Healthcare in the Republic of Ireland

The Rotunda Hospital in Dublin is the world's oldest maternity hospital, founded in 1745. It is also one of its largest, dealing with over eight thousand births in 2007.

Hospitals in Ireland generally offer a full range of healthcare including accident and emergency services. Many hospitals in Ireland, such as Connolly Hospital at Blanchardstown, are operated directly by the Health Service Executive. There are also hospitals run on a voluntary basis by organisations who receive public funding but operate with some degree of autonomy. Included in this latter group are teaching hospitals (such as University Hospital Galway) operated in conjunction with a university and hospitals with a long-standing religious ethos e.g. Tallaght University Hospital in Dublin. There are also many private hospitals. Ireland has a lower than OECD-average number of hospital beds according to the 2013 OECD Health at a Glance Report[11] The same report also noted that Ireland has fewer doctors (2.7 doctors per 1,000 population) and more nurses (12.2 nurses per 1,000 population) than average in other OECD countries. Consultants in the publicly funded hospitals are allowed to spend some of their time (typically 20%, though there is little supervision) on private practice.[5]

Ireland has reduced its spending on health care by 6.6% since the onset of the Global Financial Crisis according to the OECD's 2013 Health Report. As a consequence, waiting times for treatment have increased.

According to the Euro health consumer index waiting times for emergency treatment, minor operations, and CT scans, in Irish hospitals in 2015 were the worst in Europe, though the Irish health system was ranked 21st out of 35 European countries.[12] The Health Service Executive accepted that it lacked the capacity to provide sufficiently accessible health services. It was working to ensure that no one had to wait more than 18 months for an outpatient appointment, or inpatient treatment. According to the index, reports by patients on waiting times were considerably more pessimistic than official Irish waiting-time statistics.[13] The Euro health consumer index 2018 report continues to rank the accessibility of Ireland's Health system as the worst in Europe, with the overall ranking as 22nd of 35.[14]

In 2007,[15] 76% of inpatients were admitted to hospital for operations immediately, 11% had to wait up to one month, 4% had to wait up to three months, 1% had to wait up to six months and 4% had to wait for over six months for operations. Waiting times at the National Rehabilitation Hospital, the only such facility in the country, can be one year. For outpatients, 23% were seen on time, 44% were seen within 30 minutes, 18% waited more than an hour and 7% waited two hours.

University Hospital Galway is one of Ireland's largest hospitals, dealing with over two hundred thousand patients in 2007.

In 2007,[15] for GP services, 31% were seen without an appointment, 38% received an appointment the same day, 28% received a next day appointment and 3% had to wait over two days to be seen.

The National Treatment Purchase Fund (NTPF) was set up in 2002 for those waiting over three months for an operation or procedure, and as a result over 135,000 patients on waiting lists have been treated so far. The NTPF involves the government paying for public patients to be treated for free in a private hospital in Ireland, or sometimes abroad if necessary. The NTPF has reduced waiting times for procedures to an average of between two and five months (the average in 2009 is 2.4 months), compared to between two and five years in 2002. There are cases where essential care is needed urgently but not made available by the HSE under their NTPF, and contrary to relevant judgements by the European Court of Justice.

HSE figures quoted in April 2012[16] show that at least 178,000 people in Ireland were on waiting lists to see specialists at an outpatient clinic, and that more than 300 patients had been waiting for over four years to be seen by a consultant after being referred by their GP.

A BreastCheck centre in Galway.

Health centres provide a wide range of primary care and community services in towns and villages throughout Ireland, and are run by the HSE. Services available at these clinics include GP services, public health nurses, social work and child protection services, child health services, community welfare, disability services, older people services, chiropody, ophthalmic, speech therapy, addiction counselling and treatment, physiotherapy, occupational therapy, psychiatric services, and Home Help. These services are available for free, or at a subsidised rate.

