Dr. Sheelah Connolly:

The shared island unit of the Department of the Taoiseach recently funded research to examine the healthcare systems of Ireland and Northern Ireland, in particular to identify differences and similarities between the two systems. A key distinction between the healthcare systems of Ireland and Northern Ireland is the absence of a universal healthcare system in Ireland. In Northern Ireland, all residents are entitled to a wide range of health and social care services that are almost entirely free at the point of use. In Ireland, a majority of the population pay out-of-pocket for a range of healthcare services, including general practitioner and other primary care services. Ireland has a much greater provision of private healthcare services and a larger proportion of the population is covered by private health insurance. Despite these and other differences, both systems are currently facing similar challenges, including increases in waiting times, expenditure and demand for healthcare services and workforce shortages. As Dr. McGuinness noted, life-expectancy in Ireland in recent years has exceeded that of Northern Ireland. We also found Ireland performed better than Northern Ireland for a range of other health status indicators, including infant mortality and the proportion of the population reporting chronic conditions such as diabetes. While 20 years ago health status was generally better in Northern Ireland, and indeed the rest of the UK, relative to Ireland, the reverse now seems to be the case.

In terms of inputs into the system, our research found, for example, that the number of GPs per capitawas relatively similar across Ireland and Northern Ireland. Healthcare expenditure is measured differently across the jurisdictions. The available data suggests publicly-financed healthcare expenditure is similar in Ireland and Northern Ireland but privately financed expenditure through out-of-pocket payments and private health insurance is higher in Ireland.

Our research also examined unmet healthcare needs across the two jurisdictions. We found there are higher levels of unmet healthcare needs due to affordability issues in Ireland. This is perhaps unsurprising given the relatively high user-charges for a range of services in Ireland. However a significant and growing barrier to access healthcare in both jurisdictions relates to the large and growing waiting times, especially for hospital-based services. While long waits for publicly-financed hospital care have been a feature of the healthcare system in Ireland for a number of years, the situation in Northern Ireland has deteriorated rapidly since the onset of the Covid-19 pandemic. For example, between 2017 and 2021 the proportion of the population waiting for an inpatient appointment for more than a year increased from 12% to 20% in Ireland and from 20% to 60% in Northern Ireland.

Much of the discussion about the healthcare systems in Ireland and Northern Ireland relates to the high user charges for GP services in Ireland while such services are available free at the point of use in Northern Ireland and the rest of the UK. Last week in budget 2023 it was announced that GP care provided free at the point of use would be extended to an additional 400,000 people in Ireland. Such a reform would mean a greater alignment in terms of eligibility for GP services between the two healthcare systems. However user-charges for other services and prescription items in Ireland mean that out-of-pocket payments are likely to remain higher in Ireland in the coming years.

Differences between the two healthcare systems of Ireland and Northern Ireland provide an opportunity to examine how different approaches might impact on outcomes. However a lack of comparable data on a range of healthcare indicators across the island limits the extent to which such analysis can currently be undertaken.