover over the duration of the crisis (see section 3.2 for further discussion).

2. Health system pressures prior to the crisis

Since the start of the 2000s, overall levels of public expenditure on health have risen rapidly, albeit from a very low base ( Fig. 5.1 ), and per capita levels are now broadly in line with expenditure in other countries (OECD, 2012a ). However in the preceding 30 years, Ireland's health expenditure was considerably below the EU average, particularly for capital expenditure, which amounted to just 66% of the EU average over the period 1970–1996 (Wren, 2004 ).

Public health expenditure (capital plus current) in Ireland, 2000–2013. Note: Public health expenditure includes capital expenditure. Sources: CSO, 2014a; Department of Public Expenditure and Reform, 2014.

As illustrated in Fig. 5.1 , there have been substantial cuts in public expenditure on health since 2008 (see also Tables 5.2 and 5.3 ). The total public health budget in 2008 was €15.4 billion, that for 2013 just €13.6 billion (Department of Public Expenditure and Reform, 2012a ; Thomas et al., 2012 ). Much of the reduction in public health expenditure to date has been achieved through cuts to staff numbers and staff pay, as well as driving efficiencies across the public health system (Thomas & Burke, 2012 ). In October 2012, there was an overrun of €360 million in public health expenditure (Department of Public Expenditure and Reform, 2012a ), although this had been reduced to €75 million by the end of 2012 (HSE, 2013d ). Overruns such as these illustrate the difficulties of achieving continued expenditure reductions year on year.

Public expenditure on health in Ireland (including capital expenditure), 2006–2014.

Health care expenditure trends in Ireland, 2000–2011.

The cuts in public health expenditure have occurred against a backdrop of existing political commitments to make improvements in primary and community care, in mental health, in some chronic DMPs and in the quality of public hospital care. In 2011, the new coalition government made a commitment to introduce free care by GPs for everyone by 2015 and to implement a universal, single-tier health service through the introduction of universal health insurance (Government of Ireland, 2011a ). The new commitments reflect aspects of the pre-election manifestos of both coalition partners.

Studies on Irish health expenditure highlight the importance of national income, population size and distribution, prices and institutional features of the system (such as provider-reimbursement methods) (Brick & Nolan, 2010 ; Borowitz, Moran & Pearson, 2011 ; Normand, 2011 ). The greatest immediate pressure on the Irish health system is the reduced public health budget that is expected to meet the needs of a growing population. The Irish population is relatively young and has the highest fertility rates in the EU (Department of Health, 2012a ). Of particular relevance for longer terms financial pressures is the projected increase in the dependency ratio (the ratio of the population aged 65+ years to the population aged 18–64 years) from 0.18 in 2011 to 0.38 in 2041 (Barrett et al., 2011 ).

High and increasing prices have been a continuous source of financial pressure in the Irish health system. Between 2005 and 2011, health care costs in Ireland increased by over 20%, while overall prices increased by approximately 10% (Thomson, Jowett & Mladovsky, 2012 ). This very high health inflation was largely driven by continued increases in hospital charges, outpatient fees, doctors' fees and dental fees, which impose a particularly large burden on the section of the population with the lowest income. In addition, PHI premiums rose by 22% in 2011 and a further 16% in 2012 (CSO, 2012a , 2013a ), although these increases have also been driven by recent moves by the government to ensure full economic costing of private activity in public hospitals.

Approximately 14% of public expenditure on health in Ireland is expenditure on prescription pharmaceuticals (Gorecki et al., 2012 ). Public expenditure on pharmaceuticals rose very rapidly after 2000, but some recent measures have reversed this trend (see Brick, Gorecki & Nolan ( 2013 ) and Gorecki et al. ( 2012 ) for a full description), and legislation to introduce a system of reference pricing and generic substitution for certain pharmaceuticals was passed in 2013 (Government of Ireland, 2013b ). However, there has been slow progress on the implementation of additional cost-cutting measures (Thomson, Jowett & Mladovsky, 2012 ) and a recent comparison of ex-factory prices of the leading pharmaceuticals found that originator on-patent and generic pharmaceutical prices were higher in Ireland than in other EU Member States (Brick, Gorecki & Nolan, 2013 ). 1

Other drivers of increases in expenditure typically include unmet need (areas identified in Ireland include chronic diseases, mental health services and services for children), raised expectations (which may lead to demand for unmet needs to be met) and technological change (although there is some debate over whether technological change is a significant cost driver in health care, see for example Dormont, Grignon & Huber ( 2006 ) and Normand ( 2011 )).

A critical source of financial pressure in the Irish health care system is the means-tested medical card scheme, whereby those on low incomes receive free public health care. With rising unemployment and falling incomes, the proportion of the population with medical cards is now over 40%, up from approximately 30% in 2008 (see section 3.2 below).

Despite declining budgets and staff numbers, the Irish public health system is providing more care in certain areas to a growing, ageing population with a higher burden of chronic disease (e.g. inpatient and outpatient throughput has increased year on year since the crisis began; see section 3.3 ). However, many weaknesses in delivery and financing structures that existed before the economic crisis remain. Despite the increased expenditure on health over the 2000s, Ireland still has a very underdeveloped primary and community care sector; long waits and unequal access for public patients to hospital care; 2 concerns about poor quality and overstretched hospital infrastructure; and staffing constraints (Health Information and Quality Authority, 2007 , 2008a , 2008b ; Ruane, 2010 ).

The 2001 “Primary Care Strategy: A New Direction” recommended the introduction of an interdisciplinary team-based approach to the delivery of primary care services (Department of Health and Children, 2001a ), but its recommendations have been largely unimplemented. Despite the targets set out in successive Health Service Executive (HSE) national service plans, progress on the development of primary care teams to date has been slow (Comptroller and Auditor General, 2011 ; Department of Health, 2011 ; HSE, 2013g ).

While there are currently 426 primary care teams in place (HSE, 2013g ), those working on the ground acknowledge that just a fraction of these are fully functioning teams, as the HSE simply defines a primary care team as one where clinical team meetings have commenced (HSE, 2013g ).

A consequence of poor primary and community care service provision is the existence of long waiting lists for certain services. Recent data indicate that at least 72 000 people are waiting for physiotherapy, speech and language and occupational therapy services in the community. This is a minimum figure as waiting lists are not kept in areas where services do not exist and people have no choice but to buy the service privately or go without the service (Oireachtas, 2012a ).

Community child and adolescent mental health teams are the first line of specialist mental health services. “A Vision for Change”, the national mental health policy published in 2006, outlined that there should be 92 such teams with 1196 staff in place by 2012 (Department of Health and Children, 2006 ). A recent review shows that just 58 of these teams are in place, with under 40% of the staffing required, and that waiting times remain high (HSE, 2013g ). The government target for December 2012 was that no child would wait more than a year for their first appointment. However, by December 2012, there were 338 children waiting for their first appointment (HSE, 2012b ). The waiting list for these child and adolescent mental health services was up 17% from December 2011 (HSE, 2012b ). No such data are kept on adult mental health services but the 2012 Annual Report of the Inspector of Mental Health stated that “services were stagnant and perhaps have slipped backwards” (Mental Health Commission, 2013 ).

Home help services are an essential mechanism for caring for people in their own homes and keeping them out of hospitals and nursing homes, particularly older people. In 2008, 12.6 million home help hours were delivered to 55 366 individuals; in 2012 just 9.8 million hours were provided to 44 387 individuals, reflecting cuts to the health budget and community services (HSE, 2008 , 2013g ).

There has been strong political pressure to reduce long waiting times for treatment for public patients. Despite a dedicated budget for an independent treatment purchase fund since 2002 and renewed political pressure after the election of a new government in spring 2011, the numbers waiting for elective public hospital inpatient/day treatment have remained high. The HSE committed to the target that no adult should have to wait more than eight months for inpatient or day treatment by the end of June 2013; unfortunately, the numbers waiting in excess of eight months for both inpatient and day treatment continued to increase through 2013 (HSE, 2013f ), despite some promising reductions in the numbers at the end of 2012/2013 (National Treatment Purchase Fund, 2013 ).

In terms of outpatient services, over 100 000 people were waiting in excess of 12 months for a public hospital outpatient appointment in April 2013 (the HSE target was zero by end June 2013) (HSE, 2013f ).

The current nature of health coverage in Ireland is a significant weakness. Ireland is the only European country not to offer universal access to free or heavily subsidized GP care, and OOP GP costs are correspondingly much higher than in other countries (Thomson, Jowett & Mladovsky, 2012 ). In addition, Ireland's unusual mix of public funding, PHI and OOP payments (Ruane, 2010 ; Smith, 2010b ) results in a complex, and often conflicting, set of financial incentives (Brick et al., 2012 ). Despite its relatively small contribution to overall health financing in Ireland, PHI plays an important role in financing specific types of care, particularly public hospital care, and is subsidized by the state via tax relief on premiums and by the practice of not charging the full cost of private beds in public hospitals. 3 In this way, the existence of PHI distorts the incentives facing users and providers of health care, with well-documented negative effects on equity and efficiency (Nolan & Wiley, 2000 ; O'Reilly & Wiley, 2010 ; Brick et al., 2012 ).

3. Health system responses to the crisis

3.1. changes to public funding for the health system.

Successive budgets since October 2008 sought to curtail public expenditure, including health, as a response to the crisis. Over the course of the Troika bailout, stricter parameters and supervision have been placed on health expenditure. As illustrated in Table 5.2 , public health expenditure fell by approximately 9% in nominal terms between 2008 and 2012 and further large adjustments were required in 2013–2014. The public health system has suffered unprecedented cuts in real terms at a time when financial pressures from demographic changes and policy needs are very strong ( Table 5.3 ).

The proportion of total health expenditure coming from statutory or public sources in Ireland reduced gradually from a high of 77% in 2004 to 67% in 2011 ( Fig. 5.2 and Table 5.3 ), consistent with trends towards increasing OOP expenditure by individuals. This reduction means that, for the first time in recent years, statutory funding in Ireland as a share of total health expenditure has fallen below the average for OECD countries and is quite low for a European tax-based health financing system. Private health expenditure has continued to increase (Department of Health, 2012a ), but since 2008, the numbers of households purchasing PHI has been declining (Health Insurance Authority, 2013 ). While health now accounts for a larger share of declining public expenditure, the recovery in the share devoted to health also highlights that the initial pace of cuts could not be sustained given demand pressures. 4

Proportion of total public expenditure devoted to health in Ireland, 2007–2014. Note: (e): Estimate. Source: Department of Public Expenditure and Reform, 2012a2014.

As noted, government revenues became increasingly reliant on indirect taxation after 2000, although by 2011, the proportion of total government revenue generated by indirect taxes had fallen below the level in 2000 as the government sought to stabilize its finances (Thomson, Jowett & Mladovsky, 2012 ). Prior to the crisis, public funding for health was marginally progressive (Smith, 2010a ). Since then, a number of changes to direct taxation policy suggest that this source has become more progressive (Thomson, Jowett & Mladovsky, 2012 ). Smith ( 2010a ) concluded that indirect taxes were regressive in the late 1990s/ early 2000s. Analysing welfare and direct taxation changes in each of the six “austerity” budgets since 2008, Callan et al. ( 2012 ) found that the overall impact has been progressive but that recent budgets have been regressive because of the front-loading of tax increases and effective public sector pay cuts in the period October 2008 to April 2009.

Sin taxes (e.g. taxes on alcohol and tobacco) currently play a limited role within public revenue in Ireland (Thomson, Jowett & Mladovsky, 2012 ). A Special Action Group on Obesity was established in 2011 and in May 2013 the Institute of Public Health in Ireland published its health impact assessment of a proposed tax on sugar-sweetened drinks (Institute of Public Health in Ireland, 2013 ). However, a sugar tax has not been introduced and there are no plans at present to do so.

3.2. Changes to coverage

The breadth (who), scope (what) and depth (how much) of public cover have all changed over the duration of the crisis.

Population entitlement

Statutory entitlements to publicly financed health care in Ireland are complex (Brick et al., 2010 ; Thomson, Jowett & Mladovsky, 2012 ), as described in Table 5.4 . The most significant change reducing the breadth of cover was the abolition, in 2009, of the automatic entitlement to a medical card for those aged over 70. Nevertheless, more than half a million more people had medical cards in 2013 than in 2008, reflecting lower incomes and a significant extension of coverage during the crisis.

