Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-05-07T19:05:59.034Z Has data issue: false hasContentIssue false

Improving access to healthcare in Ireland: an implementation failure

Published online by Cambridge University Press:  22 August 2023

Sheelah Connolly*
Affiliation:
Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Ireland Department of Economics, School of Social Science and Philosophy, Trinity College Dublin, College Green, Dublin 2, Ireland

Abstract

There are significant barriers to accessing health and social care services in Ireland including high user charges, long waits and limited availability of some services. While a number of reform proposals have committed to improving access to health care, implementation of these proposals has been limited. The aim of this paper is to identify and discuss policy implementation failures concerned with improving access to health and social care services in Ireland. Four potential reasons for the repeated failure to implement stated reform proposals are identified including a failure to identify and address the practicalities of implementation, competing health care demands, the political cycle and stakeholder resistance. While there has been a shift in Irish health care policy documents in the last 10 years with increasing emphasis on ensuring access to health care based on need rather than ability to pay, a repeated failure to implement the proposed reforms raises questions as to whether there is a real commitment to improving access to health care.

Type
Article
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramsson, M and Andersson, E (2016) Changing preferences with ageing – housing choices and housing plans of older people. Housing, Theory and Society 33, 217241.CrossRefGoogle Scholar
Ansell, C, Sørensen, E and Torfing, J (2017) Improving policy implementation through collaborative policymaking. Policy and Politics 45, 467486.CrossRefGoogle Scholar
Australian Government (2014) Policy Implementation. Canberra: Department of the Prime Minister and Cabinet.Google Scholar
Brick, A and Connolly, S (2021) Waiting times for publicly funded hospital treatment: how does Ireland measure up? The Economic and Social Review 52, 4152.Google Scholar
Burke, S, Burgha, R and Thomas, S (2019) The national treatment purchase fund – a success for some patients yet a public policy failure? Administration 67, 4769.CrossRefGoogle Scholar
Cairney, P (2016) The Politics of Evidence-Based Policymaking. London: Palgrave.Google Scholar
Connolly, S and Wren, MA (2019) Universal health care in Ireland – what are the prospects for reform? Health Systems and Reform 5, 9499.CrossRefGoogle ScholarPubMed
Connolly, S, Brick, A, O'Neill, C and O'Callaghan, M (2022) An analysis of the primary care systems of Ireland and Northern Ireland. ESRI Research Series report 137. Dublin: ESRI.CrossRefGoogle Scholar
Connolly, S, Keegan, C, O'Malley, S and Regan, M (2023) Extending Eligibility for General Practitioner Care in Ireland: Cost Implications. ESRI Research Series 156. Dublin: ESRI.CrossRefGoogle Scholar
Costa-Font, J, Elvira, D and Mascarilla-Miró, O (2009) ‘Ageing in place’? Exploring elderly people's housing preferences in Spain. Urban Studies 46, 295316.CrossRefGoogle Scholar
Council of the European Union (2006) Council Conclusions on Common Values and Principles in EU Health Systems. Brussels: Council of the European Union.Google Scholar
Crosbie, B, O'Callaghan, M, O'Flanagan, S, Brennan, D, Keane, G and Behan, W (2020) A real-time measurement of general practice workload in the Republic of Ireland: a prospective study. British Journal of General Practice 70, e489e496.CrossRefGoogle ScholarPubMed
Cullinan, J, Connolly, S and Whyte, R (2021) The sustainability of Ireland's health care system. In Baltagi, B and Moscone, F (eds), The Sustainability of Health Care Systems in Europe. Bingley: Emerald Publishing, pp. 61–79.Google Scholar
Darker, C, Donnelly-Swift, E and Whiston, L (2018) Demographic factors and attitudes that influence the support of the general public for the introduction of universal healthcare in Ireland: a national survey. Health Policy 122, 147156.CrossRefGoogle ScholarPubMed
