This time is different? Lessons from past reform initiatives in the Irish health system

Abstract The publication of the Sláintecare report in May 2017 is a landmark in Irish healthcare policy. For the first time in the history of the state, the Irish political system produced an agreed long-term vision for the health system. The Irish healthcare system has attracted considerable negative comment over a long period and satisfactory healthcare reform had appeared to be impossible to achieve. The history of Irish healthcare reform is replete with policy difficulties. This paper seeks to assess the likelihood that Sláintecare will be implemented given that it is the first long-term, multielectoral cycle healthcare initiative that is agreed by all the main political parties. The paper uses a game theoretic model developed by Dal Bó, Dal Bó, and Di Tella to develop an understanding of the impact of the electoral cycle on politicians and interest groups in negotiating and implementing healthcare reform. It uses a case-study methodology, with previous Irish healthcare reform initiatives as the unit of analysis. Finally, it shows that politicians are at a distinct disadvantage due to the short-term horizon imposed on them due to the electoral cycle and that the adoption of a long-term agreed policy, like Sláintecare, is more likely to be implemented.