Entitlement to publicly financed health care in Ireland, 2013.

Eligibility for category I (medical card holders) is primarily determined on the basis of an income means test. Individuals in category II, including GP visit card holders, have access to a range of public assistance schemes such as the Drugs Payment Scheme, the Long Term Illness Scheme and the Treatment Benefit Scheme (see Thomson, Jowett & Mladovsky ( 2012 ) for further details). The share of the population in category I fell in the late 1990s because of the rapid economic growth, a steady decline in unemployment and annual increases in real incomes ( Fig. 5.3 ). However, it has increased steadily since 2005 (along with the introduction of the GP visit card), and from 2008 with the onset of the severe and prolonged recession. In December 2012, 40.4% of the population had a medical card, with an additional 2.9% of the population holding a GP visit card.

Population coverage by category in Ireland, 1990–2012. Note: Population data refer to April but coverage data refer to December. Sources: HSE, 2011a2012c2013g; CSO, 2014b; also annual reports (various years) from the Primary Care Reimbursement (more...)

Many people in category II and a small proportion of those in category I purchase PHI, which is supported in public policy via generous tax relief. PHI cover increased steadily over time, reaching a peak of 51.4% of the population in 2006, but then declining to 46.0% in 2012 5 and is declining at an increasing rate (Health Insurance Authority, 2013 ). Originally designed to offer cover for hospital care, several PHI plans now also offer some cover for GP and other primary care expenses. While everyone is entitled to public hospital care at a maximum cost of €800 per annum, individuals take out PHI in order to gain faster access into the public hospital system (Watson & Williams, 2001 ).

Proposed changes to population coverage are part of wider government commitments to reform health financing in Ireland, as set out in the 2011 Programme for Government (Government of Ireland, 2011a ). Under the banner of “universal health insurance”, entitlement to GP visit cards is to be extended to the whole population by 2015. Movement towards this goal began with the drafting of primary legislation to provide GP visit cards to those covered by certain illnesses (Dáil Éireann, 2012 ), but this aspect of the plan has since been dropped because of legislative difficulties (Cullen, 2013 ). An alternative mechanism for the extension of free GP care to the entire population is currently being developed, with suggestions that it will be extended on an age-related basis starting with children under 5 years of age.

Key targets in the phasing in of universal primary care have been missed. It is not clear how the Programme for Government proposals will change coverage in practice, partly because details of expanded coverage of other services have yet to be specified and partly because of the budgetary environment. Furthermore, the 2013 Budget announced plans to restrict eligibility to medical cards for 2013, specifically taking full medical cards away from 40 000 people and replacing them with GP visit cards (HSE, 2013b ). Moreover, the HSE Service Plan allowed for a net increase of 60 000 full medical cards in 2013, considerably less than the approximately 160 000 full medical cards granted in 2012 (HSE, 2013d ), highlighting that further rationing of medical cards would lie ahead. One million medical card reviews were planned for 2014.

Between September 2013 and March 2014, 65 000 medical cards were withdrawn. This was a result of the increased standardization of eligibility criteria brought about by the centralizing of the medical card assessment service in 2012/2013, combined with reducing income limits and tighter conditions for eligibility, as well as better linking with other government data. There was huge public and political discontent, with a range of high-profile stories in the public domain of very sick people losing their medical cards. In response to this, combined with a very poor performance of government parties in local and European elections in May 2014, the government suspended reviews of all discretionary medical cards, the removal of which caused the most controversy. They also committed to extending medical card access on the basis of need, not just financial hardship. An expert panel was established to advise government on how best to progress this issue by Autumn 2014.

The benefits package and user charges

The scope of cover has been reduced through the introduction of limits to dental and ophthalmic benefits for the whole population and the rationing of some services such as therapies and home help ( Table 5.5 ). However, most of the changes have targeted the depth of cover by increasing user charges.

Changes to statutory entitlement in Ireland, 2008–2013.

3.3. Changes to health service planning, purchasing and delivery

As noted, there is evidence that in several areas the health system is doing more with fewer resources (e.g. inpatient, emergency and day case activity) ( Fig. 5.4 ).

Inpatient, emergency and day case activity in Ireland, 2008–2012. Note: ED: Emergency department. Sources: HSE, 20102011b2012b2013g.

Further improvements in efficiency have been achieved by:

reducing the unit costs of health system inputs (such as human resources and pharmaceuticals);
improving productivity; and
moving some activities to more cost-effective levels of care.

Nevertheless, there is still scope for more efficiency in the system.

Payments to health workers and human resources policies

As pay accounts for approximately 50% of overall public health expenditure (but can be as high as 70% in the acute hospital sector) (Brick & Nolan, 2010 ), securing greater efficiencies in this expenditure via reductions in numbers, as well as optimal use of existing staff, has become a key mechanism for cutting costs. In common with the general public service, the public health service is subject to a moratorium on recruitment and promotions (since 2009), albeit with some exceptions (medical consultants, physiotherapists, etc.). In addition, there have been reductions in pay, and a number of incentivized voluntary retirement schemes. The number of full-time equivalents in the public health service has fallen by over 11 000 (or nearly 10%) since 2007, and there are now just over 101 000 full-time equivalent staff in the public health system (HSE, 2013c ). However, in this context, there are concerns over the costs of employing replacement agency staff, and despite efforts to reduce agency costs, the HSE reduced its expenditure on agency staff by just 2% in 2012 (HSE, 2013d ). There are also concerns over curtailment of some services (e.g. cancelled surgery, reduced community services). Apart from restrictions on numbers employed, changes to staffing levels, skill-mix and staff attendance patterns/rosters are being implemented within the context of the 2010–2014 and 2013–2016 Public Service Agreements (also known as the Croke Park and Haddington Road agreements, respectively). Under the terms of these agreements, staff have agreed to greater flexibility to help to achieve efficiencies in exchange for a commitment to no further pay reductions and no compulsory redundancies (up to 2016). The Haddington Road Agreement took effect from 1 July 2013 and provides for further pay cuts for those earning over €65 000 per annum, increment freezes, increases in hours worked and decreases in overtime and other premium payments.

As part of the Financial Emergency Measures in the Public Interest (FEMPI) Act 2009, there were reductions in the rates of payment to GPs, pharmacists and opticians in 2009, 2010 and 2011 (Government of Ireland, 2009 , 2010 , 2011b ) and further cuts for GPs and pharmacists were introduced in 2012 and 2013 (Department of Health, 2013 ). The 2011 Programme for Government contains a commitment to introduce a new contract for GPs and to reduce the amount GPs and hospital consultants are paid (Government of Ireland, 2011a ). A 30% lower pay scale for new consultant recruits was introduced from 1 October 2012 (HSE, 2012a ). In February 2014, a draft new GP contract was published that, if introduced, will radically alter the way GPs are paid and the type of services they provide. It has a much greater emphasis on public health and the management of chronic diseases, as well as containing more controversial measures such as a gagging clause on GPs and the ability to cut fees at any time. After months of a stand-off between GPs and government, both sides entered negotiations on a new contract in May 2014.

Pharmaceutical sector reforms

As a first step to secure greater efficiencies in the provision of pharmacy services, recent attempts have focused largely on securing price reductions, rather than attempting to influence product mix or volume. Setting the reimbursement price for pharmacy services in Ireland follows a complex procedure (Brick & Nolan, 2010 ; Brick et al., 2010 ; Gorecki et al., 2012 ; Brick, Gorecki & Nolan, 2013 ). In recent years, the ex-factory price, wholesale mark-up and retail mark-up have all been targeted (see Table 2.3 in Gorecki et al. ( 2012 ) for a summary). However, in spite of these reductions and the recent legislation on reference pricing and generic substitution (Government of Ireland, 2013b ), there have been few attempts to adopt other initiatives that would cut costs significantly, such as competitive tendering for high volume off-patent products.

A new deal with pharmaceutical manufacturers in October 2013 included reductions in the cost of in-patent and off-patent pharmaceuticals, as well as securing the provision of new and innovative pharmaceuticals. Although earmarked to deliver savings of €400 million over three years, a detailed reading of the agreement shows that new pharmaceutical costs are estimated at €210 million, therefore resulting in net savings of only €190 million (Oireachtas, 2012b ). Initial savings promised under this deal were not realized in 2012 and contributed to the need for a supplementary health budget in December 2012. A new agreement with the representative body of generic manufacturers was also completed in October 2013. The newly enacted legislation on reference pricing and generic substitution gives the HSE the power to use additional criteria other than the agreements with the pharmaceutical manufacturers (e.g. tendering, prices in other countries, etc.) to set pharmaceutical prices in Ireland. While this is a significant development, the impact of the new legislation on future pharmaceutical expenditure is uncertain (Brick, Gorecki & Nolan, 2013 ).

Delivery of clinical care programmes

Since 2008/2009, the HSE has been developing national clinical care programmes in an effort to improve quality of care and to provide more efficient care pathways and planned patient care. The cancer care programmes and subsequent clinical care programmes were a response to a series of high-profile patient safety concerns that occurred during 2007–2008 (Health Information and Quality Authority, 2008a , b ). The programmes have been designed to achieve high levels of acceptance from clinicians, who have been closely involved in their development. In many cases, the ambition is both to improve the quality of patient care and to release resources for reinvestment in the service. The approach has similarities to the successful development of new models of cancer care in Ireland, which have achieved important improvements in outcomes and have reduced variation in the care provided (HSE, 2013a ).

The clinical care programmes have been reinforced by a renewed focus of the government and the HSE on initiatives to increase efficiency by improving delivery, including work done by the Special Delivery Unit. The Special Delivery Unit, originally set up in the Department of Health, become part of the HSE in January 2013 and is focused on driving down waiting times for hospital treatment.

Hospital services

In terms of acute hospital services, the Programme for Government contains a commitment to pay hospitals according to the care they deliver and to incentivize them to deliver more care in a “money follows the patient” system (Government of Ireland, 2011a ). Up to 2012, all public hospitals received annual budgetary allocations in return for undertaking activity levels specified in the HSE's annual national service plans, with allocations largely determined by historic factors (with a small proportion of resources allocated on a case-mix basis). From 2013, public hospital resources will be allocated on the basis of projected expenditure, in preparation for the “money follows the patient” system in 2014 (HSE, 2013e ).

The payment of public hospital consultants has been the subject of much discussion since the agreement of a new consultant contract in 2008, with the degree of compliance by some consultants in relation to private practice also coming under particular scrutiny (Comptroller and Auditor General, 2010 ). Currently, public hospital services are delivered by a network of 52 hospitals, 34 of which are owned and operated by the HSE. The Programme for Government contains a commitment to establish all acute public hospitals as independent, non-profit-making trusts (Government of Ireland, 2011a ).

Delivery of integrated care

Previous analyses of the Irish health system noted the barriers to the delivery of integrated care, such as incompatible financial incentives (on the part of both users and providers), human resource constraints and poorly developed community care services (Ruane, 2010 ; Brick et al., 2012 ). Such issues will have to be resolved to secure the full potential of efficiency gains.

4. Implications for health system performance and health

4.1. cost savings and efficiency.

Ireland entered its Troika bailout in October 2010 with regular reporting by both the European Commission and the IMF. These reviews were published along with the quarterly renewed MoU in a specific section of the Department of Finance's web site (2014), demonstrating the high level of monitoring of the agreement. The review reports provide a detailed analysis on how Ireland was meeting its commitments under the MoU. Up to 2012, there was little if any mention of the health system. However, throughout 2012, there was growing attention to health. This culminated in the European Commission Working Document, Economic Adjustment Programme for Ireland , where the health sector received attention in the “fiscal policies” section. The report highlighted how, despite efforts to curtail health expenditure, there was an estimated overrun of €370 million in the HSE, which when combined with other “spending pressures… the structural gap of the health vote is about €700 million” (European Commission, 2012 , p. 21).

