The Health services in Ireland are centrally directed by the Department of Health and Children. At local level, the health services are operated by eight regional health boards. The participation of voluntary bodies in the provision of services is encouraged and many voluntary organisations receive grants from the State. The Health services are financed out of central taxation. Those with low incomes - about a third of the population - receive medical services free of charge. The rest of the population can avail of the public hospital services for a minimal charge. They also have to pay certain charges, such as for visits to the family doctor There is a system of voluntary health insurance to help meet the cost of medical treatment. In 1997, the birth rate was 14.3 per 1,000 people based on a total of 57,311 births registered during the year. Though it fell quite steeply between 1980 and 1989, the birth rate has been relatively stable since then. Ireland's birth rate remains the highest in the EU. Over 99% of births take place in hospitals. The death rate for 1997 was 8.6 per 1,000 people based on a total of 31,605 deaths registered during the year. There are 3.3 hospital beds for acute cases per 1,000 people. In addition, for every 1,000 people there are 1.8 beds in psychiatric hospitals and 4.7 in geriatric units. There approximately 128 doctors for every 100,000 people. In 1997, there was approximately [538,000] admissions to general public hospitals.

There are two categories of public health coverage and residents are automatically entitled to one or the other.

Category One Coverage

A 'medical card' which covers all ordinary and hospital costs. It also covers dental, opthalmic (eye) and aural (ear) services and appliances like glasses and hearing aids. Maternity and infant care services, including visits to doctors before and after birth are all covered. Prescribed drugs and medicines are also free.

Category One eligibility

You'll qualify for a medical card if your total family income (for a married couple under 66) is less than 127.50 pounds a week. A single person living alone (under 66) qualifies when gross income less pension taxes is 88 pounds or less. There are various adjustments based on age and number of dependents.

Category Two Coverage

Everyone else in the Republic qualifies automatically for Category Two eligibility. Every resident of Ireland is entitled to all in-patient hospital services in public wards and all out-patient public hospital services subject to a 200 pound annual maximum charge (at a daily rate of 20 pounds). Accident and emergency departments are covered if you have a referral note from your doctor. Maternity and infant care services such as doctor visits are covered for up to six weeks after birth.

All children are entitled to new eyeglasses every two years, free dental work, and free orthodonture if the child's teeth are crooked enough to justify such work purely on medical grounds. Cosmetic straightening does not qualify. All such visits are arranged through the public health service and the child deals with a health service professional staff member, doctor, dentist, or nurse. Such free services are available to all children in the Republic as long as they are in Primary School (until fourteen years of age). After that age, usually only those children whose parents have medical cards (Category One coverage) qualify for such free services.

In addition, persons spending more than 120 pounds in a 3 month period on prescribed medicines can submit a claim to have the excess refunded. Anyone certified as having a long term medical condition requiring on-going medications totalling more than 42 pounds a month can apply to join the Drug Cost Subsidisation Scheme. If you qualify, you only have to spend 42 pounds a month, and all further prescriptions for you and your family are covered. Community pharmacists all carry the necessary forms to apply for these programmes. People suffering long term illnesses such as multiple sclerosis and diabetes (the list is much longer) may apply for a special book which entitles them to free drugs and medicines for the treatment of that illness.

Private and Semi-private rooms in public hospitals can cost up to 132 pounds daily for Category Two. This is one of the areas which private insurance covers.

Visitors and EU Citizens

European Union (EU) or European Economic Area (EEA) citizens living in Ireland are automatically entitled to Category One or Category Two coverage the same as any Irish citizen. Visitors from EU countries are also entitled to free urgent medical care so long as they present form E111 which can be obtained from their own health services before visiting Ireland. Visitors from the United Kingdom are even excused the necessity of having this form, so long as they obtain treatment at a public hospital or doctor participating in the General Medical Service scheme. There are 1,650 General Practitioners who are part of the scheme. A driver's license or other proof of residence in the UK is required.

