Reform of the Irish health system towards Universal Health Coverage and the role of the private sector

Abstract Introduction Ireland stands as a compelling case study of a High Income Country setting out on Universal Health Coverage (UHC) reforms. The Irish health system has historically been a two-tier system with a large private sector and a high proportion of the population holding private health insurance (48% in 2023). The reform programme Sláintecare, adopted as a policy direction by all political parties, aims to introduce UHC, strengthen primary care capacity, address inequitable access and decentralise decision-making. The overall aim of this study is to chart the progress of the Sláintecare reforms, from their introduction in May 2017 up to December 2023, and to explore how they have changed throughout implementation. Methods A document analysis was undertaken using the READ approach. Department of Health publications, Budget reports, Service Plans, National Development plans, minutes of Health Service Executive committee meetings and transcripts of the Joint Committee of Health sessions in the Irish parliament were uploaded to NVivo and a content analysis was conducted, utilising predetermined themes. Results Areas that have made the most significant progress include the expansion of community care and lowering of some out-of-pocket costs. Since implementation began, one approach the government has taken has been to use the private sector to fill capacity gaps in the public system. For example, strategies for reducing waiting lists and using community diagnostics have largely used the private sector. However, through using the private sector, money is taken away from building capacity in the public system, which was the original goal of Sláintecare. Conclusions The private sector plays a significant role in providing care in Ireland and leveraging this for the benefit of public patients could play a positive role towards UHC, provided that funding for a purchaser-providers type model for some services from the government could be guaranteed into the future.