The Working Document pointed out how government measures intended to save money in 2012 had not materialized and specifically mentioned the failure to legislate for charging private patients in public hospitals and to enact measures to reduce the pharmaceutical bill. The Commission highlighted the scope to increase efficiencies and cost–effectiveness, such as the introduction of a unique patient identifier and “money follows the patient” to foster integrated care. It also detailed how Ireland was paying more to doctors, particularly specialists. While it acknowledged the 30% cut in pay to newly appointed consultants, it suggested a “review of the market for medical staff”, noting the lower proportion of medical consultants in Ireland compared with other EU Member States (European Commission, 2012 , p. 23). The report also suggests increasing “copayments for products and services, and tackling the unsustainable growth in medical cards, including greater use of GP visit cards to substitute for more expensive medical cards” (European Commission, 2012 , p. 22).

4.2. Access to services

While there is plenty of evidence regarding inequalities in health and health care utilization in Ireland (see Thomson, Jowett & Mladovsky ( 2012 ) for a review), there are no published data on trends since the onset of the crisis. However, in the context of reductions in breadth, scope and height of public cover, it is likely that barriers to access to health services have increased during the crisis.

4.3. Impact on health

Rates of poverty and deprivation have increased in Ireland since the beginning of the crisis. Given the causal relationship between poverty and ill health, it is inevitable that increases in poverty will impact on population health, although they are not yet evident in most health statistics. There are two possible explanations for this: first, the time lag effect between declining incomes, increasing poverty and poorer health and, second, the delay in the publication of timely health statistics. As a result, it is probably still too early to observe any potential associations, and even more difficult to determine a causal relationship between the current crisis and health outcomes.

Published data indicate that the economic crisis has, so far, not been associated with negative effects on mortality. The upward trend in life expectancy at birth has continued to 2011, the latest year for which data are available (Department of Health, 2012a ; OECD, 2013 ). Population deaths rates for men and women have continued to decline, although all death rates experienced a slight increase from 2010 to 2011 before stabilizing again in 2012 (see Fig. 5.5 ).

Total, male and female death rates per 1000 population in Ireland, 2000–2012. Source: CSO, 2014b.

Information on age-standardized death rates is available up to 2010 only but indicates a steady decline in all-cause mortality (OECD, 2012b ). While age-standardized rates of death for external causes have fallen over the period of the crisis, much of this fall is accounted for by a substantial fall in deaths from accidental causes, particularly traffic accidents. While the age-standardized rate of death for “intentional self-harm” has remained relatively steady over the period 2008–2010 (OECD, 2013 ), more recent data suggest that the number of deaths by suicide per 1000 population has increased over the period 2007–2012, although the rate fell between 2011 and 2012 (CSO, 2013d ).

A recent study in Cork City identified an association between the impact of the economic crisis and suicide (Arensman et al., 2012 ), while a number of studies have analysed the impact of economic crises (and particularly the experience of unemployment) on both physical and mental health, as well as health behaviours (Delaney, Egan & O'Connell, 2011 ; Institute of Public Health in Ireland, 2011 ). There has been a consistent increase in calls to mental health support services in the past five years. Organizations such as the Samaritans directly link the increased demand for their services with the broader economic crisis (Samaritans, 2012 ). While tobacco consumption has been falling steadily in Ireland since 2000, alcohol consumption started to decline with the onset of the economic crisis (Department of Health, 2012a ).

An important indicator of population health status is self-assessed health, which has been found to be a good predictor of mortality and use of health care in numerous international studies (Idler & Benyamini, 1997 ; van Doorslaer et al., 2000 ; Burstrom & Fredlund, 2001 ). There is little evidence that perceptions of health have declined over the period of the crisis in Ireland. Data from the Quarterly National Household Survey show that while there was a decline in the proportion reporting “very good” health over the period 2007–2010 (from 47% to 45%), the proportion reporting “good” health increased from 40% to 42%, and the proportion reporting “fair” or “bad/very bad” health was unchanged (CSO, 2011 ). More recent data are not yet available.

While it is extremely difficult to infer causal relationships between economic crises and health outcomes, behaviours or inequalities at the population level, the trends observed are consistent with those found in previous analyses for other countries. In general, there is no simple answer to the question of how economic crises impact on health outcomes, behaviours and inequalities (Suhrcke, Stuckler & Leone, 2009 ; Suhrcke & Stuckler, 2012 ). For example, Ruhm ( 2000 ) found that total mortality and eight of the ten sources of fatalities exhibited a pro-cyclical fluctuation in the United States over the period 1972–1991, with suicides representing an important exception. However, the association at the individual level between lower income, unemployment and poor health is well established (reviewed by Suhrcke & Stuckler, 2012 ). Recently, the impact of the economic crisis on health outcomes in Ireland has been debated in a series of responses to an editorial in the British Medical Journal on health and the economic crisis in Europe (Carney, 2013 ; Jackson, 2013 ; Walsh & Walsh, 2013 ).

5. Discussion

5.1. drivers of change.

The core driver of change has been the need for fiscal consolidation. Public expenditure on health increased rapidly in the pre-crisis period; nonetheless, by 2008, primary and community care services were poorly developed; the public hospital system was experiencing capacity constraints and significant patient safety concerns; and price inflation was well in excess of that experienced in other sectors of the economy (and in most other EU Member States). Nevertheless, the huge growth in health expenditure that had occurred during the boom years meant that there was room for efficiency gains in the recession. Essentially, built-in inefficiency provided a cushion for the hard fall of significant budget cuts in health. The system is now certainly more efficient than at the beginning of the crisis and is generally doing more with less (Thomson, Jowett & Mladovsky, 2012 ). The recession, at least in the first few years, proved to be a useful mechanism to reduce input costs (which were very high by international standards) and to increase productivity by treating patients more cost-effectively (e.g. increased day care in hospitals).

However, with further reductions in public health expenditure required over the period 2013–2015, there are doubts over the capacity of the system to absorb further cuts without damaging patient access and care (Thomson, Jowett & Mladovsky, 2012 ). In addition, it is now clear that the cuts proposed in each budget have proved increasingly hard to realize because of continued cost pressures (e.g. in terms of expenditure on agency staff) and failure to implement some key cost-reduction initiatives in the face of stakeholder pressure. Some input prices still remain high by international standards (Thomson, Jowett & Mladovsky, 2012 ; Brick, Gorecki & Nolan, 2013 ). It is also important to remember that such cuts are occurring in the context of a system that is experiencing significantly increased demands in the form of population ageing, increased fertility and rising rates of chronic disease.

5.2. Content and process of change

Despite the significant cuts in public health expenditure that have occurred, a crucial safety net for vulnerable groups has been maintained via the medical card scheme. However, there have been recent changes to both the breadth and depth of cover in the medical card scheme, and for those not covered by a medical card, the scope and depth of public cover has been continually eroded (see Table 5.5 ). The latter has occurred despite a recent report that found that Ireland is unusual internationally in terms of the high level of user fees that are charged for public health services (see Table 4.6 in Thomson, Jowett & Mladovsky, 2012 ).

In addition, in the context of a system that requires the majority of the population to pay the full, unregulated, OOP cost for primary care services, continued price inflation in doctors' and dentists' fees is a concern. Health care affordability is likely to become an even greater issue in future, as average annual disposable incomes continue to fall.

However, for the first time in the history of the Irish State, the principle of “a universal, single-tier health service, which guarantees access to medical care based on need, not income” (Government of Ireland, 2011a ) is a core component of official health policy. The Programme for Government notes that everyone in Ireland will be able to obtain statutory benefits from an “insurer” of their choice, including a public option. The assumption is that private insurers operating in the PHI market will compete with a public entity to offer statutory coverage. It is questionable whether a competitive insurance system will help to improve efficiency and control costs. The experience of insurer competition in Germany, the Netherlands and Switzerland suggests that such systems have not been effective in health care cost control (Westert et al., 2010 ; Maarse & Paulus, 2011 ; Schut and van de Ven, 2011 ; Busse & Blümel, 2014 ).

The Programme for Government sets out an ambitious range of reforms for the Irish health system. This involves the introduction of free GP care and universal health insurance, ostensibly all by 2016. In this regard, the economic crisis has helped to highlight the need for reform in the system, which was largely ignored in the pre-crisis period. The crisis has also reduced opposition to change (O'Riordan & Thomas, 2010 ) as can be seen most clearly by the implementation of the Public Service Agreements and the acceptance by stakeholders of the broad range of initiatives to cut costs around human resources and pharmaceuticals.

The ultimate aim of Irish and international health policy is to improve population health (Department of Health and Children, 2001b ). In this regard, it is important to analyse the extent to which the economic crisis, and health system responses, have impacted on population health. Impacts on general population health are difficult to identify at this stage of the crisis because of the time lag in effects, although some initial health impacts have been identified in the Irish context, particularly in terms of mental health outcomes, as detailed above.

5.3. Implementation challenges

Despite the acknowledgement of the need for changes, the continued austerity seems now to be working against reform. In 2013, the first steps to free GP care were postponed. Further delays in implementing policy may well be likely as the health system battles to continue to provide quality care with shrinking budgets and demographic pressures. In addition, it is unlikely that capacity can be expanded sufficiently to cope with the effects of removing price barriers to care without an injection of more funds and resources into the system (Thomas, Normand & Smith, 2008 ).

Perhaps of even greater concern is the slow erosion of public health entitlements and increase in co-payments that has occurred throughout the crisis. The creation of increased barriers to accessing pharmaceuticals through higher co-payments is of particular concern. Developments such as these raise questions about the extent to which the principle of “a universal, single-tier health service, which guarantees access to medical care based on need, not income” is being implemented in the current climate.

5.4. Resilience in response to the crisis

Beyond the substantive issues outlined above, some reflection is possible at this early stage of analysis. Interviews with senior health system decision-makers (carried out as part of a wider project on resilience in the Irish health system) provide some important insights. 6 As mentioned above, the core driver of change throughout the crisis has been the requirement for fiscal consolidation. Interviewees reflected that, “the financial requirements and the economic sovereignty of the country is taking precedent now”. The bailout agreement with the Troika (which ran to the end of 2013) framed this consolidation: “the arrangement with our partners as we call them, the EU/IMF and the ECB [the Troika] is ruling our policy approach”.

In the years before the crisis, the health system was largely in development mode. Interviewees noted, though, a lack of strategic thinking during this time, “in the period, say from 1997 to 2008, the solution to most problems, including health, was to throw money at the problem”. The crisis, and by implication the cost-cutting that has followed, was considered an opportunity to address what interviewees considered to be an over-resourcing of the system during the years of budgetary surplus: “in terms of strategic development the fact that we are in such huge economic and financial difficulty means that people are likely to be far more open to looking at alternative major reforms in health care than they would have been previously”. The influence of the Troika has “allowed or forced the political system to make more unpalatable decisions than they otherwise would have made”.

The health system reform policy itself may be considered another important driver of change as, at least in principle it is framing decisions being made. Nonetheless, implementation is fraught with a range of challenges, both organizational and political. These include, among others, stakeholder resistance, system complexity and pressure for reform in other sectors, which diffuses the focus on health. In effect, the economic crisis is forcing fiscal consolidation decisions, such as increased OOP payments, which seem to undermine the global policy drive towards universality for example.

Despite negative effects of the crisis, such as a reduction in health funding, less access to health care and less coverage, interviewees noted that “managing with less” has resulted in greater system efficiency and productivity. This trend seems now to have reached its limit, however, as the crisis is sustained and further rationalization becomes more difficult. Within these parameters, a tentative sequence has been identified whereby the first phase response of the Irish health system to the crisis has resulted in limited levels of financial resilience and significant adaptive resilience – enabled by surplus resourcing of the system during the period of economic boom (Thomas et al., 2012 ).

The system is now in a more challenging phase during which its transformative capacity is being tested. If the crisis as “opportunity” and the health system reform policy are core drivers of change, benefiting from this time in terms of better service delivery and health outcomes will require different kinds of system response. Whether changed system patterns are possible is unclear. Interviewees questioned, for example, if politicians could overcome the challenges of system reform, “I think we have learned a lot from it [the recession] certainly but with a question, is the political will there to take it on, to sort it out?” Further challenges include the capacity to use evidence to drive policy, a noted lack of management capacity to deliver on efficiency and reform targets, and a lack of integrated management systems.