Establishing Residency - non-EU citizens The Department of Health has issued guidelines concerning criteria for establishing residency. "A non-EU national should be regarded as 'ordinarily resident' in Ireland if he/she satisfies the health board that it is his/her intention to remain in Ireland for a minimum period of one year. Examples of the evidence which may be sought in this context include:

• proof of property purchase or rental, including evidence that the property in question is the applicant's principal residence;
• evidence of transfer of funds, bank accounts, pensions;
• Aliens's Registration Book ("Green Book"), residence permit as stamped on passport;
• work permits or visas, statements from employers etc;
• where necessary, the signing of an affidavit by the applicant.
• A non-EU national who is in Ireland as a student should be regarded as 'ordinarily resident' if he/she is attending a registered course of study of at least one academic year's duration.
• A dependant of a non-EU national must also satisfy the criterion of 'ordinary residence' in order to establish eligibility for health services here i.e. the fact that a non-EU national has established his/her eligibility does not imply that non-resident dependants are also elibible."

Guide

A complete guide to health services is available from the Department of Health. Send for:

Information Guide to our Health Services (ISBN 1-873820-01-1)

Department of Health
Hawkins House
Dublin 2
Ireland

The guide is also available at the Department's internet site

Private Health Insurers The Public Health Care System is remarkable, but it has some gaps. That's where private health insurance comes in. There are roughly 3.5 million people in the Irish Republic and 1.4 million of them are covered by private insurance over and above the public health entitlements.

There are only two government authorised private medical insurance companies. They are the Voluntary Health Insurance Board (VHI) and BUPA Health Insurance Ireland (pronounced boo-pah). VHI is a semi-state body that has existed for decades. BUPA is a major private insurer that has only recently begun offering policies in Ireland.

Roughly 75% of private insurance buyers choose VHI's mid-range Plan B or the comparable BUPA Essential Plus scheme.

Charges vary according to plan and whether the coverage is group or individual. Even after choosing a plan, there are options for increased coverage at additional cost.

Contact each company for their latest brochure, or check out their Web sites.

Those with private insurance pay the doctor up front, then reclaim the expense at the end of the year if the deductible/excess is passed. Major expenses such as hospital visits are billed directly to the health insurer.

Other Costs

A standard visit to a doctor costs about 25 pounds, though in parts of Dublin it can be higher. In Ireland doctors still make house calls and there is no extra charge. Drugs aren't covered by private insurance at all, unless they're part of a hospital stay or outpatient prescription. There is no non-emergency dental coverage or eye glass cover. Specialists charge about 40 pounds per visit. Dental visits vary considerably depending on the service provided, but a simple filling should cost around 30 pounds.

Privately paid Orthodonture is not cheap. The cost for a full course of treatment currently is around 2400 pounds (paid over two years) though individual practictioners may charge greater or lesser amounts depending on the work required. This sum is deductible from income taxes.

There are drawbacks to the entire population having free medical care. They include:

• 30,500 people on hospital waiting lists.
• 6,592 - waiting for ear, nose, and throat procedures.
• 1,600 - waiting for cardiac operations.
• 1,299 - waiting for hip replacements, nearly 500 for more than a year.

Percentage of Adults waiting more than 12 months for public hospital treatment:

• Cardiac Surgery - 68%
• Ear, Nose, Throat - 41%
• Gynaecology - 21%
• Ophthalmology - 31%
• Orthopaedics - 48%
• Plastic Surgery - 61%
• Surgery (General) - 30%
• Urology - 46%
• Vascular - 61%

Percentage of Children waiting more than 6 months for public hospital treatment:

• Cardiac Surgery - 62%
• Ear, Nose, Throat - 57%
• Ophthalmology - 50%
• Orthopaedics - 84%
• Plastic Surgery - 45%
• Surgery (General) - 45%
• Urology - 61%

Over 50% of children awaiting treatment have been on waiting lists more than six months. And 20% of patients on the waiting lists for cardiac surgery die while awaiting operations.

These are sobering statistics and are a strong argument for private insurance. On the other hand, the public health service last year treated almost 2 million people in out-patient hospital clinics and another 1,138,000 in hospital casualty departments (emergency rooms).