Health Insurance in Ireland: Issues and Challenges

The context in which Ireland's complex mix of public and private health care operates has changed radically, widening the divide between those with and without health insurance and calling into question the public-private structure on which Ireland has relied for many years. Ireland now has one of the highest levels of PHI coverage in the OECD, despite the fact that hospital care is what private health insurance mostly covers, and everyone has entitlement to public hospital care from the state. The insured can avail of private health care, but much of this private care is actually delivered in public hospitals. The resulting two-tier system is now widely regarded as problematic from an equity perspective, but there are also serious efficiency issues arising from the incentive structures embedded in this particularly close intertwining of public and private.