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Republic of Ireland Healthcare System

The Republic of Ireland has a two-tier healthcare system that provides universal coverage while also allowing private health insurance and care. The public part of the system is governed by the Health Act of 1970, which established the Health Service Executive (HSE) to administer public health services across Ireland.

The public system, sometimes referred to as the medical card system, is funded through taxes and provides free health services to low-income individuals and families. Around 40% of the population is entitled to a medical card, which covers visits to a general practitioner (GP), prescribed medications, hospital care, dental services, eye tests, maternity services, and more. Those over 70 years of age are automatically eligible for a medical card.

For those without a medical card, there are still substantial public subsidies. GP visits have a capped co-pay for non-medical card patients. Public hospitals provide free emergency and maternity services to all Irish citizens, though waiting times for elective procedures can be longer than for private patients.

The other key component of healthcare in Ireland is private insurance and care. Around 45% of people in Ireland have private health insurance, which helps cover the costs of private care and enables faster access to elective treatments. Many companies provide health insurance plans as an employment benefit. The insurance market is regulated but companies still compete on premium costs and services covered.

Most GPs in Ireland are self-employed and accept both public medical cards and private insurance. Patients can typically choose their primary care provider. About 30% of the population now pays out-of-pocket to see a GP outside of public coverage or insurance. Many specialists also accept both public and private patients. Private hospitals are available but are smaller in number compared to public hospitals.

The public and private systems in Ireland are very intertwined. Even public hospitals can accommodate private care and patients with insurance. The challenges come when public facilities or resources get prioritised toward more profitable private care. Ireland has fewer hospital beds, doctors, and nurses per capita compared to many other European countries.

Prescription drugs are paid for under the medical card up to certain limits, after which some co-pays apply. Those without a medical card must pay the full cost of medications, though low-income residents can get support through the national drug payment scheme. Dental care, optical care, physiotherapy, and most mental healthcare are also excluded from public coverage for adults.

The HSE oversees the system at a national level, but health services are delivered by seven regional care organisations. The Department of Health develops overall policy and legislation. Funding comes from both central taxation and a health levy applied directly to income. Health spending accounts for about 15% of Ireland's gross domestic product.

Ireland spends far less on healthcare than the United States but more than its neighbors like the UK. The hybrid public-private model has helped achieve universal coverage but also introduces some inequities. Wealth enables faster access and better coverage for some segments of the population. Out-of-pocket costs have risen over the last decade as the economy has struggled.

Satisfaction surveys show the Irish generally value their health services. Wait times, costs, and infrastructure are perpetual issues, though typically on par with healthcare systems in other EU countries. Life expectancy and mortality rates are reasonable by European standards. The system continues to aim for greater efficiency, more capacity, and reduced waiting times while also serving an ageing population. Further integration and cooperation between the public and private health sectors remains both a challenge and an opportunity.

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