This presentation by David MOLONEY was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm

1. Irish Health Reforms
3rd Meeting of the Joint Network on Fiscal
Sustainability of Health Systems
OECD 24-25 April 2014

2. Evolution of public spending in Ireland relative to economic output
Source: Dept. of Finance
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
0
20
40
60
80
100
120
140
160
180
200
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014
Departmental Expenditure GDP Departmental Expenditure as % of GDP

3. Allocations by spending area in 2014
3
Source: Dept. of Public Expenditure and Reform
37%
26%
17%
4%
6%
10%
Social Protection Health Education Justice Capital All Others

4. Expenditure Reductions 2008 to 2014
Since 2009 peak, there has been 10 percentage point reduction in Departmental
Expenditure as % GNP and a 8 percentage point reduction in Departmental Expenditure
as % GDP
15%
20%
25%
30%
35%
40%
45%
50%
2008 2009 2010 2011 2012 2013 2014
%
Year
Departmental Expenditure as % GDP / GNP
Departmental Expenditure as % GDP Departmental Expenditure as % GNP

5. Expenditure Reductions 2008 to 2014
-12
-10
-8
-6
-4
-2
0
2
PS Pay PS Pensions SW - Live
Register
SW - Other Health non-
pay
Education
non-pay
Other Gross Capital
Expenditure
Gross Total
Expenditure
€billion

6. Health Expenditure 2009 - 2013

7. Pay in the Irish Health Sector

8. User Charges
2010 (Introduced) 2013
Medical Card Holders (43% of
population)
Co-payment of €0.50 per
item up to a max of €10
per month per household
Co-payment of €2.50 per
item up to a max of €25
per month per household
Private Clients (under the Drug
Payment Scheme
Clients pay full cost of
Drugs up to max of €120
per month per household
Clients pay full cost of
Drugs up to max of €144
per month per household
Charges for Drugs

9. User Charges
2009 2013
Private Clients without GP
referral
€66 per visit €100 per visit
Medical Card Holders
Private Clients with GP
referral
Certain other named
groups
Free of Charge Free of Charge
Statutory Charges for attendance at Hospital Accident and Emergency Department

10. Current Reforms
Current system is primarily funded through taxation, including tax
breaks on private medical insurance, user charges and private
insurance
The delivery of a single-tier health system, supported by Universal
Health Insurance is a central pillar of the Government’s health reform
programme
Aiming at a health system where access is determined by need and
costs are borne fairly

11. Overall Health Basket*
Services
covered by
UHI Basket
Services
outside
UHI basket
comprised of
 Funded By UHI through
insurance premiums
 GP, acute hospitals,
acute mental health
services
 Government will decide
on basket with advice
of Expert Commission
 Funded by
Exchequer/ General
Taxation/ Out of
pocket
 Social care services,
long term care, public
health, social
inclusion
Services Outside the Health Basket
Supplemental
Services e.g.
Alternative
Medicine
 Funded by private out
of pocket payments
 May purchase
supplementary
insurance for these
services if available
Health Service Provision
* Provided by Public & Private Providers

12. How Will the UHI Model Operate?
• Pay Premiums to Insurers to finance the
delivery of health services in UHI basket
Consumers
• Pay Subsidies to Insurers for those who
qualify
• Centrally fund some services, e.g. ED
Government
• Commission health services from public
and private providers
Insurers

13. What Will All This Mean For…?
• Consumers
• Insurers
• Public Providers
• Private Providers
• Regulatory Bodies