THIS TIME ON CODE WACK!
In honor of St. Patrick’s Day, we’re featuring Ireland’s healthcare reform agenda known as Sláintecare. What healthcare challenges have plagued the country – and how will Sláintecare help?
To find out, we interviewed Dr. Sara Burke, associate professor and director of the Centre for Health Policy and Management in Trinity College Dublin’s School of Medicine. She is the Principal Investigator of a research project entitled ‘Health system foundations for Sláintecare implementation in 2020 and beyond …’ and Co-Director of SPHeRE, Ireland’s national research training program for population health, policy and health services research. Her research interests include health policy, inequities in health, healthcare access and the politics of health reform. This is the first of two episodes with Dr. Burke.
Check out the Transcript and Show Notes for more!
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SHOW NOTES
WE DISCUSS
Can you give us a brief overview of Sláintecare and how it aims to transform Ireland’s healthcare system?
“Sláintecare is a 10-year plan for health reform that was devised through political consensus. And that political consensus I think is key to it.
“So there was a parliamentary committee of all colors and creeds that came together to devise the plan. And one of the logics of the plan was that every time there was a new government or even a new minister – ’cause sometimes there can be a couple of different ministers within one government – there was new plan that kept on changing and there was never time for a plan to embed and give the system time to actually reform.
“And there were persistent issues like poor access to care, long wait times to access care, inequalities in who got access to care and these were of particular concern to the politicians who set up the group and to the terms of reference. And it specifically was given a remit to deliver timely access to a universal healthcare system cause In Ireland to this day; we like the United States, we don’t have universal access to care based on need.” – Dr. Sara Burke
Why did it take Ireland so long to catch up with other European countries that have universal health care?
“Great question. I think it is a combination of when a lot of other healthcare systems did in Europe was post-World War ii and we were a small, very fragile democracy. We were just about 20 years old.
“The Irish Republic was formed in the early 1920s, but we were very poor, very conservative with a very strong Catholic church and policy decisions were made, indeed, similar to the arguments against Obamacare, in Ireland, in the 1950s, not to go the route of other European countries.
“ And we’re really only coming to it late in the last 10 or 15 years. There’s been a sort of political commitment to, to try and deliver on it and be on par with other European democracies.” – Dr. Sara Burke
How does Sláintecare compare to fully single-payer models like Canada’s system?
“In some ways it’s similar, but the big difference is that Canada and indeed many models within Europe are insurance-based and a lot of the money to fund them comes from employers and employees. Whereas single-payer models have better access and better outcomes and they’re particularly good for equity.
“And we know that systems like the United States of America, where there’s huge amounts of private providers, have the worst health outcomes. It drives, it incentivizes the wrong type of care in the wrong place. It over treats people with money, it undertreats people without money … It results in worse population health outcomes.
“Ireland could go for a Canadian or a Belgian or a different European insurance model, but this parliamentary committee chose to go with a tax- funded model.
“And actually one of the reasons for that was that the previous government in place in Ireland in 2011 had proposed a new insurance based model and that didn’t work. It never happened.
“It was a failed policy proposal and that was one of the reasons for the genesis of Sláintecare … But critical to that was rejecting the previous model, which was much more similar to a Dutch or an American, or a United States model with these competing private providers and insurers. And there’s good evidence to show that probably wouldn’t work in an Irish context. So we went a tax-funded route.” – Dr. Sara Burke
Helpful Links
Sláintecare – our strategy for improving Ireland’s healthcare system, Health Service Executive (HSE), Government of Ireland
HSE publishes 2025 National Service Plan, Health Service Executive (HSE)
Structured Population Health, Policy and Health Services Research Education, SPHeRE Programme
From universal health insurance to universal healthcare? The shifting health policy landscape in Ireland since the economic crisis, Science Direct
Reform of the Irish health system towards Universal Health Coverage and the role of the private sector, European Journal of Public Health
Episode Transcript
Read the full episode transcript.
Biography: Dr. Sara Burke
Dr. Sara Burke is Associate Professor and Director of the Centre for Health Policy and Management in the Trinity College School of Medicine. She is the lead researcher on an Evidence for Policy HRB-funded project for the Department of Health producing a new Health System in Transition report for Ireland and the European Observatory on Health systems and Policies.
Her research interests are health policy, health systems, inequities in health and access to healthcare as well as the politics of health reform.
Sara is a Co-Director of the national SPHeRE structured PhD programme, she loves to teach and is module lead on health systems and policy on the MSc in Health Policy and Management and the SPHeRE programme as well as teaching undergraduates. For many years Sara had a weekly health slot on RTE Radio 1’s Drivetime programme, she is the author of a book entitled Irish Apartheid and an occasional contributor to national media. More: Health Policy and Management – Medicine | Trinity College Dublin (tcd.ie) & Sara Burke’Trinity Research – Trinity College Dublin (tcd.ie)
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