New report on healthcare: could Ireland’s emerging healthcare reforms hold lessons for the UK?
Elliot Bidgood, 17 December 2013
The NHS’s founding mission to provide quality care for all regardless of ability to pay remains as crucial today as it was when it was founded 65 years ago. However, in 2013 the service has faced challenges in terms of accountability, rationing and outcomes, and looking abroad remains a valuable way to gain inspiration and learn best practice. Today I am publishing a new report for the Civitas ‘Healthcare Systems’ series, exploring healthcare in the Republic of Ireland and the bold reform programme the Irish government is currently pursuing, known as Universal Health Insurance (UHI). The report is available here.
Healthcare in Ireland currently centres on the Health Service Executive (HSE), a centrally-administered national service financed from general taxation that is also the nation’s largest employer. Many experts therefore categorise Ireland alongside the NHS amongst health systems, though forms of private financing and voluntary sector provision do play a comparatively greater secondary role there.
Ireland also faces similar challenges; waits and rationing are historic issues, as are centralisation and accountability. Health outcomes somewhat lag continental Europe, and those that can afford private insurance have quicker access to better services. The Euro Health Consumer Index (EHCI) ranked the UK and Ireland as the 13th and 14th best systems in Europe in 2013 (in 2012, it commented that “quite similar healthcare systems should be expected not to end up far apart in the ranking. This is confirmed by finding…Ireland and the UK clinging together”). On mortality amenable to healthcare, the UK placed 19th out of 31 OECD nations in 2007 with 86 avoidable deaths per 100,000, while Ireland was 17th, with 82 per 100,000.
Two years ago, a new Irish coalition government decided to act on longstanding concerns by announcing Universal Health Insurance (UHI), a radical plan to fundamentally overhaul the Irish health system within a decade and convert it into a continental-style Social Health Insurance (SHI) model based on the Dutch health system, ranked number one by both the EHCI and the Commonwealth Fund. Civitas previously published a report on the Dutch model, which was updated this year and is available here. The significance of Ireland’s current transformation for Britain is three-fold:
- A relatively close cousin with similar challenges: Although there are inevitable differences, the NHS and Ireland’s HSE-centric tax-financed system have many common features, place similarly in some international rankings and face familiar challenges in terms of waiting times, funding, centralisation, accountability, technological uptake, equity and clinical outcomes. Population health factors and cultural familiarity can also aid comparisons – the Republic of Ireland is the only foreign country we share a land border with, after all
- Near-unprecedented example of bold reform: Several individuals and organisations, Civitas among them, have suggested a move from our current centrally-run, tax-financed health model to continental-style universal social insurance as a way to improve UK healthcare. However, Ireland may be the first example in recent memory of a Western European nation explicitly pursuing such a bold course of reform – on top of Ireland’s existing comparability to Britain, this makes Ireland’s reforms a potentially very valuable case study for British health professionals and policymakers to follow. Given likely future constraints on future NHS funding, Ireland’s determinations as to what will be included within their new state-guaranteed treatment package will also be worth noting
- Cross-party support for reform amid fiscal crisis: Ireland’s reform process has been getting underway at a time of huge fiscal and economic crisis, which has made savings in healthcare a necessity. Further, the reforms are being implemented by a right-left coalition consisting of the Fine Gael and Labour parties, each of which put forward detailed plans for some version of continental-style UHI before the 2011 Irish election. Irish Labour’s advocacy of UHI is particularly notable from a British politics standpoint, demonstrating that the rightful commitment of the social democratic centre-left to universal, free at the point of use healthcare can translate into support for a social insurance model
Ireland’s plans are still unfolding and as with any large-scale reform effort, they will take some years and need to surmount certain obstacles. But overall, Ireland is offering bold leadership and represents a powerful emerging case study for fundamental reform that will offer many relevant lessons for the UK, especially in light of our common health challenges.
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