The Irish Health Services and their Administration and Financing
| DOI | 10.1177/002085236803400107 |
| Author | Brendan Hensey |
| Date | 01 March 1968 |
| Published date | 01 March 1968 |
| Subject Matter | Articles |
The Irish Health Services and
their Administration and Financing
by Brendan HENSEY
UDC 351.84 : 368.4 (417)
I. HISTORICAL
smaller rural authorities were amalgamated
into county-wide units and later the urban
For the purposes of this article, health
district councils lost their health functions.
services are taken to include only those ser-
Finally, in 1960, the administration of health
vices under which public authorities arrange,
services in the larger urban areas -
the county
or pay for, the diagnosis, prevention and treat-
boroughs of Dublin, Cork, Limerick and Wa-
ment of human illness.
The preventive ser-
terford -
and the contiguous areas was na-
vices covered will not include those designed
tionalised and that year also saw an end to
to provide a healthy environment, such as
legal distinctions in administration between the
water supply and sewage disposal schemes.
mental health services and the other services.
The present administration, discussed below,
Administration
is therefore, comparatively simple.
Until the early part of this century, the
The responsibility for the central adminis-
development of health services in Ireland pa-
tration of the services was in the beginning
ralleled fairly closely the development in Great
in the hands of the Irish Poor Law Commis-
Britain, and the provision of these services was
sioners, and was later transferred to the Irish
an intrinsic function of the developing local
Local Government Board.
With the estab-
government system. Three sets of authorities
lishment of the Irish Government in the nine-
were then involved in the services.
Preventive
teen-twenties, the Department of Local Govern-
services, including the appointment of medical
ment and Public Health became responsible
officers of health and the notification, preven-
for the services.
In 1947, this Department
tion and cure of infectious diseases became
was split so that general local government and
the responsibility of the elected sanitary autho-
the sanitary services are now the responsibility
rities for urban and rural districts.
Treatment
of the Department of Local Government while
of the ill, however, mainly became the respon-
the separate Department of Health is concern-
sibility of a different group of local authorities
ed with the health services as defined at the
-
those set up within the Poor Law system,
commencement of the article.
Health admin-
while a third group of bodies, outside the local
istration in Ireland is separate from the social
government system, was charged with the care
insurance administration, and compulsory in-
and custody of the mentally-ill in lunatic asy-
surance contributions do not meet any part of
lums.
Several voluntary hospitals were also
the local health authorities’ expenditure.
established by religious orders and philanthro-
pic bodies.
Scope of Services
At the time, there was little co-ordination
The services provided by these changing
at the local level in the arrangements for the
authorities have
services. If
developed considerably in
we except the mental treatment
service, it
scope since their foundation in the nineteenth
can be said that each service, as it
century. The harsh principles of the Poor
was introduced, was made the responsibility
Law
of whichever of the existing
governed eligibility for the
sets of local bodies
major services
at the beginning and limited health budgets
was looked upon as the most convenient to
administer it.
As
meant that developments in the quality of the
a result of this the respon-
services were slow in
sibility for the services became divided
coming. While much
among
was done in organising the preventive services
many local bodies.
By 1920, there were well
in the early part of this century and many good
over three hundred of these.
hospitals were built in the nineteen-thirties,
Since then, there have been successive re-
major changes in the scope and quality of
ductions in the number of local bodies con-
most of the services did not come until the
cerned with health administration. First, the
years following the Second World War, dur-
40
ing which there were substantial developments
By following this broad principle,
in the tuberculosis service, the hospital services
there has been a more effective use of
and the maternity and child care services.
the necessarily limited proportion of the
national product which can be devoted
to the public development of health ser-
II. THE PRESENT SERVICES AND
vices than if an effort had been made to
PROPOSED DEVELOPMENTS
develop on a much broader base a
scheme with the features of a compre-
Scope
hensive free-for-all national health ser-
vice. &dquo;
While the public authorities in Ireland have
become increasingly involved in arrangements
For the detailed application of this policy
for caring for the health of the people, their
the community is regarded as falling into three
function is still regarded as a limited one and
income groups. The lower income group,
it is not Government policy that private ar-
which is made up of those persons accepted
rangements for medical care should be sup-
by the local health authority as being in need
planted except where this is shown to be ne-
of having all health services provided at public
cessary.
A
review of the existing services and
expenses, contains about thirty per cent of the
a statement of policy for their future develop-
population; the middle income group, which is
ment (1) published by the Government in 1966
defined by reference to specific limits on
included the following general statement on
means (2) and is regarded as being in need
this policy :
of help only insofar as the more expensive
services are concerned, includes a further sixty
&dquo;
In developing the services on the
per cent or so and the upper income group,
lines summarised above, the Govern-
which includes those regarded as being able
ment did not accept the proposition that
to make private arrangements for medical care,
the State had a duty to provide un-
makes up the remaining ten per cent.
conditionally all medical, dental and
other health services free of cost for
The services provided and the categories
everyone, without regard to individual
eligible for each are shown on the following
need or circumstances. On the other
page.
hand, no service is designed so that a
Some of the services listed -
those provid-
person must show dire want before he
ing milk for mothers and children and mater-
can avail himself of it.
The preventive
nity cash grants and financial aid to disabled
services, being designed to protect the
persons and persons with infectious disease -
community as well as to succour the
are not within the definition given at the open-
individual, are available to all without
ing of this article. There are historical reasons
regard to means. Eligibility for the
why these services have become entwined in
curative services which, under the Public
the health administration rather than in that
Assistance code, was subject to a strictly
for the other income maintenance and social
applied means test, is now governed by
welfare...
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