Such organizational challenges compound the strategic process of response to the crisis. In practice this seems to some extent unplanned or reactive; interviewees recognized that their core challenge at that moment was to maintain a safe and efficient service first and foremost. Generating the motivation and additional resources for system reform is difficult. Reflection and lesson learning are questioned in this context: “we don't think clearly or radically enough to bring about these kinds of changes”. It is too early to clearly identify the lessons being learnt in practice through the experience of the crisis; nonetheless the opportunities to do this are valued, “I think we need to be prepared to step back a bit and think more. So often in this job and in the health services generally at any sort of a senior level you're just working flat out from one thing to the next to the next to the next and it's difficult to take the time out and step back and say, 'look what are we learning from this?'”. Beyond the fiscal indicators of system resilience and preparedness, as reported above, identifying and understanding the full consequence and implications of the economic crisis for the health system will require prioritizing high-quality reflection and dialogue.

6. Conclusions

The Irish economy suffered a particularly severe financial and economic crisis. Key domestic causes were related to the fragility of the banking system, pro-cyclical government expenditure, an imbalanced taxation portfolio and lax government oversight and regulation. While in response, public expenditure on health has fallen by about 9% since its peak, public health care expenditure has been relatively protected in the recession compared with other sectors, primarily because of cost pressures from demographic trends and from increasing chronic disease prevalence.

Substantial efficiencies have been made to the public health care system through an emphasis on lowering unit costs, increasing productivity and reallocating services across levels of care. While there is potential for more efficiency, the “easy” cuts have been made and political obstacles to further cuts are very real around human resources and pharmaceuticals.

The affordability of accessing services is a concern, given the lower health care expenditure by government and regular increases of co-payments for a variety of services and for insurance premiums. Consequently, there is an increasing burden on households to pay for health care at the same time that disposable income has fallen. Nevertheless, the medical card scheme has functioned well and protected access to health care for the poorest and for most of those aged over 70. While the government's commitment towards a new universal health care system remains intact, progress has been delayed and there are concerns about implementation within the continued context of scarce public resources.

Appendix 5.1

Major crisis-related events and changes in the Irish health care system, 2008–2013.

Acknowledgement

The authors would like to thank Matthew Jowett who acted as an internal reviewer for this chapter.

Arensman E, et al. First report of the Suicide Support and Information System. Cork: National Suicide Research Foundation; 2012.
Barrett A, et al. Fifty plus in Ireland 2011. First results from the Irish Longitudinal Study on Ageing (TILDA). Dublin: The Irish Longitudinal Study on Ageing; 2011.
Borowitz M, Moran V, Pearson M. The performance of the Irish health system in an international context. In: Callan T, editor. Budget perspectives 2012. Dublin: Economic and Social Research Institute; 2011. pp. 23–56.
Brick A, Nolan A. The sustainability of Irish health expenditure. In: Callan T, editor. Budget perspectives 2011. Dublin: Economic and Social Research Institute; 2010. pp. 83–118.
Brick A, et al. Resource allocation, financing and sustainability in health care. Evidence for the Expert Group on Resource Allocation and Financing in the Health Sector. Dublin: Department of Health and Children and Economic and Social Research Institute; 2010.
Brick A, et al. Conflicting financial incentives in the Irish health-care system. Economic and Social Review. 2012; 43 :273–301.
Brick A, Gorecki P, Nolan A. Ireland: pharmaceutical prices, prescribing practices and usage of generics in a comparative context. Dublin: Economic and Social Research Institute; 2013. (ESRI Research Series No. 32)
Burstrom B, Fredlund P. Self rated health: is it as good a predictor of subsequent mortality among adults in lower as well as in higher social classes? Journal of Epidemiology & Community Health. 2001; 55 :836–840. [ PMC free article : PMC1763304 ] [ PubMed : 11604441 ]
Busse R, Blümel M. Germany: health system review. Health Systems in Transition. 2014; 16 (2):1–296. [ PubMed : 25115137 ]
Callan T, et al. Budget 2013: distributional impact. Dublin: Economic and Social Research Institute; 2012.
Carney P. Re: health and the economic crisis. BMJ. 2013; 346 :f4140.
Carswell S. Nine-year government bond drops below 6%: lowest rate since bailout. Irish Times. 2012 22 August.
Citizen's Information Board. Budget 2013. Dublin: Citizen's Information Board; 2014. [online] ( http://www .citizensinformation .ie/en/money_and_tax /budget_2013.html , accessed 29 October 2014)
Comptroller and Auditor General. Annual report 2009. Dublin: Stationery Office; 2010.
Comptroller and Auditor General. Annual report 2010. Dublin: Stationery Office; 2011.
CSO. Quarterly national household survey (Q3 2010): health status and health services utilisation. Dublin: Central Statistics Office; 2011.
CSO. Consumer price index detailed sub-indices, December 2011. Dublin: Central Statistics Office; 2012a.
CSO. Quarterly national accounts (Q4 2011 and year 2011 preliminary). Dublin: Central Statistics Office; 2012b.
CSO. Consumer price index detailed sub-indices, December 2012. Dublin: Central Statistics Office; 2013a.
CSO. Quarterly national household survey (Q1 2013). Dublin: Central Statistics Office; 2013b.
CSO. Survey on income and living conditions (SILC): 2011 and revised 2010 results. Dublin: Central Statistics Office; 2013c.
CSO. Vital statistics (Q4 and yearly summary). Dublin: Central Statistics Office; 2013d.
CSO. Statistics: CPA01: consumer price index by commodity group, year and statistic. Dublin: Central Statistics Office; 2014a. ( http://www .cso.ie/px /pxeirestat/Statire/SelectVarVal/Define .asp?Maintable =CPA01&Planguage=0 , 3 November 2014)
CSO. Statistics:CNA20: population by yearly age, sex, marital status and year. Dublin: Central Statistics Office; 2014b. ( http://www .cso.ie/px /pxeirestat/Statire/SelectVarVal/Define .asp?MainTable =CNA20&PLanguage =0&PXSId=0 , 3 November 2014)
Cullen P. GP card plan for long-term illness to be dropped. Irish Times. 2013 8 May.
Dáil Éireann. Long-term illness scheme. Written Answers. 2012; 771 (3):5.
Delaney L, Egan M, O'Connell N. The experience of unemployment in Ireland: a thematic analysis. Dublin: University College Dublin; 2011. (Geary WP2011/16)
Department of Health. Comprehensive review of expenditure September 2011. Dublin: Department of Health; 2011.
Department of Health. Health in Ireland: key trends 2012. Dublin: Department of Health; 2012a.
Department of Health. Health statistics 2011. Dublin: Department of Health; 2012b.
Department of Health. Reduction in fees paid to general practitioners and pharmacists. Dublin: Department of Health; 2013.
Department of Health and Children. Primary care: a new direction. Dublin: The Stationery Office; 2001a.
Department of Health and Children. Quality and fairness: a health system for you. Dublin: The Stationery Office; 2001b.
Department of Health and Children. Report of the Expert Group on Mental Health Policy: a vision for change. Dublin: The Stationery Office; 2006.
Department of Finance. Ireland's programme (EU–IMF programme). Dublin: Department of Finance; 2014. ( http://www .finance.gov .ie/what-we-do/eu-international /irelands-programme-eu-imf-programme , accessed 29 October 2014)
Department of Public Expenditure and Reform. Expenditure report 2013. Dublin: Department of Public Expenditure and Reform; 2012a.
Department of Public Expenditure and Reform. Medium term fiscal statement November 2012 incorporating the Department of Finance's autumn forecasts. Dublin: Department of Public Expenditure and Reform; 2012b.
Department of Public Expenditure and Reform. Estimates of public expenditure 2000–2013. Dublin: Department of Public Expenditure and Reform; 2014. ( http://databank .per.gov .ie/Expenditure.aspx?rep=GrossVH , accessed 29 October 2014)
Dormont B, Grignon M, Huber H. Health expenditure growth: reassessing the threat of ageing. Health Economics. 2006; 15 :947–963. [ PubMed : 16958079 ]
Duffy D, Timoney K. Quarterly economic commentary: spring 2013. Dublin: Economic and Social Research Institute; 2013.
European Commission. Economic adjustment programme for Ireland. Brussels: Directorate General for Economic and Financial Affairs; 2012. [Winter 2012 European Commission Working Document]
Eurostat. Health and long term care indicators. Luxembourg: Eurostat; 2013. ( http://epp .eurostat.ec .europa.eu/portal/page /portal/employment _social_policy_equality /social_protection _social_inclusion /indicators/health_long_term_care , accessed 9 August 2013)
Gorecki P, et al. Delivery of pharmaceuticals in Ireland: getting a bigger bang for the buck. Dublin: Economic and Social Research Institute; 2012. (ESRI Research Series 24)
Government of Ireland. Statutory Instrument No. 262 of 2009: health professionals (reductions of payments to general practitioners) regulations 2009. Dublin: The Stationery Office; 2009.
Government of Ireland. Statutory Instrument No. 638 of 2010: health professionals (reductions of payments to general practitioners) regulations 2010. Dublin: The Stationery Office; 2010.
Government of Ireland. Government for national recovery 2011–2016. Dublin: Stationery Office; 2011a.
Government of Ireland. Statutory Instrument No. 556 of 2011: health professionals (reductions of payments to general practitioners) regulations 2011. Dublin: The Stationery Office; 2011b.
Government of Ireland. Health (Amendment) Bill 2013. Dublin: Stationery Office; 2013a.
Government of Ireland. Health (Pricing and Supply of Medical Goods) Act 2013. Dublin: Stationery Office; 2013b.
Health Information and Quality Authority. National Hygiene Services quality review 2007. Dublin: Health Information and Quality Authority; 2007.
Health Information and Quality Authority. Investigation into the circumstances surrounding the provision of care to Rebecca O'Malley, in relation to her symptomatic breast disease, the Pathology Services at Cork University Hospital, Symptomatic Breast Disease Services at Mid Western Regional. Dublin: Health Information and Quality Authority; 2008a.
Health Information and Quality Authority. Investigation report into the pathology service and the symptomatic breast disease service at University Hospital Galway. Dublin: Health Information and Quality Authority; 2008b.
Health Insurance Authority. Annual report and accounts 2011. Dublin: Health Insurance Authority; 2012.
Health Insurance Authority. May newsletter. Dublin: Health Insurance Authority; 2013.
Health Policy and Management. Research projects. Dublin: Health Policy and Management, Trinity College; 2013. ( www .medicine.tcd.ie/health _policy_management /research/research-projects /Resilience-Project.php , accessed 29 October 2014)
HSE. National service plan 2009. Dublin: Health Service Executive; 2008. ( http://www .hse.ie/eng /services/Publications /corporate/National _Service_Plan_2009.pdf , accessed 29 October 2014)
HSE. Supplementary report December 2009. Dublin: Health Service Executive; 2010.
HSE. Supplementary report June 2011. Dublin: Health Service Executive; 2011a.
HSE. Supplementary report December 2010. Dublin: Health Service Executive; 2011b.
HSE. Revised salary scales: new medical consultants. Dublin: Health Service Executive; 2012a. (HR Circular 017/2012)
HSE. Supplementary report December 2011. Dublin: Health Service Executive; 2012b.
HSE. Supplementary report June 2012. Dublin: Health Service Executive; 2012c.
HSE. List of national clincial care programmes. Dublin: Health Service Executive; 2013a. ( http://www .hse.ie/eng /about/Who/clinical/natclinprog/ , accessed 29 October 2014)
HSE. National service plan 2013. Dublin: Health Service Executive; 2013b.
HSE. Performance report April 2013. Dublin: Health Service Executive; 2013c.
HSE. Performance report December 2012. Dublin: Health Service Executive; 2013d.
HSE. PQ 7530-13. Dublin: Health Service Executive; 2013e.
HSE. Supplementary report April 2013. Dublin: Health Service Executive; 2013f.
HSE. Supplementary report December 2012. Dublin: Health Service Executive; 2013g.
Idler E, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health and Social Behaviour. 1997; 38 :21–37. [ PubMed : 9097506 ]
Institute of Public Health in Ireland. Facing the challenge. The impact of recession and unemployment on men’s health in Ireland. Dublin: Institute of Public Health in Ireland; 2011.
Institute of Public Health in Ireland. Proposed sugar sweetened drinks tax: health impact assessment full report. Dublin: Institute of Public Health; 2013.
Jackson T. Re: health and the economic crisis. BMJ. 2013; 346 :f4140. Í.
Maarse H, Paulus A. The politics of health care reform in the Netherlands since 2006. Health Economics, Policy and Law. 2011; 6 :125–134. [ PubMed : 21269528 ]
Mental Health Commission. Annual report of the Mental Health Commission including the report of the Inspector of Mental Health Services. Dublin: Mental Health Commission; 2013.
National Treatment Purchase Fund. National trend analysis of waiting times. Dublin: National Treatment Purchase Fund; 2013.
Nolan B, Wiley M. Private practice in Irish public hospitals. Dublin: Economic and Social Research Institute; 2000. (General Research Series 175)
Normand C. The health care system in Ireland: controlling expenditure and making best use of resources. In: Callan T, editor. Budget Perspectives 2012. Dublin: Economic and Social Research Institute; 2011. pp. 57–84.
OECD. Health at a glance 2011. OECD indicators. Paris: Organisation for Co-operation and Development; 2012a.
OECD. Health statistics 2012. Paris: Organisation for Co-operation and Development; 2012b. ( http://www .oecd.org/els /health-systems/health-data.htm , accessed 5 November 2014)
OECD. Health statistics 2013. Paris: Organisation for Co-operation and Development; 2013. ( http://www .oecd.org/els /health-systems/health-data.htm , accessed 5 November 2014)
OECD. Health statistics 2014. Paris: Organisation for Co-operation and Development; 2014. ( http://www .oecd.org/els /health-systems/health-data.htm , accessed 5 November 2014)
Oireachtas. Dáil question response from Minister of State at the Department of Health (Ms Lynch) to Deputy Róisín Shortall for written answer on 21 February 2013 (Parliamentary Question Ref 9490/13). Dublin: Oireachtas; 2012a. ( www .orieachtas.ie . http: //oireachtasdebates .oireachtas.ie/debates%20authoring /debateswebpack .nsf/takes /dail2013022100075?opendocumentWRAA01200 , accessed 29 October 2014)
Oireachtas. Dáil question response to Thomas Broughan from Minister James Reilly, 23 October 2012 (Parliamentary Question 658). Dublin: Oireachtas; 2012b. http: //oireachtasdebates .oireachtas.ie/debates%20authoring /debateswebpack .nsf/(indexlookupdail) /20121023~WRAA?opendocumentWRAA02200 , accessed 29 October 2014)
O'Reilly J, Wiley M. Who's that sleeping in my bed? Potential and actual utilisation of public and private beds in-patient beds in Irish acute public hospitals. Journal of Health Services Research and Policy. 2010; 15 :210–214. [ PubMed : 20592047 ]
O'Riordan M, Thomas S. Support for policy development of SHI in Ireland: a review of stakeholder views and values. Dublin: Trinity College and NUI Galway; 2011. (prepared for the Minister of Health)
Ruane F. Report of the Expert Group on Resource Allocation and Financing in the Health Sector. Dublin: Department of Health and Children; 2010.
Ruhm C. Are recessions good for your health? Quarterly Journal of Economics. 2000; 115 :617–650.
Samaritans. Impact report 2010–2011. Dublin: Samaritans; 2012. http://www .samaritans .org/sites/default/files /kcfinder/files /samaritans%20ireland%20impact%20report .pdf , accessed 29 October 2014)
Schut E, van de Ven W. Effects of purchaser competition in the Dutch health system: is the glass half full or half empty? Health Economics, Policy and Law. 2011; 6 :109–123. [ PubMed : 21269527 ]
Smith S. Equity in Irish health care financing: measurement issues. Health Economics, Policy and Law. 2010a; 5 :149–169. [ PubMed : 19723353 ]
Smith S. The Irish health basket: a basket case? European Journal of Health Economics. 2010b; 11 :343–350. [ PubMed : 19655185 ]
Suhrcke M, Stuckler D. Will the recession be bad for our health? It depends. Social Science & Medicine. 2012; 74 :647–653. [ PubMed : 22226605 ]
Suhrcke M, Stuckler D, Leone T. Recession and health in Europe: what to expect? Brussels: European Commission DG Employment, Social Affairs and Equal Opportunities; 2009.
Thomas S, Burke S. Coping with austerity in the Irish health system. Eurohealth. 2012; 18 :7–9.
Thomas S, Normand C, Smith S. Social health insurance: further options for Ireland. Dublin: Trinity College Dublin and the Adelaide Hospital Society; 2008.
Thomas S, Ryan P, Normand C. Effective foundations for the financing and organisation of social health insurance in Ireland. Dublin: the Adelaide Hospital Society; 2010.
Thomas S, et al. Resilience of the Irish health system: surviving and using the economic contraction. Dublin: Trinity College Dublin; 2012. (Year 1 report of the Resilience Project)
Thomson S, Jowett M, Mladovsky P, editors. Health system responses to financial pressures in Ireland: policy options in an international context. Copenhagen: WHO Regional Office for Europe for the European Observatory on Health Systems and Policies; 2012. ( http://www .euro.who.int /__data/assets/pdf_file /0006/260088/Health-system-responses-to-financial-pressures-in-Ireland.pdf , accessed 29 October 2014)
Thomas S, et al. A framework for assessing health system resilience in an economic crisis: Ireland as a test case. BMC Health Services Research. 2013; 13 :450. [ PMC free article : PMC3816300 ] [ PubMed : 24171814 ]
van Doorslaer, et al. Equity in the delivery of health care in Europe and the US. Journal of Health Economics. 2000; 19 :553–583. [ PubMed : 11184794 ]
Walsh B, Walsh D. Re: health and the economic crisis. BMJ. 2013; 346 :f4140.
Watson D, Williams J. Perceptions of the quality of health care in the public and private sectors in Ireland. Dublin: University College Dublin (Report to the Centre for Insurance Studies, Graduate Business School, University College Dublin); 2001.
Westert G, et al. Dutch health care performance report 2010. Bilthoven: National Institute for Public Health and the Environment; 2010.
Wren M-A. Health spending and the black hole. Dublin: Economic and Social Research Institute; 2004. (Quarterly Economic Commentary) ( http://www .esri.ie/pdf/QEC0904SA_Wren .pdf , accessed 29 October 2014)

