The 2011 proposal for Universal Health Insurance in Ireland: Potential implications for healthcare expenditure

•In 2011, a commitment was made to the development of a single-tier health system in Ireland.•The proposed system was to be partly financed by Universal Health Insurance.•The available evidence suggests that the proposed model would increase healthcare expenditure.•As a result, the proposed model no longer appears to be on the political agenda.

The Irish healthcare system has long been criticised for a number of perceived weaknesses, including access to healthcare based on ability-to-pay rather than need. Consequently, in 2011, a newly elected government committed to the development of a universal, single-tier system based on need and financed through Universal Health Insurance (UHI). This article draws on the national and international evidence to identify the potential impact of the proposed model on healthcare expenditure in Ireland. Despite a pledge that health spending under UHI would be no greater than in the current predominantly tax-funded model, the available evidence is suggestive that the proposed model involving competing insurers would increase healthcare expenditure, in part due to an increase in administrative costs and profits. As a result the proposed model of UHI appears to be no longer on the political agenda. Although the Government has been criticised for abandoning its model of UHI, it has done so based on national and international evidence about the relatively high additional costs associated with this particular model.