ESRI publishes report examining primary healthcare on the island

An analysis of the primary care systems of Ireland and Northern Ireland is the third output in the joint research programme between the ESRI and Shared Island unit in the Department of the Taoiseach

On Thursday 10 March 2022, the ESRI will publish a report An analysis of the primary care systems of Ireland and Northern Ireland. This is the third report from the ESRI joint research programme with the Shared Island unit of the Department of the Taoiseach on The Economic and Social Opportunities from Increased Cooperation on the Shared Island.

The report examines the primary healthcare systems of Ireland and Northern Ireland. The analysis also sought to identify what comparable data are currently available on the two healthcare systems.

A key distinction between the healthcare systems of Ireland and Northern Ireland is the absence of a universal healthcare system in Ireland. In Northern Ireland, all residents are entitled to a wide range of health and social care services that are almost entirely free at the point of use, while in Ireland, a majority of the population pay out of pocket for a range of healthcare services, including general practitioner (GP) and other primary care services. Relative to Northern Ireland, a significantly higher proportion of the population in Ireland are covered by private health insurance.

Despite these differences, both systems are currently facing similar challenges including increasing demand for healthcare services, increasing expenditure and workforce shortages.

Findings of the research include:

  • For both socio-economic and health status, the available evidence suggests that one system does not consistently do better than the other. However, for some population health measures, including life expectancy and infant mortality, Ireland has performed better than Northern Ireland in recent years.
  • In terms of potentially avoidable hospitalisations (hospitalisations which might have been prevented if timely and effective primary care was provided), neither system consistently performed better than the other.
  • The proportion of invited participants availing of a range of preventive services (e.g. screening and vaccinations) appears similar across the jurisdictions.
  • There are higher levels of unmet healthcare needs due to affordability issues in Ireland relative to Northern Ireland.
  • However, the most common reason for unmet healthcare needs in both Ireland and Northern Ireland relates to long waits to access care. Driven by the COVID-19 pandemic and associated curtailment of some healthcare services, both jurisdictions have seen a significant increase in the proportion waiting more than 12 months for both out-patient and day and in-patient services, with this increase particularly evident in Northern Ireland. For example, between 2017 and 2021, for day and in-patient services, the proportion on the waiting list for more than one year has increased from 12 to 20 per cent in Ireland and from 20 to 60 per cent in Northern Ireland.
  • In general, there is a lack of comparable data on healthcare system indicators across Ireland and Northern Ireland, which significantly limits the type of analysis that could be undertaken.

The significant challenges currently being experienced in both systems - particularly in the areas of waiting lists and recruitment - might provide fresh impetus for at least exploring the potential for greater cooperation in relation to health matters. If greater cooperation on health policy and planning is to occur between Ireland and Northern Ireland, there is a need for significant reform in data collection and sharing.

Lead author of the report, Dr Sheelah Connolly said:

Similarities and differences between the healthcare systems of Ireland and Northern Ireland provide an opportunity to examine how different systems and policies influence outcomes.

The analysis carried out for this Shared Island research suggests that there have been improvements in population health indicators in Ireland in recent years, which have not been experienced to the same extent in Northern Ireland. Further research should be undertaken to understand the reasons for these differences as this may provide evidence on how to improve population health.”