Department of Health (2015a) Statement by Minister Varadkar Following Cabinet Discussion on UHI. Dublin: Department of Health.Google Scholar
Department of Health (2015b) Press Release – Over 163,000 Children and 23,000 People Over 70s Sign-up for GP Care. Dublin: Department of Health.Google Scholar
Department of Health (2022) Health in Ireland: Key Trends 2022. Dublin: Department of Health.Google Scholar
Department of Health and Children (2002) Minister Appoints Head of National Treatment Purchase Fund. Dublin: Department of Health and Children.Google Scholar
Department of the Taoiseach (2011) Programme for Government 2011–2016. Dublin: Department of the Taoiseach.Google Scholar
Donnelly, S, O'Brien, M, Begley, E and Brennan, J (2016) Meeting Older People's Preferences for Care; Policy but What About Practice? Dublin: University College Dublin.Google Scholar
Dwyer, O (2021) Doctors displeased with some ‘alarming’ terms in draft Sláintecare consultant contract. The Journal, 14th June 2021, https://www.thejournal.ie/slaintecare-consultant-contract-criticism-5463054-Jun2021/.Google Scholar
Eighan, J, Walsh, B, Smith, S, Wren, MA, Barron, S and Morgenroth, E (2019) A profile of physiotherapy supply in Ireland. Irish Journal of Medical Science 188, 1927.CrossRefGoogle ScholarPubMed
Ferris, T (2015) Reflections on the public policy process in Ireland. Administration 62, 87106.Google Scholar
Fox, S, Kenny, L, Day, MR, O'Connell, C, Finnerty, J and Timmons, S (2017) Exploring the housing needs of older people in standard and sheltered social housing. Gerontology and Geriatric Medicine 3, 2333721417702349.CrossRefGoogle ScholarPubMed
Goodey, C (2015) Why GPs Oppose Free Care for Children Under 6. Dublin: National Association of General Practitioners.Google Scholar
Government of Ireland (2018) Slaintecare Implementation Strategy. Dublin: Government of Ireland.Google Scholar
Health Service Executive (2009) Public and Private Patients in Public Hospitals: Guidance to Health Service Management on the Treatment of Public and Private Patients. Dublin: Health Service Executive.Google Scholar
Hill, M (2014) The Public Policy Process. New York: Routledge.CrossRefGoogle Scholar
Houses of the Oireachtas Committee on the Future of Healthcare (2017) Slaintecare Report. Dublin: Houses of the Oireachtas.Google Scholar
Hudson, B, Hunter, D and Peckham, S (2019) Policy failure and the policy-implementation gap: can policy support programs help? Policy Design and Practice 2, 114.CrossRefGoogle Scholar
Independent review group (2019) Report of Independent Review Group Established to Examine Private Activity in Public Hospitals. Dublin: Department of Health.Google Scholar
Keegan, C, Brick, A and Wren, MA (2018) An examination of activity in public and private hospitals in Ireland, 2015. Working Paper 601. Dublin: Economic and Social Research Institute.Google Scholar
Keegan, C, Brick, A, Bergin, A, Wren, MA, Henry, E and Whyte, R (2020) Projections of expenditure for public hospitals in Ireland, 2018–2035, based on the Hippocrates Model. ESRI Research Series Report 117. Dublin: ESRI.CrossRefGoogle Scholar
Kingdon, J (1994) Agendas, Alternatives and Public Policies, 2nd Edn., New York: HarperCollins College Publishers.Google Scholar
Kramer, C and Pfaffenbach, C (2016) Should I stay or should I go? Housing preferences upon retirement in Germany. Journal of Housing and the Built Environment 31, 239256.CrossRefGoogle Scholar
Kringos, D, Boerma, W, Bourgueil, Y, Cartier, T, Dedeu, T, Hasvold, T, Hutchinson, A, Lember, M, Oleszczyk, M, Rotar Pavlic, D, Svab, I, Tedeschi, P, Wilm, S, Wilson, A, Windak, A, Van der Zee, J and Groenewegen, P (2013) The strength of primary care in Europe: an international comparative study. British Journal of General Practice 63, e742e750.CrossRefGoogle ScholarPubMed
Leahy, P (2023) Government to press ahead with new hospital contracts despite no agreement doctors’ groups. Irish Times, Jan 14 2023. Available at https://www.irishtimes.com/health/2023/01/14/government-to-press-ahead-with-new-consultant-contracts/ (accessed 27th March 2023).Google Scholar