The study also found that originator off-patent pharmaceutical prices were lower in Ireland than in other EU Member States.

While medical cards have been proven to be a pro-poor measure, those with medical cards often have to wait longer to gain access to public hospital care than those with PHI or who can afford to pay privately (Ruane, 2010 ).

However, recently drafted legislation provides for significantly increased charges for private beds in public hospitals (Government of Ireland, 2013a ).

In addition, it is important to understand the extent to which cost-shifting to the private sector has occurred, via the government’s policy to increase OOP payments and the rapid increase in premiums for PHI (discussed in section 3.2 ).

Figures calculated from the Health Insurance Authority ( 2012 , 2013 ) and the CSO databank.

This section draws heavily on interviews with senior health system decision-makers in Ireland as part of the HRB-funded project "Resilience of the Irish health system: surviving and utilising the economic contraction". Further details on the methodology for the qualitative component of the research are available from Health Policy and Management ( 2013 ). See also Thomas et al. ( 2013 ).

Cite this Page Nolan A, Barry S, Burke S, et al. The impact of the crisis on the health system and health in Ireland. In: Maresso A, Mladovsky P, Thomson S, et al., editors. Economic crisis, health systems and health in Europe: Country experience [Internet]. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2015. (Observatory Studies Series, No. 41.) 5.
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The nature and magnitude of the financial and economic crisis
Health system pressures prior to the crisis
Health system responses to the crisis
Implications for health system performance and health
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The Irish Healthcare System: A Morality Tale

PMID: 31113514
DOI: 10.1017/S0963180119000100

A country's healthcare system-the protection and healing of some its weakest people, its sick and injured-could be considered to be one of the most definitive expressions of its national morality. In recent decades, Ireland has experienced profound cultural changes; from a mostly monocultural and religious society to a multi-ethnic one, where secular ideas predominate. Economically, it is largely neoliberal, with one of the world's most open economies, and one of its lowest corporate tax rates; though there is also a welfare state. Its healthcare system has reflected these cultural changes. The system has evolved, gradually, from being run almost exclusively by religious groups, to becoming essentially secular in nature (though religious groups are still involved at the ownership level). Overall, the system is run according to the two competing secular ideologies which currently predominate; it is a two-tier system, with a mix of a neoliberally oriented (though government subsidized) private system, and a public system. The latter has been starved of resources in recent decades; so to achieve good, or at times adequate healthcare, it is almost essential to have private health insurance (which about half of the population have).This two-tier system has led to significant concerns and occasional scandals; for example, patients dying while on waiting lists for public treatment, who could have been treated and possibly saved if they had health insurance. A purely ethical approach to healthcare-with the aim of healing the sick-has been mixed with competing motives, such as the desire for profit in the private sector, or for short term savings and box-ticking in the public system. Thus, good healthcare practice and best moral practice are being undermined by competing agendas.In this article, I describe and reflect ethically on the Irish healthcare system, and how it has evolved to its current state. I also discuss how dysfunction in the healthcare system, leading to the death of a pregnant woman, Savita Halappanavar, was a major factor in a constitutional ban on abortion being overturned.

Keywords: Catholic Church; Ireland; Irish healthcare system; Savita Halappanavar; abortion referendum; ethics; health insurance; morality; neoliberalism.

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Reform of the Irish Healthcare System: What Reform?

First Online: 05 October 2016

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Sara Burke 3

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This chapter outlines what happened to the Irish health system over the last decade, detailing the constant reorganising and restructuring which had little positive impact on patient care. It chronicles Ireland’s unusual public–private mix, an outlier in a European and OECD context, in that there is no universal access to healthcare. The impact of the economic crisis on health is assessed, demonstrating how during austerity inequalities in access to healthcare persisted and resulted in people paying more and waiting for longer for some aspects of essential care. It concludes by proposing that Ireland is at a critical juncture where it can maintain the status quo or pursue a path towards universal access to healthcare.

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A Cross Comparative Analysis of the U.S., German, and Italian Healthcare System

Chapter Nine: Reducing Healthcare Costs in Portugal: Outcomes and Implications for Public and Private Medicine

Exploring the Neoliberal Health Legacy in Britain

Barrington, R. (1987). Health, medicine and politics in Ireland 1900–1970 . Dublin: IPA.

Google Scholar

Brick, A., Nolan, A., O’Reilly, J., & Smith, S. (2010). Resource allocation, financing and sustainability in health care. Evidence for the expert group, volume 1 . Dublin: DHC/ESRI.

Brick, A., Gorecki, P., & Nolan, A. (2014). Ireland: Pharmaceutical prices, prescribing practices and usage of generics in a comparative context . Dublin: ESRI.

Burke, S. (2009). Irish apartheid. Healthcare inequality in Ireland . Dublin: New Island.

Burke, S. (2013). How three policies aimed at increasing for-profit hospital care became an accepted method of reform in Ireland between 2000 and 2005. ‘How many ditches do you die on?’. Ph.D, TCD.

Burke, S. (2014) There was absolutely nothing natural about the death of Dhara Kivlehan. Irish Independent , 4 October.

Burke, S., Barry, S., Thomas, S. (2014a). Indicators of health system coverage and activity in Ireland during the economic crisis, 2008–2014—From “more with less” to “less with less”. Health Policy , 117 (3), 275–278

Burke, S., Thomas, S., Barry, S., & Keegan, C. (2014b). Overview of resilience project: Concepts, research stages and initial findings, Presentation to the HSE Masterclass 24 May, Dublin Convention Centre: HSE/Trinity.

Children’s Mental Health Coalition. (2015). Meeting the mental health support needs of children and adolescents: A children’s mental health coalition view . Dublin: Children’s Mental Health Coalition.

Connor, M. (2014). Is the Irish health system at an inflection point? Is further consolidation safe? Unpublished: Griffith University, Australia.

DH. (2012a). Future health: A strategic framework for reform of the health service 2012–2015 . Dublin: DH.

DH. (2012b). National carers strategy . Dublin: DH.

DH. (2013a). Healthy Ireland—A framework for improved health and well-being 2013–2025 . Dublin: DH.

