After WW2 all European countries were faced with the same problem; how to provide an equitable, effective and cost efficient healthcare service for its citizens. It didn’t take too much deep thinking to realise that “the (profit driven) free hand of the market” would not solve this problem,,,(unless you were USA)

Healthcare is regarded as a “Merit Good”, that is, it should be available to all regardless of their ability to pay. Decisions regarding the treatment of your ailment should be based on its severity & urgency and not on your ability to pay.

Whether through general taxation or social insurance contributions the funding of such a service involves redistribution from the better-off to the less well-off as a “benefit in kind”, thus ensuring that the funds are used for the intended purpose, Healthcare.

So far we have been referring to a public healthcare service, but what about those with enough dosh who can pay either directly or through insurance to be treated privately? The initial reaction to people accessing privately provided health services is, Good on them”, this will reduce the burden on the public sector and in theory should reduce waiting times. Theory and practice are two very different things and for this particular theory to work in practice it depends on two important assumptions.

1) Both sectors provide genuinely comparable services. 2)The public sector should be the “default option” for the majority of the population and there should be a broad level of user  satisfaction with it. In Ireland these assumptions do not stand up well to scrutiny.

Ireland has a Universal Entitlement to public healthcare, in theory, but in practice this is severely limited in many ways. As a result private insurance has steadily risen from 18% in 1977, 35% in 1990 to a peak of 52% in 2009. As the recession persisted this % dropped to 45%.in 2015.

A follow up will look at how Ireland specifically addressed (or failed to address) the whole healthcare issue and how some other countries choose alternative routes