In 2012 a programme of developing 35 primary care centres was announced. By July 2017 only one was operational. 14 are to be constructed by public-private partnerships.[17]

Primary health care in Ireland is mostly provided by general practitioners (GPs), who generally operate as sole traders or in health centres with other GPs and sometimes nurses. Most GPs also offer house visits to their patients, with emergency "out-of-hours" GP services available in all parts of the country. GPs generally charge on a per-consultation fee basis, usually charging anything up to €65, depending on the region. People with Medical Cards or GP Visit Cards are exempt from charges. About 60% of the population have to pay up-front in cash.[5] Many GPs provide free services to those with hepatitis C and maternity and infant services. Those with private health insurance can, depending on their plan, have their GP costs paid or refunded, either fully or partially, by the insurance company. People can also claim tax relief for GP visit costs.

Prescription drugs and medical appliances are available to all for a small fee (medical card holders), reduced cost (Drugs Payment Scheme) or in certain circumstances free (under the Long Term Illness Scheme) to residents of Ireland. The Drugs Payment Scheme ensures that every household has to pay no more than €124 per calendar month for a month's supply of prescribed medicines and medical appliances,[18] to be cut to €114 from April 2020.[19] Some private health insurance plans provide partial reimbursement up to the Drugs Payment Scheme threshold.[20] Those who are entitled to a medical card pay a government levy for each item dispensed. The levy is €2.00 up to a maximum of €20 per family per calendar month. Those who are suffering from one of a list of 16 long-term illnesses do not have to pay for medicines or medical appliances related to their conditions.[21] Ireland has below-average use of generic medication according to the OECD, despite being a major exporter. The levy was reduced to €1.50 from April 2019 for medical card holders over the age of 70,[22] and will be further cut to €1 from April 2020.[19]

All immunisation vaccines for children are provided free of charge, in schools, health clinics and hospitals.

Recovering heroin addicts can receive methadone treatment free of charge under the Methadone Treatment Scheme.[23]

The health service was said to have a ‘frail IT system’ and a ‘very-low level of cyber security maturity’ in a report by PricewaterhouseCoopers on ransomware attacks in 2021. Coombe Women & Infants University Hospital was targeted on 15 December 2021 forcing its IT services to be shut down.[24]

The HSE provide dental, optical (vision) and aural (hearing) health care. Medical Card holders and their dependents, Health Amendment Act Card holders and children get these services free. Other people can get these services free or at a reduced cost from the Treatment Benefit Scheme or private insurance. People who pay the full price to private practitioners can claim tax relief.[25]

The HSE also provide mental health services, and treatment and rehabilitation services for alcohol and drug addicts. The Irish healthcare system is often criticized for not providing sufficient services for those with mental health issues,[26] leading to a rapidly growing suicide rate,[27] and ineffective services delivered to young people.[28]

Those and their dependants without a Medical Card or private health insurance can receive medical services free or at a subsidised rate from the Treatment Benefit Scheme, which takes into account the compulsory Social Insurance Fund (PRSI) contributions they have made. People can also claim tax relief on medical expenses not covered by the State or by private health insurance. Those with private health insurance are provided with tax credits, which are passed directly to the insurance company and lower the customer's premium.

Visitors to Ireland who hold a European Health Insurance Card do not have to pay for emergency treatment from a general practitioner or specialist, emergency dental, oral or aural treatment, inpatient or outpatient hospital treatment or prescription medicines. Those who need dialysis, oxygen therapy or other specialised treatments can arrange for them before their visit.

Ireland was ranked 19th out of 34 European countries on the Personalised Health Index in 2021. The use of telemedicine has grown exponentially during the COVID-19 pandemic in the Republic of Ireland and electronic prescriptions have been widely adopted. Ireland scores very poorly for Decision Support Systems in mHealth It was given high scores for legislation on Electronic Health Records but the use of electronic records across healthcare facilities was graded as poor. The problem was said to be lack of infrastructure and delays in implementing data-sharing policies.[29]

A survey, commissioned by the HSE in 2007, found that patient satisfaction with the health service was quite high, with 90% of inpatients and 85% of outpatients saying they were satisfied with their treatment. In addition to this, 97% said they were satisfied with the care provided by their GP.[30]

The 2008 Health Consumer Powerhouse Euro Health Consumer Index report ranked Ireland's public healthcare system 11th out of 31 European countries.[31] This is an improvement on the 2007 report which ranked Ireland 16th out of 29 countries,[32] and a drastic improvement on the 2006 report, in which Ireland was ranked 26th out of 26 countries.[33]