The provision of healthcare in a changing Ireland

Described by The Economist in 1988 as “easily the poorest country in rich north-west Europe”, Ireland underwent an unprecedented economic transformation during the 1990s. From a country marred by chronic budget deficits, high levels of unemployment and widespread emigration, it became the European Union’s success story. Over a period of only a few years, Ireland emerged as an economic frontrunner, with sustained economic growth, and was seemingly ‘getting richer’ all the time. Ironically, the aetiology of this revolution has ultimately become its downfall; the phenomenon of globalisation. Ireland’s geographic position on the periphery of Europe, combined with competitive taxation policies and corporate incentive schemes, made it the ideal base for US companies to bridge the Atlantic and target the European market. The influx of large multinational investment placed Ireland at the heart of this new global economy and provided the financial stimulus and momentum for what was, in economic and real terms, a dramatic turning point in Irish interests. However, Ireland’s open market economy was, and remains, reliant on global trade and investment, particularly from the US. In 2007, the credit and housing boom in the United States crumbled, triggering a banking and financial market crisis that infected their economy and, by proxy, that of Ireland. The Irish success story received a rude awakening and a sharp reversal in its fortunes. Health expenditure trends in Ireland have naturally followed the national economic position. Strict economising in the earlier part of the 1990s gave way to exponential increases in expenditure between 1996 and 2002. The publication of the 2001 Health Strategy ‘Quality and Fairness: A Health System for You’ reaffirmed the governing principles of Irish health policy: equity, quality and accountability, with the additional focus of placing the patient at the centre of future reform. This strategy centred on six key areas: strengthening primary care provision; developing the acute hospital system; improving funding; better planning and training for the healthcare workforce; review of the current healthcare structures; and, improving health information systems. This strategy paved the way for a number of reports that changed the landscape of Irish healthcare. For the most part, this change has been quite visible