Malone, F (2023) Maternity care: new contracts mean private patients won't get to choose consultants. Irish Times, January 17th 2023. Available at https://www.irishtimes.com/opinion/2023/01/17/slaintecare-consultants-contract-should-not-apply-to-maternity-services/ (accessed 23rd March 2023).Google Scholar
McDonnell, T, Nicholson, E, Bury, G, Collins, C, Conlon, C, Denny, K, O'Callaghan, M and McAuliffe, E (2022) Policy of free GP care for children under 6 years: the impact on daytime and out-of-hours general practice. Social Science and Medicine 296, 114792.CrossRefGoogle ScholarPubMed
Mercille, J (2018) Neoliberalism and health care: the case of the Irish nursing home sector. Critical Public Health 28, 546559.CrossRefGoogle Scholar
Mercille, J, Turner, B and Lucey, DS (2022) Ireland's takeover of private hospitals during the COVID-19 pandemic. Health Economics, Policy and Law 17, 232237.CrossRefGoogle ScholarPubMed
Nolan, A (2008) Evaluating the impact of eligibility for free care on the use of general practitioner (GP) services: a difference-in-difference matching approach. Social Science and Medicine 67, 11641172.CrossRefGoogle ScholarPubMed
Nolan, A and Layte, R (2017) The impact of transitions in insurance coverage on GP visiting among children in Ireland. Social Science and Medicine 180, 94100.CrossRefGoogle ScholarPubMed
O'Mahony, J (2021) Revision of Ireland's cost-effectiveness threshold: new state-industry drug pricing deal should adequately reflect opportunity costs. PharmacoEconomics Open 5, 339348.CrossRefGoogle ScholarPubMed
O'Reilly, D, O'Dowd, T, Galway, K, Murphy, A, O'Neill, C, Shryane, E, Steele, K, Bury, G, Gilliland, A and Kelly, A (2007) Consultation charges in Ireland deter a large proportion of patients from seeing the GP: results of a cross-sectional survey. European Journal of General Practice 13, 231236.CrossRefGoogle Scholar
Privalko, I, Maître, B, Watson, D and Grotti, R (2019) Access to Care Services Across Europe. Dublin: Department of Employment Affairs and Social Protection and Economic and Social Research Institute.Google Scholar
Reich, M, Harris, J, Ikegami, N, Maeda, A, Cashin, C, Araujo, EC, Takemi, K and Evans, TG (2016) Moving towards universal health coverage: lessons from 11 country studies. The Lancet 387, 811816.CrossRefGoogle ScholarPubMed
Stuckler, D, Feigl, A, Basu, S and McKee, M (2010) The Political Economy of Universal Health Coverage. Geneva: World Health Organization.Google Scholar
Teljeur, C, Thomas, S, O'Kelly, F and O'Dowd, T (2010) General practitioner workforce planning: assessment of four policy directions. BMC Health Services Research 10, 148.CrossRefGoogle ScholarPubMed
Thomas, S, Burke, S and Barry, S (2014) The Irish health-care system and austerity: sharing the pain. The Lancet 383, 15451546.CrossRefGoogle ScholarPubMed
Turner, B (2015) Unwinding the state subsidisation of private health insurance in Ireland. Health Policy 119, 13491357.CrossRefGoogle ScholarPubMed
Tussing, D and Wren, MA (2006) How Ireland Cares: The Case for Health Care Reform. Dublin, New Island.Google Scholar
Walsh, B and Lyons, S (2021) Demand for the Statutory Home Support Scheme. Dublin: Economic and Social Research Institute.Google Scholar
Walsh, B, Keegan, C, Brick, A, Connolly, S, Bergin, A, Wren, MA, Lyons, S, Hill, L and Smith, S (2021) Projection of Expenditure for Primary, Community and Long-Term Care Ireland, 2019–2035, Based on the HIPPOCRATES Model. Dublin: Economic and Social Research Institute.CrossRefGoogle Scholar
Whyte, R, Connolly, S and Wren, MA (2020) Insurance status and waiting times for hospital-based services in Ireland. Health Policy 124, 11741181.CrossRefGoogle ScholarPubMed
Wren, MA and Connolly, S (2019) A European late starter: lessons from the history of reform in Irish health care. Health Economics, Policy, and Law 14, 355373.CrossRefGoogle ScholarPubMed
Wren, MA, Keegan, C, Walsh, B, Bergin, A, Eighan, J, Brick, A, Connolly, S, Watson, D and Banks, J (2017) Projections of demand for healthcare in Ireland, 2015–2030. First Report from the Hippocrates Model. Dublin: Economic and Social Research Institute.CrossRefGoogle Scholar
Yu, H (2015) Universal health insurance coverage for 1.3 billion people: what accounts for China's success? Health Policy 119, 11451152.CrossRefGoogle ScholarPubMed