An approach to estimating the effects of financing system change on Irish healthcare expenditure

The Irish healthcare system is a complex mix of public and private. The system is predominantly tax-financed (in 2013, 77 per cent of healthcare financing came from general taxation revenues); however, private health insurance and out-of-pocket payments are also used to finance significant amounts of healthcare expenditure. There are a number of different eligibility categories for public healthcare services in Ireland. Those in Category I (full medical cardholders) are entitled to free public health services but pay a co-charge for prescription items. Those in Category II are entitled to subsidised public hospital services and prescription medicines, but pay the full cost of other services including General Practitioner (GP) care. In October 2005, the GP visit card was introduced; GP visit cardholders have the same entitlements to free GP care as Category I individuals, but the same entitlements to all other public health services (including prescription medicines) as Category II individuals. Eligibility for a full medical/GP visit card is assessed primarily on the basis of an income means test, with a higher threshold applying to the GP visit card. A significant proportion of the population (42 per cent in 2014 (Department of Health, 2015a)), hold private health insurance, which mainly provides cover for private or semi-private acute hospital services.