health care

1. Health
Care
system
in
Ireland
Ms.
Mylene

2. • Total
popula7on
(2013)
4,627,000
• Gross
na7onal
income
per
capita
(PPP
interna7onal
$,
2012)
35,090
• Life
expectancy
at
birth
m/f
(years,
2012)
79/83
• Probability
of
dying
under
five
(per
1
000
live
births,)
4
• 7800
living
with
HIV

3.
• Health
care
in
Ireland
is
two-­‐7er:
public
and
private
sectors
exist.
• The
public
health
care
system
is
governed
by
the
Health
Act
2004,
which
established
a
new
body
to
be
responsible
for
providing
health
and
personal
social
services
to
everyone
living
in
Ireland
–
the
Health
Service
Execu0ve.

4. • The
new
na7onal
health
service
came
into
being
officially
on
1
January
2005;
however
the
new
structures
are
currently
in
the
process
of
being
established
as
the
reform
programme
con7nues.
•
In
addi7on
to
the
public-­‐sector,
there
is
also
a
large
private
healthcare
market

5. • Everyone
living
in
the
country,
and
visitors
to
Ireland
who
hold
a
European
Health
Insurance
Card,
are
en7tled
to
free
maintenance
and
treatment
in
public
beds
in
Health
Service
Execu7ve
and
voluntary
hospitals.

6. • Outpa7ent
services
are
also
provided
for
free.
However
the
majority
of
pa7ents
on
median
incomes
or
above,
are
required
to
pay
subsidised
hospital
charges.

7. The
Medical
Card
–
which
en7tles
holders
to
•
free
hospital
care,
•
GP
visits,
• dental
services,
• op7cal
services,
•
aural
services,
• prescrip7on
drugs
• and
medical
appliances-­‐
is
available
to
those
receiving
welfare
payments,
low
earners,
those
with
certain
long-­‐term
or
severe
illnesses
and
in
certain
other
cases.

8.
• Many
poli7cal
par7es
support
extending
the
availability
of
the
Medical
Card
to
eventually
cover
everyone
resident
in
Ireland
–
they
currently
cover
31.9%
of
the
popula7on.
• Those
on
slightly
higher
incomes
are
eligible
for
a
GP
Visit
Card
which
en7tles
the
holder
to
free
general
prac77oner
visits.
• or
persons
over
70
years
who
are
not
en7tled
to
a
medical
card
or
GP
visit
card
they
instead
receive
an
annual
cash
grant
of
€400
up
to
a
certain
income.

9. • People
who
are
not
en0tled
to
a
Medical
Card
(i.e.
68.1%
of
the
popula7on)
must
pay
fees
for
certain
health
care
services.
• There
is
a
€100
A&E
charge
for
those
who
acend
an
accident
and
emergency
department
without
a
referral
lecer
from
a
family
doctor
• Hospital
charges
(for
inpa7ents)
are
a
flat
fee
of
€100
per
day
up
to
a
maximum
of
€1000
in
any
twelve-­‐month
period,
• Specialist
assessments
and
diagnos0c
assessments
(such
as
X-­‐
rays,
laboratory
tests,
physiotherapy,
etc.)
are
provided
for
free
• If
a
person
cannot
afford
to
pay
hospital
charges,
the
HSE
will
provide
the
services
free
of
charge.

10. • that
Ireland
has
fewer
doctors
(2.7
doctors
per
1,000
popula7on)
and
more
nurses
(12.2
nurses
per
1,000
popula7on)
than
average
in
other
OECD
countries.

11. There
have
been
drama7c
reduc7ons
in
mortality
from
the
three
principal
causes
of
death
in
Ireland-­‐
heart
disease,
cancer
and
stroke
in
recent
years-­‐
age-­‐standardised
mortality
rate
for
heart
disease
has
fallen
by
59%
between
1990-­‐2011
and
now
stands
just
above
the
OECD
rate
at
136
deaths
per
100,000
popula7on
per
annum.
• for
stroke
has
fallen
by
51%
in
the
same
period
to
below
the
OECD
average
(61
deaths
from
stroke
per
100,000
popula7on
per
annum).
•
Deaths
from
cancer
have
fallen
by
21%
between
1990-­‐2011
to
217
per
100,000

12. Wai7ng
lists
• Ireland
has
reduced
its
spending
on
healthcare
by
6.6%
since
the
onset
of
the
Global
Financial
Crisis
according
to
the
OECD's
2013
Health
Report.
• As
a
result
wai7ng
7mes
for
treatment
have
been
noted
to
increase.

13. • In
2007,
76%
of
inpa7ents
were
admiced
to
hospital
for
opera7ons
immediately,
11%
had
to
wait
up
to
one
month,
• 4%
had
to
wait
up
to
three
months,
• 1%
had
to
wait
up
to
six
months
and
•
4%
had
to
wait
for
over
six
months
for
opera7ons.

