Ireland’s Crazy Three Tier Health System


A new report on Health Inequalities in Europe ( has highlighted the problems with Ireland’s three tier health system.

The three tiers are:

  • A private insurance system which is held by 45% of the population. The reports states that people with voluntary health insurance enjoy favourable conditions, e.g., obtaining faster access to diagnostics and hospital treatments, even from public providers, thereby giving rise to health inequalities.’
  • A medical card system held by 37% of the population. These wait longer for operations and procedures. There are currently 600,000 people on hospital waiting lists and 100,000 outstanding outpatient appointments.
  • The rest who are in a twilight zone as they do not qualify for a medical card and cannot afford medical insurance. These end up paying more because Ireland is unique in Europe in not having universal health coverage for primary care.

Many middle income people are being frightened into taking out private insurance because they know how bad the health system is. But this means that they end up paying more for health security than they should.

Similarly, those on the medical card and those in the twilight zone are losing out because they must wait longer for a basic medical service – or worry about paying for simple procedures.

We need a National Health Service that is funded through general taxation and treats people according to medical need– not the size of their wallet.

There are two reasons why we don’t have such a health system.

Historically, the Catholic Bishops and the medical establishment opposed an attempt by Noel Browne to introduce a Mother and Child scheme in 1951. This was seen as the first step towards creating a national health service. But the Bishops denounced it as a move towards a ‘totalitarianism’ because it involved state spending. The Labour Party obediently toed the line and scuppered Browne’s bill.

Secondly, Fianna Fail and Fine Gael have dominated our political system ever since and as right wing parties are opposed to any moves to create a  fully public heath system.

We need to remove them from power and undo the legacy of the Bishops to create a proper health system.