Addressing Inequities in the Irish Health Care System Through Social Health Insurance

18 Pages Posted: 22 Jun 2007

See all articles by Steve Thomas

Steve Thomas

Trinity College (Dublin), Health Policy and Management

Charles Normand

Trinity College (Dublin)

Samantha Smith

Trinity College (Dublin)

Date Written: May 2007

Abstract

The Irish health care system is unusual in that there is no subsidy for access to GP services for the majority of the population. Further a high proportion of the population has subsidised and supplementary private medical insurance. Current financial incentives and flows of subsidisation between the public and private sectors produce some odd features. Careful analysis of these financing mechanisms shows extensive inequities, with those on low incomes, but above the tax threshold, being the worst off. Further, the inequities and inefficiencies have been perpetuated by a lack of transparency in the health financing system.

The authors explore the case for change and the options for Social Health Insurance (SHI) design that would be most relevant for the Irish health care system. Four possible scenarios for SHI are set out to improve equity and efficiency. The models vary according to the improved access that they give their members in terms of Primary Health Care, private/semi-private hospital beds and access to consultants. At one extreme, the levelling up (Rolls Royce) option provides hospital care on a par with what is currently available through private insurance and free GP access. At the other, the 'Mini' option reduces the cost of access to GPs and lowers public sector hospital charges for the uncovered population. Drawing on data from public accounts and the private insurance industry, the authors review the resource implications of these scenarios, with and without efficiency gains. Costs range from 2.2 billion to 380 million (or from an additional 1.5% to 0.3% of GDP).

The authors also analyse the potential financing mechanisms. The additional payments for the options would range from 6.0% of taxable income for the Rolls Royce option to only 2.5% for the priority PHC option and 1.1% for the Mini. With efficiency gains these rates would reduce so that the Mini option pays for itself.

Finally the authors explore the issues of transition and implementation, noting the institutional, stakeholder and capacity bottlenecks which currently exist.

Keywords: Social Health Insurance, equity, financing

Suggested Citation

Thomas, Steve and Normand, Charles and Smith, Samantha, Addressing Inequities in the Irish Health Care System Through Social Health Insurance (May 2007). iHEA 2007 6th World Congress: Explorations in Health Economics Paper, Available at SSRN: https://ssrn.com/abstract=993750 or http://dx.doi.org/10.2139/ssrn.993750

Steve Thomas (Contact Author)

Trinity College (Dublin), Health Policy and Management ( email )

2-3 College Green
Dublin, Leinster D2
Ireland
00 353 1 8963880 (Phone)

Charles Normand

Trinity College (Dublin) ( email )

2-3 College Green
Dublin, Leinster D2
Ireland

Samantha Smith

Trinity College (Dublin) ( email )

2-3 College Green
Dublin, Leinster D2
Ireland

Do you have a job opening that you would like to promote on SSRN?

Paper statistics

Downloads
150
Abstract Views
1,636
rank
241,880
PlumX Metrics