DH. (2013b). The establishment of hospital groups as a transition to independent hospital trusts . Dublin: DH.

DH. (2013c). Securing the future of small hospitals . Dublin: DH.

DH. (2014). The pathway to universal healthcare: White paper on universal health insurance . Dublin: DH.

DH. (2015a). Emergency department task force report . Dublin: DH.

DH. (2015b). Healthcare quality indicators in the Irish health system . Dublin: DH.

DHC. (2001a). Quality and fairness a health system for you . Dublin: DHC.

DHC. (2001b). Primary care a new direction . Dublin: DHC.

DHC. (2003a). Audit and structures and functions in the health system (the prospectus report) . Dublin: DHC.

DHC. (2003b). Commission on financial management and control systems in the health service (Brennan Report) . Dublin: DHC.

DHC. (2003c). Report of national task force on medical staffing (Hanly Report) . Dublin: DHC.

DHC. (2006). A vision for change . Dublin: DHC.

EC. (2013). The impact of the financial crisis on unmet needs for healthcare . Athens/Brussels: EC Employment, Social Affairs and Inclusion.

GoI. (2011). Government for national recovery 2011–2016 . Dublin: FG/LP.

HIA. (2013). HIA annual report and accounts 2012 . Dublin: HIAI.

HIAI. (2015). Market statistics for number of people with private health insurance inpatient cover. http://www.hia.ie/sites/default/files/Website%20Statistics%20270315.pdf . Accessed 27 Apr 2015.

HIQA. (2013). Investigation into the care and treatment of Savita Halappanavar in University College Galway Hospital and 19 other maternity units in Ireland . Dublin: HIQA.

HIQA. (2015). Report of the investigation into the safety, quality and standards of services provided by the health service executive to patients in the Midlands Regional Hospital, Portlaoise . Dublin: HIQA.

HSE. (2006). The health service reform programme . Dublin: HSE.

HSE. (2009). HSE national service plan 2009 . Dublin: HSE.

HSE. (2014a). Community healthcare organisations—Report and recommendations of the integrated service area review group . Dublin: HSE.

HSE. (2014b). Health service executive plan for acute services 2014 . Dublin: HSE.

HSE. (2014c). HSE national service plan 2015 . Dublin: HSE.

HSE. (2015a). Health service performance report, April 2015 . Dublin: HSE.

HSE. (2015b). Health service performance report, January 2015 . Dublin: HSE.

HSE. (2015c). Primary care reimbursement service statistical analysis of claims and payments 2013 . Dublin: HSE.

Keane, F. (2014). Report of the expert panel on medical need for medical card eligibility . Dublin: HSE.

Layte, R., Nolan, A., & Nolan, B. (2007). Poor prescriptions. Poverty and access to community health services . Dublin: Combat Poverty Agency.

Maarse, M., & Normand, C. (2009). Market competition in European hospital care. In B. Rechel, S. Wright, N. Edwards, B. Dowdeswell, & M. McKee (Eds.), Investing in hospitals in the future (pp. 103–122). Copenhagen: European Observatory on Health Systems and Policies/WHO.

Mental Health Commission. (2015). Mental health commission annual report 2014, including report of the inspector of mental health services . Dublin: Mental Health Commission.

Murphy, C., Moore, P., McHugh, S., & Nolan, H. (2014). Health and social care utilisation. In A. Nolan, C. O’Regan, C. Dooley, D. Wallace, A. Hever, H. Cronin, E. Hudson, & R. A. Kenny (Eds.), The over 50s in a changing Ireland. Economic circumstances, health and well-being 2014 . Dublin: TILDA.

NHI. (2011). Annual private nursing homes survey 2009/2010 . Dublin: NHI.

Nolan, A., Barry, S., Burke, S., & Thomas, S. (2014). Observatory-WHO study on the impact of the financial crisis on health and health systems in Europe. Case study Ireland . London: WHO European Observatory on Health Systems.

Normand, C. (2015). Funding universal health and social care in Ireland: Ageing, dying and affordability (NERI research seminar). Dublin: NERI.

Normand, C., & Thomas, S. (2009). Health care financing and the health system. In G. Carrin, K. Buse, H. K. Heggenhougen, & S. R. Quah (Eds.), Health systems policy, finance, and organization . Oxford: Elsevier.

NTPF. (2015a). Outpatient national waiting list figures by group/hospitals as at 26/03/2015 . Dublin: NTPF.

NTPF. (2015b). Inpatient/day case national waiting times by group/hospital as at 26/05/2015 . Dublin: NTPF.

O’Brien, T. (2013). Tony O’Brien HSE Director General commenting on the publication of the HIQA report into the death of Savita Halappanavar, 9 November . Dublin: HSE.

O’Riordan, M., Collins, C., & Doran, G. (2013). Access to diagnostics—A key enabler for a primary care led health service . Dublin: ICGP.

Organisation for Economic Co-operation and Development (OECD). (2015). Health at a glance 2015 . Paris: OECD.

Revenue Commissioners. (2015). Costs of credits, allowances and reliefs . Dublin: Revenue Commissioners.

Smith, S., & Normand, C. (2010). Equity in health care: The Irish perspective. Health Economics, Policy and Law, 5 (2), 149–169.

Article Google Scholar

Thomas, S., Burke, S., & Barry, S. (2014). The Irish health-care system and austerity: Sharing the pain. The Lancet, 383 , 1545–1546.

Thomson, S., Jowett, M., & Mladovsky, P. (2014). Health system responses to financial pressures in Ireland. Policy options in an international context . Copenhagen: WHO.

Tussing, D. A., & Wren, M. A. (2005). How Ireland cares. The case for healthcare reform . Dublin: New Island.

WHO. (2015). National health accounts indicators . Geneva: WHO.

Wren, M. A. (2003). Unhealthy state. Anatomy of a sick society . Dublin: New Island.

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Department of Sociology, Maynooth University, Maynooth, Ireland

Mary P. Murphy

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Burke, S. (2016). Reform of the Irish Healthcare System: What Reform?. In: Murphy, M., Dukelow, F. (eds) The Irish Welfare State in the Twenty-First Century. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-137-57138-0_8

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Ireland's healthcare system: What exactly are we doing wrong?

WHAT IS WRONG with Ireland’s healthcare system?

Long waiting lists, healthcare professionals under pressure, and emergency services at breaking point are some of the most common complaints that we hear about, but what can we do to change it?

And before you say ‘money’, the short response to that is it’s not the main problem – a recent report seriously questioned whether increasing the money going into the healthcare system would make things better by the same proportion.

Using some of the metrics that Ireland scored the lowest on as part of the EuroHealth Consumer Index 2016 , we’ve taken a look at what are the worst aspects of our healthcare system, and what we could do to change it (with a quick reminder that it’s not just the healthcare system at fault, either).

What did we score worst on?

In the EuroHealth report, a ‘matrix’ shows how each of the 35 countries surveyed scored under six main headings, marking them with a green, yellow or red mark to represent ‘good’, ‘intermediary’ or ‘not-so-good’ respectively.

To view this image in Full click here.

The matrix is broken down into six headings and the number of subheadings, and out of those six headings, Ireland scored ‘not-so-good’ on the following:

1. Patient Rights and Information (12)

No-fault malpractice insurance
Right to second opinion
Online booking of appointments
e-prescriptions

2. Accessibility (6)

Direct access to specialist
Major elective surgery <90 days
CT scan <7 days
A&E waiting times

3. Outcomes (9)

COPD mortality

4. Range and Reach of Services (8)

Equity of healthcare systems
Cataract operations per 100,000 age 65+

5. Prevention (7)

Physical activity

We were given all ‘intermediate’ or ‘good’ marks under the sixth category; Pharmaceuticals.

Based on this score sheet, we grouped some of those subheadings together, had a look at what we’re doing wrong, and possible ways of fixing it.

Accessibility is the main issue for the Irish healthcare system (we scored badly on 4/6 criteria); patient rights were an issue too.

We also had a quick look at what we scored badly on that don’t have anything to do with the healthcare system: COPD mortality attitudes to alcohol and exercise.

Lastly, there’s a general look at what needs to be done to improve the Irish healthcare system, and Simon Harris’ attitude towards it.

Accessibility

Ireland ranked the worst in a survey of European countries for long waiting list times: both in terms of the number of people waiting and the length of time.

This isn’t a problem that can be solved by money or funding (there’s no obvious link between access to healthcare and healthcare funding), but rather it’s an issue of system or management reform.

One major difference between the four countries with the worst waiting times and those with the best is that the latter never had systems where hospitals/clinics were financed beforehand to provide healthcare for citizens.

Dr Arne Björnberg used to be European Manager for healthcare solutions for IBM back in the 1990s and is now Chairman of the Health Consumer Powerhouse. He explains:

On the contrary, their hospitals and primary care doctors were always remunerated for services provided, so that in Belgium, Switzerland, Germany and Austria waiting lists are short or non-existent.

So basically, if people are on waiting lists for prolonged periods of time, it means hospitals aren’t getting money. They have to see and treat patients to get paid by the state.

To show how much of a difference this approach to healthcare makes, Germany’s waiting times to see your primary care doctor were measured in minutes, not weeks.

Again; this isn’t a funding issue as Macedonia, which isn’t a particularly wealthy country has one of the best rates of accessible healthcare, while Sweden has one of the worst.

The Irish Nurses and Midwives Organisation and the Irish Medical Organisation say that most accessibility problems come down to staffing issues – that there are simply not enough staff in proportion to patients.

That’s difficult to compare to other countries, but a recent FactCheck from the end of last year showed that there has only been a slight decrease in the numbers of whole time equivalent staff working in the healthcare system.

Patient rights and information

Under this heading, Ireland doesn’t have access to no-fault malpractice insurance, a right to second opinion, online booking of appointments or e-prescriptions.

In countries such as Norway (which topped the list on patients the information and rights) they offer insurance that covers a patient who suffers because of treatment – even though there might be no one at fault.

The Nordic countries are good examples for patient malpractice insurance, where the issue of ’who might have made an error’ is separated from the issue ‘has the patient suffered because of preventive causes?’.

Nordic healthcare institutions are carrying insurance for the latter circumstance, meaning that it is very rare for patients having to enlist expensive lawyers to push malpractice cases.

In Norway, you’re also entitled to a second opinion if your request for a referral has been rejected. You can speak with any doctor for a second opinion including an emergency doctor, private doctor, or online doctor.

Macedonia and Serbia have implemented a system which displays where healthcare specialists around the country are, with their availability displayed to view. GPs can book a patient for a referral if needed, so that the patient leaves the office with a date and time.

Macedonia also have an e-prescriptions facility, meaning patients who have repeat prescriptions can apply for them from their home, meaning patients don’t have to book GP appointments just to get prescriptions.

“These are important,” says Björnberg. “If you agree that patients are grown-ups who should be supported at taking their own decisions on their health.”

It’s not all the healthcare system’s fault though and some things made it to the list that aren’t under the Department of Health’s remit.

Chronic Obstructive Pulmonary Disease deaths, although recorded included in the report, doesn’t make up the ‘final score’ for countries assessed as part of the Euro Health Index. This is because the data is so poor; very heavy smokers Bulgaria, for example, report very low rates of COPD death, which is simply not possible.

What makes it worth mentioning here, though, is that Ireland and Britain have had the highest COPD death rates in Europe for years – and we’re unsure as to why.

You do have a lot of rain, damp and draughty houses,” says Dr Björnberg. “But the connection of that to COPD is not proven.

COPD is a disease that makes it hard to empty air out of your lungs. This is because the airways get smaller leading to airflow obstruction, which can result in shortness of breath as you try to push the air through a smaller gap.

Most people with COPD are smokers or have smoked in the past. Sometimes COPD is caused by working or living for many years in an environment where there is exposure to smoke, dust or other fumes.

So cold and damp weather is worth being wary of.

Alcohol and exercise

Ireland also scored badly in terms of alcohol consumption and physical activity, which are preventative healthcare measures.

In Ireland, it’s not the alcohol intake in itself that’s the problem, but rather the massive drinking sessions in one go, compared to the Mediterranean’s moderate intake that’s spread out over time.

“A steady moderate alcohol intake seems to be beneficial against Cardiovascular Disease, and thus having a positive effect on public health,” says Björnberg.

