Health Systems in Transition Vol. 11 No. 4 2009 Ireland Health system review David McDaid • Miriam Wiley Anna Maresso • Elias Mossialos Editorial Board Editor in chief Elias Mossialos, London School of Economics and Political Science, United Kingdom Editors Reinhard Busse, Berlin Technical University, Germany Josep Figueras, European Observatory on Health Systems and Policies Martin McKee, London School of Hygiene and Tropical Medicine, United Kingdom Richard Saltman, Emory University, United States Editorial team Sara Allin, University of Toronto, Canada Matthew Gaskins, Berlin Technical University, Germany Cristina Hernandez Quevedo, European Observatory on Health Systems and Policies Anna Maresso, European Observatory on Health Systems and Policies David McDaid, European Observatory on Health Systems and Policies Sherry Merkur, European Observatory on Health Systems and Policies Philipa Mladovsky, European Observatory on Health Systems and Policies Bernd Rechel, European Observatory on Health Systems and Policies Erica Richardson, European Observatory on Health Systems and Policies Sarah Thomson, European Observatory on Health Systems and Policies Ewout van Ginneken, Technical University, Berlin Managing editor Jonathan North, European Observatory on Health systems and Policies International advisory board Tit Albreht, Institute of Public Health, Slovenia Carlos Alvarez-Dardet Díaz, University of Alicante, Spain Rifat Atun, Global Fund, Switzerland Johan Calltorp, Nordic School of Public Health, Sweden Armin Fidler, The World Bank Colleen Flood, University of Toronto, Canada Péter Gaál, Semmelweis University, Hungary Unto Häkkinen, Centre for Health Economics at Stakes, Finland William Hsiao, Harvard University, United States Alan Krasnik, University of Copenhagen, Denmark Joseph Kutzin, World Health Organization Regional Office for Europe Soonman Kwon, Seoul National University, Korea John Lavis, McMaster University, Canada Vivien Lin, La Trobe University, Australia Greg Marchildon, University of Regina, Canada Alan Maynard, University of York, United Kingdom Nata Menabde, World Health Organization Regional Office for Europe Ellen Nolte, Rand Corporation, United Kingdom Charles Normand, University of Dublin, Ireland Robin Osborn, The Commonwealth Fund, United States Dominique Polton, National Health Insurance Fund for Salaried Staff (CNAMTS), France Sophia Schlette, Health Policy Monitor, Germany Igor Sheiman, Higher School of Economics, Russian Federation Peter C. Smith, Imperial College, United Kingdom Wynand P.M.M. van de Ven, Erasmus University, The Netherlands Witold Zatonski, Marie Sklodowska-Curie Memorial Cancer Centre, Poland Health Systems in Transition David McDaid, European Observatory on Health Systems and Policies Miriam Wiley, Economic and Social Research Institute (ESRI), Dublin Anna Maresso, European Observatory on Health Systems and Policies Elias Mossialos, European Observatory on Health Systems and Policies Ireland: Health System Review 2009 The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Keywords: DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS – organization and administration QUESTIONNAIRE IRELAND © World Health Organization 2009, on behalf of the European Observatory on Health Systems and Policies All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Please address requests about this to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the WHO/Europe web site at http://www.euro.who.int/PubRequest The views expressed by authors or editors do not necessarily represent the decisions or the stated policies of the European Observatory on Health Systems and Policies or any of its partners. 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Health Systems in Transition, 2009; 11(4): 1 – 268 ISSN 1817-6127 Vol. 11 No. 4 Health systems in transition Ireland Contents Preface ............................................................................................................v Acknowledgements ..................................................................................... vii List of abbreviations .....................................................................................ix List of tables, figures and boxes ................................................................. xiii Abstract ..................................................................................................... xvii Executive summary .....................................................................................xix 1. Introduction ..........................................................................................1 1.1 Geography and social demography ...............................................1 1.2 Economic context ..........................................................................4 1.3 Political context .............................................................................7 1.4 Health status .................................................................................11 2. Organizational structure .....................................................................17 2.1 Brief overview of the health care system ....................................17 2.2 Historical background ..................................................................19 2.3 Organizational overview ..............................................................24 2.4 Decentralization and recentralization ..........................................37 2.5 Patient empowerment ..................................................................38 3. Financing ...........................................................................................51 3.1 Health expenditure .......................................................................52 3.2 Population coverage and basis for entitlement ............................66 3.3 Revenue collection and complementary sources of funding .......76 3.4 Pooling of funds ...........................................................................91 3.5 Purchasing and purchaser–provider relationships .......................94 3.6 Payment mechanisms for health system personnel .....................98 4. Planning and regulation ...................................................................103 4.1 Regulation ..................................................................................103 4.2 Planning and health information management ..........................112 iii Health systems in transition Ireland 5. Physical and human resources .........................................................121 5.1 Physical resources ......................................................................121 5.2 Human resources .......................................................................128 6. Provision of services ........................................................................155 6.1 Public health services ................................................................155 6.2 Patient pathways ........................................................................160 6.3 Primary/ambulatory care ...........................................................161 6.4 Secondary and tertiary care .......................................................170 6.5 Ambulance services ...................................................................179 6.6 Pharmaceutical care ...................................................................181 6.7 Long-term care ...........................................................................185 6.8 Palliative care .............................................................................186