Problems in healthcare, public and private mix In recent years the health care sector has been the focus of much debate. Even during the boom in Ireland, the Health Care Sector was widely criticized as having poor outcomes for patients compared to other countries and being a ‘two tier’ system, Despite large increases in Health Care expenditure during the boom these problems continued.

One problem that can still be noticed and felt today in any A&E department in Dublin for instance is the over crowdedness and the incredibly long waiting time for to be seen. Also In recent times some pollutants/experts have repeated money or funding Is ‘not the problem’ for the Health System but the system itself. The operation of the complex mix of public and private health care has changed radically over the past decade as the nature of the insurance market has changed In response to E regulations.

Private health insurance plays a distinctive role in the Irish health care system, with nearly half the population now having such insurance despite the fact that everyone has entitlement to public hospital care (subject to retain charges unless the family falls below a specified low-income threshold), and much of the insured’s private care is delivered in public hospitals which is a crucial difference between Ireland and many other countries. The resulting two-tier system is problematic from both an efficiency and an equity perspective.

Private health Insurance figures are declining slightly at present due to current recession and latest budget Oust below 50%). Public hospitals in Ireland allocate a certain number of beds for private use and insulate activity Is monitored to ensure that they do not exceed their private activity cap. There are concerns that public hospitals and consultants are sidestepping these restrictions. This results in public hospital resources being diverted away from public patients towards private patients.

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This means it is cheaper for private Insurance companies to send private patients to public hospitals compared to private hospitals which again put public hospitals under further capacity pressures. While health has become an extremely high-profile and literally sensitive topic, health insurance has not come centre-stage in that debate – which has instead focused on waiting times for public hospital care and the location of those hospitals.

The two-tier hospital system Is now widely regarded as problematic from an equity perspective, but there are also serious efficiency Issues to be faced because of the incentive structures embedded in this particularly close intertwining of public and private. The introduction of competition in the health Insurance market, e. . PUPA and VII, in a tightly regulated setting, has led to a wider range of Insurance products but does not address these fundamental problems.

The fact that risk equalization payments across insurers have not been implemented 1 OFF structured. Ireland shows that a structure designed to take advantage of possible benefits for the public system of close interaction with private care can create perverse incentives, be inequitable in terms of access and utilization, and undermine that public system. It also demonstrates that, in a system where private insurance has a substantial role and affords preferential access to care, the political economy of reform can be highly problematic.

Those with insurance may well be reluctant to give up preferential access and what is perceived to be better-quality care. Together with the difficulties in negotiating satisfactory contractual arrangements with medical consultants and other health service providers, this means that there are major obstacles to structural reform that seeks to increase both equity and efficiency.


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