Ireland's health system is primarily funded from general taxation and is publicly provided, although
private health care retains a considerable role. It is a unique structure, a mixture of universal health
service free at the point of consumption and a fee-based private system where individuals subscribe to
private health insurance that covers some of their medical expenses. The recent history of the Irish
health services saw consolidation of existing services and an expansion into new areas to adapt
to changing practices and needs. There has also been a drive to extract maximum efficiency
so as to maintain the volume and quality of patient services at a time of very tight
financial constraints. Introduction of
new health technologies continued to accelerate.
New technologies tended to spread rapidly before systematic appraisal of their
costs and benefits. When the state is involved in funding the public hospital system, acceptance of new
technology is a matter for discussion between agencies and the Department of Health and Children. Decisions
about spending annual “development funding” have generally
not been based on careful assessment of proposals for new technology. In 1995, a healthcare reform put
new Public Health Departments in Health Boards in a prime position in Ireland's health services
organization. These departments now emphasize evidence-based medicine. While Ireland does not have a
national health technology assessment (HTA) program, there are plans to form an advisory group
on HTA in 1998. HTA is seen as a significant element of future health policy in Ireland.
