Services - Health and Social Security

The health system is primarily funded from general taxation and is publicly provided although private health care retains a considerable role. Public health expenditure in 1994 amounted to IR£2,085 million or 5.9% of GDP. Private health expenditure was estimated at a further IR£660 million or approximately 2% of GDP. The Department of Health also has responsibility for services such as social work, adoption, child care etc.

The Health Strategy Shaping a Healthier Future, published in 1994, aims to enhance the health and quality of life of the population. In future, it is intended to assess the health care system by its effectiveness; i.e. the benefits received by the users of services, rather than by levels of service. A high degree of emphasis is placed on preventative medicine. In particular, efforts are being made to address the main contributors to premature mortality such as smoking, alcohol abuse, poor nutrition, lack of exercise, etc.

  • Main Causes of Premature Death

    Life expectancy is 72.2 years for men and 77.7 years for women. Premature deaths arise mainly from what are often referred to today as "diseases of civilisation". These included cardiovascular disease (heart attacks and strokes) and cancer. At 361 deaths per 100,000 of population in 1991 the rate of death from cardiovascular disease is higher than the average in the European Union. The rate of death from stroke has fallen to the EU average in recent years but the rate of death from heart attacks, while falling also, is still above average. The death rate from cancer is 245 per 100,000 and is increasing. This is above the EU average. There has been a marked drop in deaths from accidents. At 49 deaths per 100,000 the rate is considerably below the EU average.

  • Administrative Structure of the Services

    At national level, the Department of Health sets the budget for the health services, plans the overall development of the services and initiates regulatory and legislative change. The provision of health care at regional level is the responsibility of the eight Health Boards. Voluntary hospitals and agencies, although outside the health board structure, are an important and integral part of the health care system. Voluntary hospitals, mainly run by religious orders, report to the Department and receive their funding from it.

  • Eligibility for the Public Health Services

    Everybody ordinarily resident in Ireland has either full or limited eligibility for the public health services; the type of eligibility is determined by a means test. Approximately one-third of the population has full eligibility and these have free access to the complete range of services. The remainder of the population have limited eligibility; this entitles them to consultant and hospital care subject to small charges. They obtain GP services and prescribed drugs privately. They can avail of refund schemes in cases of excessive expenditure on prescribed drug expenditure.

  • Private Health Insurance

    Approximately one-third of the population opts to take out private health insurance. Prior to 1994 a State company, the Voluntary Health Insurance Board, had a virtual monopoly on the provision of such insurance. While this monopoly has now been abolished, any insurance company operating in the country is required to do so on a community rating basis, whereby everybody in a scheme pays the same premium regardless of risk.

  • The Delivery of Services

    The health services can be divided into three main categories:

    • - Community-based services, including the general practitioner service, home nursing, preventative and detection programmes such as school health examinations and immunisation programmes, and dental, ophthalmic, aural and other services.

    • - General Hospital Services. These include 63 acute public hospitals which are owned and funded by the Health Boards; voluntary hospitals which are operated by their own boards which are funded by the Department of Health; and 24 private hospitals, which operate independently of the Department. The public hospitals have approximately 12,000 beds; the average length of stay is 6.5 to 7 days.

    • - Special Hospital Services, which provide treatment for the mentally ill.

  • Social Security

    The Social Welfare system seeks to be comprehensive in its coverage of social need, responsive to new and changing needs, and fair, consistent, simple and cost effective in administration.

    The services provided by the Department of Social Welfare can be categorised as follows:

    • social insurance benefits based on pay-related social insurance (PRSI) contributions. These contributions are compulsory for employees and the self-employed;

    • social assistance allowances payable to people who do not have insurance cover. These payments are made on the basis of the claimant satisfying a means test;

    • universal services such as child benefit and free travel for the elderly, which do not depend on PRSI or means.
    The social insurance scheme provides cash benefits for people who become ill, unemployed, take maternity leave or reach pensionable age (66 years). The scheme allows for payments for orphans, people who become widowed, and women deserted by their husbands. A range of dental and optical services is available to insured workers and their dependent spouses.

    The social assistance scheme includes payments for people who are unemployed, blind, orphaned, people who reach pensionable age and for lone parents. There are special schemes for working families on low incomes and a supplementary scheme to help people in difficult financial circumstances.

    A number of schemes are designed to enable the long term unemployed to improve their chances of gaining employment. Grant schemes exist to support voluntary and community activity. These include support for locally based women’s groups, the Community Development Programme, etc.

    At the end of 1994 some 820,000 persons were in receipt of a weekly social welfare payment. Expenditure on Social Welfare amounted to IR£3,776m, equal to 10.7% of GDP, in that year.

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