Alcohol intake is the cause of around 900 incidences of cancer in Ireland each year, and 500 of these patients will die of their disease.

Ireland has also a rising rate of obesity: with the Royal College of Physicians warning that Ireland could become the fattest country in Europe by 2030 if urgent action isn’t taken.

Efforts have been made to curb this rate by promoting exercise among young people, and imposing more regulations on sugary and fatty foods.

Health Minister’s mission

Björnberg’s major assertion on how to fix healthcare systems revolves around two key concepts: demanding better management results, something he says all healthcare systems are looking at, and taking politics out of the healthcare system.

If that sounds familiar, it’s because it echoes previous promises made by health minister Simon Harris: who upon his appointment, promised to fix the healthcare system by taking the political element out of it, and more recently, asked for improvements from hospital managers.

Harris clarified that this didn’t mean firing managers, but asking them to improve their way of operating, and looking at other hospitals’ examples of how to improve conditions, like any other business would.

“It’s not difficult,” according to Björnberg. ”You just need to manage in a way that motivates staff, maximises production, keeps costs down, and monitors the output of healthcare.”

Apart from that, just stand in the main entrance of the hospital with a cane to keep amateurs out and let the professionals do their jobs.

“And by amateurs, I mean politicians.”

Read: How Ireland’s hospitals are massaging the numbers of people on trolleys

Factcheck: nursing union leader liam doran’s claims about the irish health service.

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Honours Irish essay on the Health System

19-05-2008 2:10pm #1 JessicaFletcher Closed Accounts Posts: 4 ✭ Join Date: May 2008 Posts: 1 I was just wondering if anyone would be able to help me with some notes for an Irish essay on the health system. Im a mature student doing a lot of the course on my own in the hope of getting in to do Primary school teaching next year. At this late stage I am just hoping for some info fast as my grinds teacher wasnt much help and I still have so much study to do Any help would be really really appreciated 0

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Health and social care leaders say ethnic minority communities are ‘very fabric of our health and care system’

Members of the northern ireland confederation for health and social care have condemned the recent violence.

Health and social care leaders in Northern Ireland have said that ethnic minority communities are the “very fabric of our health and care system” amid the recent racist attacks in Belfast.

Members of the Northern Ireland Confederation for Health and Social Care (NICON) have joined together to condemn the violence and warned that “attacks or intimidation will hurt the whole of our society”.

Mark Taylor, NICON spokesperson, said: “As the representative body for health and social care (HSC) leaders in Northern Ireland, including chairs and chief executives, NICON wishes to express our shock at the racist attacks and intimidation that have taken place over the last few days.

“We highly value our ethnic minority communities who contribute much to our society.

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“More specifically, we highly value our ethnic minority HSC staff.

“They are part of the very fabric of our health and care system – we are completely dependent on them.

“We spend a lot of time and money attracting skilled and compassionate staff from other parts of the world.

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“Our members have been doing everything we can to support and care for colleagues, and we will redouble our efforts to ensure they feel safe to stay.

“We welcome the many other voices beyond health and social care who have also set out their support for those who feel threatened by these attacks.

“To the ringleaders of this violence, we want to highlight that any continuation of the attacks or intimidation will hurt the whole of our society.”

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Guidehealth Secures $14M for AI-Powered Value-Based Care

by Fred Pennic 08/07/2024 Leave a Comment

What You Should Know:

– Guidehealth , an AI-powered healthcare services provider raises $14M in seed funding led by Memorial Hermann Health System , with participation from healthcare entrepreneur Sidd Pagadipati and other industry leaders.

– The funding will accelerate Guidehealth’s mission to improve health outcomes and increase access to care through value-based care (VBC) models. The company’s AI-driven platform and clinical support services help health systems and clinically integrated networks (CINs) optimize care delivery, reduce costs, and enhance patient experiences.

Recent Traction

Guidehealth has experienced rapid growth since its founding, expanding its customer base to include top health systems and CINs serving over 500,000 lives. The company’s acquisition of Arcadia’s value-based care managed services division has further strengthened its position in the market.

“Memorial Hermann is an internationally acclaimed clinical leader whose brand is synonymous with patient-centered, community-based healthcare excellence. Receiving this financial support is an honor, and the strategic expertise its leaders bring to the table is invaluable,” said Dr. Sanjay Doddamani, Founder and CEO of Guidehealth. “As we transform care delivery for health systems and affiliated physician networks, we will continue to enhance our datasets and clinical services that power our award-winning value-based managed services platform.”

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Announcing the NeurIPS 2023 Paper Awards

Communications Chairs 2023 2023 Conference awards , neurips2023

By Amir Globerson, Kate Saenko, Moritz Hardt, Sergey Levine and Comms Chair, Sahra Ghalebikesabi

We are honored to announce the award-winning papers for NeurIPS 2023! This year’s prestigious awards consist of the Test of Time Award plus two Outstanding Paper Awards in each of these three categories:

Two Outstanding Main Track Papers
Two Outstanding Main Track Runner-Ups
Two Outstanding Datasets and Benchmark Track Papers

This year’s organizers received a record number of paper submissions. Of the 13,300 submitted papers that were reviewed by 968 Area Chairs, 98 senior area chairs, and 396 Ethics reviewers 3,540 were accepted after 502 papers were flagged for ethics reviews .

We thank the awards committee for the main track: Yoav Artzi, Chelsea Finn, Ludwig Schmidt, Ricardo Silva, Isabel Valera, and Mengdi Wang. For the Datasets and Benchmarks track, we thank Sergio Escalera, Isabelle Guyon, Neil Lawrence, Dina Machuve, Olga Russakovsky, Hugo Jair Escalante, Deepti Ghadiyaram, and Serena Yeung. Conflicts of interest were taken into account in the decision process.

Congratulations to all the authors! See Posters Sessions Tue-Thur in Great Hall & B1-B2 (level 1).

Outstanding Main Track Papers

Privacy Auditing with One (1) Training Run Authors: Thomas Steinke · Milad Nasr · Matthew Jagielski

Poster session 2: Tue 12 Dec 5:15 p.m. — 7:15 p.m. CST, #1523

Oral: Tue 12 Dec 3:40 p.m. — 4:40 p.m. CST, Room R06-R09 (level 2)

Abstract: We propose a scheme for auditing differentially private machine learning systems with a single training run. This exploits the parallelism of being able to add or remove multiple training examples independently. We analyze this using the connection between differential privacy and statistical generalization, which avoids the cost of group privacy. Our auditing scheme requires minimal assumptions about the algorithm and can be applied in the black-box or white-box setting. We demonstrate the effectiveness of our framework by applying it to DP-SGD, where we can achieve meaningful empirical privacy lower bounds by training only one model. In contrast, standard methods would require training hundreds of models.

Are Emergent Abilities of Large Language Models a Mirage? Authors: Rylan Schaeffer · Brando Miranda · Sanmi Koyejo

Poster session 6: Thu 14 Dec 5:00 p.m. — 7:00 p.m. CST, #1108

Oral: Thu 14 Dec 3:20 p.m. — 3:35 p.m. CST, Hall C2 (level 1)

Abstract: Recent work claims that large language models display emergent abilities, abilities not present in smaller-scale models that are present in larger-scale models. What makes emergent abilities intriguing is two-fold: their sharpness, transitioning seemingly instantaneously from not present to present, and their unpredictability , appearing at seemingly unforeseeable model scales. Here, we present an alternative explanation for emergent abilities: that for a particular task and model family, when analyzing fixed model outputs, emergent abilities appear due to the researcher’s choice of metric rather than due to fundamental changes in model behavior with scale. Specifically, nonlinear or discontinuous metrics produce apparent emergent abilities, whereas linear or continuous metrics produce smooth, continuous, predictable changes in model performance. We present our alternative explanation in a simple mathematical model, then test it in three complementary ways: we (1) make, test and confirm three predictions on the effect of metric choice using the InstructGPT/GPT-3 family on tasks with claimed emergent abilities, (2) make, test and confirm two predictions about metric choices in a meta-analysis of emergent abilities on BIG-Bench; and (3) show how to choose metrics to produce never-before-seen seemingly emergent abilities in multiple vision tasks across diverse deep networks. Via all three analyses, we provide evidence that alleged emergent abilities evaporate with different metrics or with better statistics, and may not be a fundamental property of scaling AI models.

Outstanding Main Track Runner-Ups

Scaling Data-Constrained Language Models Authors : Niklas Muennighoff · Alexander Rush · Boaz Barak · Teven Le Scao · Nouamane Tazi · Aleksandra Piktus · Sampo Pyysalo · Thomas Wolf · Colin Raffel

Poster session 2: Tue 12 Dec 5:15 p.m. — 7:15 p.m. CST, #813

Oral: Tue 12 Dec 3:40 p.m. — 4:40 p.m. CST, Hall C2 (level 1)

Abstract : The current trend of scaling language models involves increasing both parameter count and training dataset size. Extrapolating this trend suggests that training dataset size may soon be limited by the amount of text data available on the internet. Motivated by this limit, we investigate scaling language models in data-constrained regimes. Specifically, we run a large set of experiments varying the extent of data repetition and compute budget, ranging up to 900 billion training tokens and 9 billion parameter models. We find that with constrained data for a fixed compute budget, training with up to 4 epochs of repeated data yields negligible changes to loss compared to having unique data. However, with more repetition, the value of adding compute eventually decays to zero. We propose and empirically validate a scaling law for compute optimality that accounts for the decreasing value of repeated tokens and excess parameters. Finally, we experiment with approaches mitigating data scarcity, including augmenting the training dataset with code data or removing commonly used filters. Models and datasets from our 400 training runs are freely available at https://github.com/huggingface/datablations .

Direct Preference Optimization: Your Language Model is Secretly a Reward Model Authors: Rafael Rafailov · Archit Sharma · Eric Mitchell · Christopher D Manning · Stefano Ermon · Chelsea Finn

Poster session 6: Thu 14 Dec 5:00 p.m. — 7:00 p.m. CST, #625

Oral: Thu 14 Dec 3:50 p.m. — 4:05 p.m. CST, Ballroom A-C (level 2)

Abstract: While large-scale unsupervised language models (LMs) learn broad world knowledge and some reasoning skills, achieving precise control of their behavior is difficult due to the completely unsupervised nature of their training. Existing methods for gaining such steerability collect human labels of the relative quality of model generations and fine-tune the unsupervised LM to align with these preferences, often with reinforcement learning from human feedback (RLHF). However, RLHF is a complex and often unstable procedure, first fitting a reward model that reflects the human preferences, and then fine-tuning the large unsupervised LM using reinforcement learning to maximize this estimated reward without drifting too far from the original model. In this paper, we leverage a mapping between reward functions and optimal policies to show that this constrained reward maximization problem can be optimized exactly with a single stage of policy training, essentially solving a classification problem on the human preference data. The resulting algorithm, which we call Direct Preference Optimization (DPO), is stable, performant, and computationally lightweight, eliminating the need for fitting a reward model, sampling from the LM during fine-tuning, or performing significant hyperparameter tuning. Our experiments show that DPO can fine-tune LMs to align with human preferences as well as or better than existing methods. Notably, fine-tuning with DPO exceeds RLHF’s ability to control sentiment of generations and improves response quality in summarization and single-turn dialogue while being substantially simpler to implement and train.

