Uncovering the complex role of private health insurance in Ireland

Abstract

The role of private health insurance in the Irish health system can be assessed from different angles and from all angles it appears complex. Despite universal entitlement to public hospital services, private cover – predominantly for hospital services – is purchased by nearly half of the population. This high level of demand has remained buoyant over time in the face of premium increases, adverse economic conditions, reductions in public subsidies and controversy within the market. Also, while private health insurance accounts for less than 15% of total spending on health, it commands a high profile in media and policy discussions and has substantial leverage over how public and private resources are allocated within the health system, particularly in the acute care sector. This chapter analyses the structure and development of the market for private health insurance in Ireland and considers its impact on the wider health system. The market’s development has been complicated, involving a series of high-level Irish and European court cases, highly visible exits from the market and other structural changes. In addition, its role has changed over time, as entitlements to publicly financed health care have also changed. However, one of the most distinctive aspects of the Irish experience comes from the complex interaction between publicly and privately financed health care and the impact of private health insurance on the distribution of resources in the wider health system. The chapter unpicks these complexities, highlighting critical issues around equity and efficiency.