14. • For
outpa7ents,
23%
were
seen
on
>me,
44%
were
seen
within
30
minutes,
18%
waited
more
than
an
hour
and
7%
waited
two
hours.

15. The
Na7onal
Treatment
Purchase
Fund
(NTPF)
• was
set
up
in
2002
for
those
wai>ng
over
three
months
for
an
opera7on
or
procedure,
and
as
a
result
over
135,000
pa7ents
on
wai7ng
lists
have
been
treated
so
far.

16. • The
NTPF
has
reduced
wai7ng
7mes
for
procedures
to
an
average
of
between
two
and
five
months
(with
the
average
in
2009
being
2.4
months),
compared
to
between
two
and
five
years
in
2002.

17. Health
centers
• provide
a
wide
range
of
primary
care
and
community
services
in
towns
and
villages
throughout
Ireland,
and
are
run
by
the
HSE.

18. Drugs
• Prescrip0on
drugs
and
medical
appliances
are
available
to
all
for
free
or
at
a
reduced
cost.
•
Some
private
health
insurance
plans
provide
par>al
reimbursement
up
to
the
Drugs
Payment
Scheme
threshold.
• Those
who
hold
Medical
Cards,
suffering
from
long-­‐
term
illnesses,
or
who
have
Hepa>>s
C,
do
not
have
to
pay
anything
for
medicines
or
appliances
• .

19. • Ireland
has
below
average
use
of
generic
medica0on
according
to
the
OECD,
despite
being
a
major
exporter.
• All
immunisa7on
vaccines
for
children
are
provided
free
of
charge,
and
are
provided
in
schools,
health
clinics
or
hospitals.
• Recovering
heroin
addicts
are
able
to
get
methadone
treatment
for
free
under
the
Methadone
Treatment
Scheme.

20. Other
services
• HSE
provide
dental,
op0cal
(vision)
and
aural
(hearing)
health
care.
Medical
Card
holders
and
their
dependants,
Health
Amendment
Act
Card
holders
and
children
get
these
services
for
free.
•
Other
people
can
get
these
services
for
free
or
at
a
reduced
cost
from
the
Treatment
Benefit
Scheme
and/or
private
insurance

21. • The
HSE
also
provide
mental
health
services,
and
treatment
and
rehabilita>on
services
for
alcohol
and
drug
addicts.

22. Payment
schemes
• Those
without
a
Medical
Card
or
private
health
insurance
are
able
to
receive
medical
services
for
free
or
at
a
subsidised
rate
from
the
Treatment
Benefit
Scheme
–
as
are
their
dependants
–
which
brings
into
account
the
compulsory
Social
Insurance
Fund
(PRSI)
contribu7ons
they
have
made.
• People
can
also
claim
tax-­‐relief
on
medical
expenses
that
are
not
covered
by
the
State
or
by
private
health
insurance.

23. • Visitors
to
Ireland
who
hold
a
European
Health
Insurance
Card
do
not
have
to
pay
anything
for
emergency
treatment
from
a
general
prac77oner
or
specialist,
emergency
dental,
oral
or
aural
treatment,
inpa7ent
or
outpa7ent
hospital
treatment
or
prescrip7on
medicines.
• Those
who
need
dialysis,
oxygen
therapy
or
other
such
treatments,
can
arrange
for
it
before
their
visit.

24. The
Health
Service
Execu7ve
(HSE)
manages
the
delivery
of
the
en7re
health
service
as
a
single
na7onal
en7ty.
There
are
four
HSE
administra7ve
areas
•
HSE
Dublin
Mid-­‐Leinster,
•
HSE
Dublin
North-­‐East,
• HSE
South
and
HSE
West),
which
are
in
turn
divided
into
32
Local
Health
Offices
(LHOs).
The
HSE
is
Ireland's
largest
employer
with
over
100,000
workers;
and
has
an
annual
budget
of
€16
billion,
more
than
any
other
public
sector
organisa7on.

25. • The
HSE's
organisa0onal
structure
is
divided
into
three
main
areas:
• Health
and
Personal
Social
Services,
which
in
turn
is
divided
into
three
service
delivery
units:
1. The
Na7onal
Hospitals
Office
(NHO),
which
manages
acute
hospital
and
ambulance
services.
2. Primary,
Community
and
Con7nuing
Care
(PCCC),
which
delivers
health
and
personal
social
services
in
the
community
and
other
semngs.
3. Popula7on
Health,
which
promotes
and
protects
the
health
of
the
en7re
popula7on.

26. Support
Services,
which
enables
the
HSE
to
func7on
efficiently
and
cost
effec7vely.
Reform
and
Innova7on,
which
drives
the
HSE's
strategic
and
corporate
planning
processes.
• The
Minister
for
Health
has
responsibility
for
semng
overall
policy
with
regard
to
the
health
service.

27. End
of
lecture