Outstanding Datasets and Benchmarks Papers

In the dataset category :

ClimSim: A large multi-scale dataset for hybrid physics-ML climate emulation

Authors: Sungduk Yu · Walter Hannah · Liran Peng · Jerry Lin · Mohamed Aziz Bhouri · Ritwik Gupta · Björn Lütjens · Justus C. Will · Gunnar Behrens · Julius Busecke · Nora Loose · Charles Stern · Tom Beucler · Bryce Harrop · Benjamin Hillman · Andrea Jenney · Savannah L. Ferretti · Nana Liu · Animashree Anandkumar · Noah Brenowitz · Veronika Eyring · Nicholas Geneva · Pierre Gentine · Stephan Mandt · Jaideep Pathak · Akshay Subramaniam · Carl Vondrick · Rose Yu · Laure Zanna · Tian Zheng · Ryan Abernathey · Fiaz Ahmed · David Bader · Pierre Baldi · Elizabeth Barnes · Christopher Bretherton · Peter Caldwell · Wayne Chuang · Yilun Han · YU HUANG · Fernando Iglesias-Suarez · Sanket Jantre · Karthik Kashinath · Marat Khairoutdinov · Thorsten Kurth · Nicholas Lutsko · Po-Lun Ma · Griffin Mooers · J. David Neelin · David Randall · Sara Shamekh · Mark Taylor · Nathan Urban · Janni Yuval · Guang Zhang · Mike Pritchard

Poster session 4: Wed 13 Dec 5:00 p.m. — 7:00 p.m. CST, #105

Oral: Wed 13 Dec 3:45 p.m. — 4:00 p.m. CST, Ballroom A-C (level 2)

Abstract: Modern climate projections lack adequate spatial and temporal resolution due to computational constraints. A consequence is inaccurate and imprecise predictions of critical processes such as storms. Hybrid methods that combine physics with machine learning (ML) have introduced a new generation of higher fidelity climate simulators that can sidestep Moore’s Law by outsourcing compute-hungry, short, high-resolution simulations to ML emulators. However, this hybrid ML-physics simulation approach requires domain-specific treatment and has been inaccessible to ML experts because of lack of training data and relevant, easy-to-use workflows. We present ClimSim, the largest-ever dataset designed for hybrid ML-physics research. It comprises multi-scale climate simulations, developed by a consortium of climate scientists and ML researchers. It consists of 5.7 billion pairs of multivariate input and output vectors that isolate the influence of locally-nested, high-resolution, high-fidelity physics on a host climate simulator’s macro-scale physical state. The dataset is global in coverage, spans multiple years at high sampling frequency, and is designed such that resulting emulators are compatible with downstream coupling into operational climate simulators. We implement a range of deterministic and stochastic regression baselines to highlight the ML challenges and their scoring. The data (https://huggingface.co/datasets/LEAP/ClimSim_high-res) and code (https://leap-stc.github.io/ClimSim) are released openly to support the development of hybrid ML-physics and high-fidelity climate simulations for the benefit of science and society.

In the benchmark category :

DecodingTrust: A Comprehensive Assessment of Trustworthiness in GPT Models

Authors: Boxin Wang · Weixin Chen · Hengzhi Pei · Chulin Xie · Mintong Kang · Chenhui Zhang · Chejian Xu · Zidi Xiong · Ritik Dutta · Rylan Schaeffer · Sang Truong · Simran Arora · Mantas Mazeika · Dan Hendrycks · Zinan Lin · Yu Cheng · Sanmi Koyejo · Dawn Song · Bo Li

Poster session 1: Tue 12 Dec 10:45 a.m. — 12:45 p.m. CST, #1618

Oral: Tue 12 Dec 10:30 a.m. — 10:45 a.m. CST, Ballroom A-C (Level 2)

Abstract: Generative Pre-trained Transformer (GPT) models have exhibited exciting progress in capabilities, capturing the interest of practitioners and the public alike. Yet, while the literature on the trustworthiness of GPT models remains limited, practitioners have proposed employing capable GPT models for sensitive applications to healthcare and finance – where mistakes can be costly. To this end, this work proposes a comprehensive trustworthiness evaluation for large language models with a focus on GPT-4 and GPT-3.5, considering diverse perspectives – including toxicity, stereotype bias, adversarial robustness, out-of-distribution robustness, robustness on adversarial demonstrations, privacy, machine ethics, and fairness. Based on our evaluations, we discover previously unpublished vulnerabilities to trustworthiness threats. For instance, we find that GPT models can be easily misled to generate toxic and biased outputs and leak private information in both training data and conversation history. We also find that although GPT-4 is usually more trustworthy than GPT-3.5 on standard benchmarks, GPT-4 is more vulnerable given jailbreaking system or user prompts, potentially due to the reason that GPT-4 follows the (misleading) instructions more precisely. Our work illustrates a comprehensive trustworthiness evaluation of GPT models and sheds light on the trustworthiness gaps. Our benchmark is publicly available at https://decodingtrust.github.io/.

Test of Time

This year, following the usual practice, we chose a NeurIPS paper from 10 years ago to receive the Test of Time Award, and “ Distributed Representations of Words and Phrases and their Compositionality ” by Tomas Mikolov, Ilya Sutskever, Kai Chen, Greg Corrado, and Jeffrey Dean, won.

Published at NeurIPS 2013 and cited over 40,000 times, the work introduced the seminal word embedding technique word2vec. Demonstrating the power of learning from large amounts of unstructured text, the work catalyzed progress that marked the beginning of a new era in natural language processing.

Greg Corrado and Jeffrey Dean will be giving a talk about this work and related research on Tuesday, 12 Dec at 3:05 – 3:25 pm CST in Hall F.

2023 Conference

Announcing NeurIPS 2023 Invited Talks

Reflections on the neurips 2023 ethics review process, neurips newsletter – november 2023.

IMAGES

The Irish Public Healthcare Sector
WHAT SHOULD
MJL Irish Essay Competition
(DOC) A critical review of the performance of the Irish health system
Essay on Health
Essay on Health Education

COMMENTS

Irish essay on the health system Flashcards
1. It is clear that time must be spent on a discussion about the health system and the political system and of course the about politicians themselves, and its widely believed throughout the country that the government is working for the good of the people but only for the good of themselves. Click the card to flip it 👆. 1 / 7.
PDF The Irish Healthcare System
focuses on health insurance and the Irish health system more widely, has been published nationally and internationally and he is a frequent contributor to national media discussions on the Irish health system. Brian is also co-director of the Postgraduate Diploma/MSc in Health Economics ... In an essay published in 1733, Jonathan Swift
Irish Essay
Study with Quizlet and memorize flashcards containing terms like There is not a day that passes by were we do not hear about the healthcare system in Ireland., It is no exaggeration, I think, that there is a problem with the system here in Ireland., On the other hand, we cannot forget the good work done by the healthcare workers. and more.
Ireland's Health Care System: Some Issues and Challenges
Anne Nolan and Brian Nolan1. 1. Introduction. A variety of recent reports and strategy documents have highlighted the intimidating range of challenges facing Ireland's health system as it seeks to improve its performance. In this short paper we cannot deal with these in any comprehensive fashion, but instead focus on three specific issues.
The impact of the crisis on the health system and health in Ireland
Previous analyses of the Irish health system noted the barriers to the delivery of integrated care, such as incompatible financial incentives (on the part of both users and providers), human resource constraints and poorly developed community care services (Ruane, 2010; Brick et al., 2012). Such issues will have to be resolved to secure the ...
Health crisis
Mon Jan 09 2023 - 00:10. A chara, - The complex, costly and dynamic nature of healthcare provision continues to challenge healthcare systems globally. In Ireland the delivery of safe, high ...
The Irish health system: developments in strategy, structure, funding
As the Irish health system embarks upon its first major structural reorganisation in over 30 years, developments within this system over the past two decades are assessed. Real cuts in health expenditure achieved in the 1980s contrast sharply with the unprecedented increase in resources devoted to the health system in the 1990s.
Ireland's Health Care System: Some Issues and Challenges
A variety of recent reports and strategy documents have highlighted the intimidating range of challenges facing Ireland-s health system as it seeks to improve its performance. In this short paper we cannot deal with these in any comprehensive fashion, but instead focus on three specific issues. First, we illustrate the value of trying to benchmark performance against other countries, as well ...
Universal Health Care in Ireland—What Are the Prospects for Reform?
The aim of this article is to examine the prospects for reforming the Irish health care system by introducing universal health care. This was done by reviewing the national and international literature on health system reform in order to identify factors that may help or hinder reform in the Irish context. A number of potential factors were ...
PDF About the Irish health system
Welcome to Ireland. The Health Service Executive (HSE) has developed this short guide to help you understand the Irish public health system. The guide is in three parts: Part 1 gives you information on how to access different types of health care, the services that are free and how the GP (doctor), pharmacy (chemist) and hospital systems work.
This article has been published in Health https://doi.org/10.1017
Lessons from the history of reform in Irish health care . 1. Introduction . The Irish healthcare system is unusual within the European context, since it is not designed with the objective of offering universal, equitable access to either primary or acute hospital care. A complex mixed public-private system persists despite much
Ireland's health system is one of the lowest ...
Ireland's health system ranked 22nd out of 35 countries in the broader European region in the European Health consumer index in 2018, but on the issue of accessibility Ireland ranked last.
Irish Essay
Study with Quizlet and memorise flashcards containing terms like There is not a day that passes by were we do not hear about the healthcare system in Ireland., It is no exaggeration, I think, that there is a problem with the system here in Ireland., On the other hand, we cannot forget the good work done by the healthcare workers. and others.
The Irish Healthcare System: A Morality Tale
A country's healthcare system-the protection and healing of some its weakest people, its sick and injured-could be considered to be one of the most definitive expressions of its national morality. In recent decades, Ireland has experienced profound cultural changes; from a mostly monocultural and religious society to a multi-ethnic one, where ...
Reform of the Irish Healthcare System: What Reform?
The health section in the PfG and Future Health, if delivered, could have resulted in radical change of the Irish health system. The 2011 PfG, which at the time of writing was four years old, remains largely unimplemented. Of its 85 health actions, just 17 of them had been acted upon.
Irish Essay
Irish essay on the health system. 7 terms. hannahconroy2021. Preview. Irish Essay - Healthcare System. 15 terms. lucyrocke. Preview. Straith pictiúr - Cuairt ar Aintín i Nua-Eabhrac . 18 terms. Megan_Greene401. Preview. Cluastuiscint 2022 Deferred Paper FOCLÓIR. 39 terms. cennis30.
Ireland's healthcare system: What exactly are we doing wrong?
Accessibility is the main issue for the Irish healthcare system (we scored badly on 4/6 criteria); patient rights were an issue too. We also had a quick look at what we scored badly on that don ...
New Ireland: Building a better healthcare system for all
Paul Cullen. Sat Jun 26 2021 - 06:00. Battered and bruised, and tired beyond belief, the health service is crawling away from a Covid-19 world towards the promise of a post-pandemic future. Better ...
Honours Irish essay on the Health System
Honours Irish essay on the Health System. 19-05-2008 2:10pm #1. JessicaFletcher. Closed Accounts Posts: 4 . Join Date: May 2008. Posts: 1. I was just wondering if anyone would be able to help me with some notes for an Irish essay on the health system. Im a mature student doing a lot of the course on my own in the hope of getting in to do ...
Health and social care leaders say ethnic minority ...
August 08, 2024 at 0:01am BST. Health and social care leaders in Northern Ireland have said that ethnic minority communities are the "very fabric of our health and care system" amid the recent ...
Guidehealth Secures $14M for AI-Powered Value-Based Care
What You Should Know: - Guidehealth, an AI-powered healthcare services provider raises $14M in seed funding led by Memorial Hermann Health System, with participation from healthcare entrepreneur ...
Irish- health system essay Flashcards
Nurses. Nua- cháilithe. Newly qualified. Deireadh leis na liostaí fada fanachta chun coinne a fháil le dochtúir. The long waiting lists for an appointment with a doctor would end. a léitheoir. reader. Study with Quizlet and memorize flashcards containing terms like Caithear go leor ama, ag plé, Cúrsaí polaitíochta and more.
Advertising coalition shuts down after Musk's X sues
The dispute stemmed from Musk's $44 billion (€40.1 billion) purchase of X, then known as Twitter, in 2022. Musk promised a new era of unrestricted speech and annulled many of the platform's ...
Announcing the NeurIPS 2023 Paper Awards
Announcing the NeurIPS 2023 Paper Awards By Amir Globerson, Kate Saenko, Moritz Hardt, Sergey Levine and Comms Chair, Sahra Ghalebikesabi . We are honored to announce the award-winning papers for NeurIPS 2023! This year's prestigious awards consist of the Test of Time Award plus two Outstanding Paper Awards in each of these three categories: . Two Outstanding Main Track Papers
Irish Essay
To get a better job abroad. Chun post níos fearr a fháil thar lear. Underpaid. Réamhíochta. unfair. éagórach. Is it not the responsibility. Nach bhfuil freagracht ar... Study with Quizlet and memorize flashcards containing terms like This is a great scandal, Definite date, They have to wait again and more.