Overall responsibility for the health care system lies with the Government, exercised through the Department of Health and Children (DoHC), under the direction of the Minister of Health and Children (MoHC). As part of the reforms the Health Boards that had been responsible for the provision of health care and personal social services were abolished on 1 January 2005 and replaced by a single body, the Health Service Executive (HSE). Many of the functions and staff
from the former health care structure have been relocated within the new HSE. With a budget of more than €13 billion it is the largest employer in the country, with more than 65 000 staff in direct employment and a further 35 000 employed by voluntary hospitals and bodies funded by the HSE.
A range of statutory and non-statutory agencies also play a role in both the regulation and provision of services. These include the Irish Cancer Screening Board (ICSB) and the Irish Blood Transfusion Service. Many other executive agencies were merged or abolished and subsumed within the HSE as part of the reform measures. Other ministries with an interest in the health system include the Department of Social and Family Affairs (DSFA), which has responsibility for social welfare payments, including various forms of income support, disability allowances and payments made to support family carers.
The Department of Justice, Equality and Law Reform, through the Director of Prison Medical Services, is responsible for the health of the prison population.
More than 50% of the population have voluntary private health insurance. By far the largest insurance body is the Voluntary Health Insurance (VHI) Board set up in 1957. As of September 2006, the VHI Board’s share of the private insurance market was approximately 75%. It has operated as a non-profitmaking, semi-state private insurance body, with board members appointed by the MoHC. At the time of writing, it is undergoing a process of reform to put it on the same operating platform as the other two principal private health insurance providers, which cover most of the remainder of the private health insurance market. A Health Insurance Authority (HIA) was set up by the Government in 2001 to regulate private insurance. It helps promote competition while ensuring schemes use community rating, have open enrolment and provide lifetime cover. However, the triggering of risk-equalization payments between the insurers has led to upheaval in the insurance market in recent years and a series of legal challenges both in Ireland and at EU level. This may have a major impact on the future shape of VHI.
The Irish health care system remains predominantly tax funded. In 2006, 78.3% of total health expenditure (both public and private) was raised from taxation, including pay-related social insurance (PRSI) and other sources of government income, such as excise duties. The remaining components of total health expenditure are from private sources, in particular out-of-pocket household expenditure on general practitioner (GP) visits, pharmaceuticals and public/ private hospital stays, as well as payments to VHI providers. ( HiT )