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Private health expenditure in Ireland: Assessing the affordability of private financing of health care.

Authors
  • Johnston, Bridget M1
  • Burke, Sara2
  • Barry, Sarah2
  • Normand, Charles2
  • Ní Fhallúin, Maebh2
  • Thomas, Steve2
  • 1 Centre for Health Policy and Management, Trinity College Dublin, 2-4 Foster Place, Dublin 2, Ireland. Electronic address: [email protected] , (Ireland)
  • 2 Centre for Health Policy and Management, Trinity College Dublin, 2-4 Foster Place, Dublin 2, Ireland. , (Ireland)
Type
Published Article
Journal
Health policy (Amsterdam, Netherlands)
Publication Date
Oct 01, 2019
Volume
123
Issue
10
Pages
963–969
Identifiers
DOI: 10.1016/j.healthpol.2019.08.002
PMID: 31421910
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

This paper investigates the affordability of private health expenditure among Irish households and the services contributing towards financial hardship. We use data from the Irish Household Budget Survey, a representative survey of household spending in Ireland, covering 2009-10 and 2015-16. Private health expenditure comprises out-of-pocket payments for health and social care services and private health insurance (PHI) premiums. The poverty threshold is 60% of median total equivalised consumption and households with consumption below this level were defined as poor. Households were classified as having unaffordable health expenditure if: 1) they were poor and reported any spending; 2) they were pushed below poverty threshold by health spending; or 3) their spending on health exceeded 40% of capacity to pay. Despite signs of economic recovery, the incidence of unaffordable private health spending increased over the years-from 15% in 2009-10 to 18.8% in 2015-16. People on low incomes were disproportionately affected. The largest component of unaffordable spending for poorer households is PHI and not user charges, which have actually fallen as a cause of hardship. Our findings indicate that reliance on private health expenditure as a funding mechanism undermines the fundamental goals of equity and appropriate access within the health care system. Copyright © 2019 Elsevier B.V. All rights reserved.

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