Box 1 Healthcare entitlements in Ireland

Ireland has a mixed entitlements system: there are publicly funded programmes to increase access to healthcare aimed at those with low incomes and/or high healthcare need. There are three main healthcare entitlement categories: ‘basic eligibility’, General Practitioner (GP) Visit Card (partial eligibility) and Medical Card (full eligibility) [16]. These three categories are mutually exclusive.

- ‘Basic eligibility’ entitles people to access the hospital system though with a range of co-payments. At the time of data collection there were upper-limits on charges for inpatient care (€80 per day and €800 annually), emergency department attendance (€100 per visit) and prescription medicines (€114 per month at end of 2021, €100 per month at start of 2022) [17, 18]. Patients must pay out-of-pocket for GP visits, with no upper limit. The average cost of a GP visit in Ireland is €54 [19].

- For the GP Visit Card, basic eligibility applies but there is also coverage for GP consultation fees [20]. Those under 70 with household incomes below a threshold are entitled to a GP visit card, with all adults aged over 70 years eligible [16, 21]. As an example of this threshold, a single person living alone aged under 66 years would be entitled to the GP visit card if their weekly income was below €304 (less tax) [22].

- The Medical Card is a means-tested scheme which provides free primary, community and hospital care, and heavily subsidised prescription medicines [23]. The income threshold for adults for the Medical Card at the time of data collection was approximately 40% lower than the GP visit card threshold [16].

In 2020, 35% of people in Ireland had a Medical Card, 11% had a GP Visit Card and 54% had basic eligibility [24]. Approximately 46% of the population have private health insurance [25], which facilitates access to private care but generally does not cover GP care. Others pay the full cost out-of-pocket for private care.