Private vs public – healthcare in Ireland has deep inequalities

In the heart of Ireland’s health crisis, patients and healthcare professionals reveal a stark two-tier system where access to medical care depends increasingly on financial means.

Ireland’s healthcare system, ranked sixth globally by CEO World Magazine’s Health Care Index for 2024, faces significant challenges despite its high standing. With a 68 out of 100 score, Ireland trails behind Taiwan, South Korea, Australia, Canada, and Sweden. Despite spending above the EU average on healthcare, the system struggles with capacity issues and equitable access to care.

Despite spending $6,047 per capita on health – above the OECD average of $4,986 – and public sector funding covering 77% of expenditures. Ireland operates a two-tier system where private patients often receive faster access to care, exacerbating equity concerns compared to countries like Canada or the UK.

Despite recent efforts to increase capacity, with a 28% rise in hospital beds over the past decade, Ireland still faces a significant deficit. Estimates suggest a shortfall of approximately 1,000 inpatient beds in public acute hospitals, with an additional need for over 300 beds annually to keep pace with population growth and ageing.

The lack of universal coverage for primary care in Ireland, unique among Western European countries, further exacerbates the strain on the healthcare system.

This coverage gap and long waiting times for specialist appointments and elective surgeries remain significant sources of patient dissatisfaction. The situation is particularly challenging for those seeking mental health services, as explained by one patient: “I’ve been waiting for an ADHD assessment through the public system for over two years now. If I had €2,000 to spare for a private clinic, I could get diagnosed and start treatment in just a few weeks. As a student, I can’t afford that option.”

Another patient’s experience further emphasizes this stark contrast between public and private healthcare. “As an Erasmus student from France, I don’t have Irish health insurance. I’ve been trying to see a psychiatrist in a public hospital with a GP referral for months, but I haven’t seen anyone yet. I’m forced to have my medication shipped from Paris because I can’t access the care I need here.”

A healthcare worker at St Patrick’s Hospital anonymously highlighted the systemic challenges, mentioning that the “choice is either waiting undiagnosed and untreated for a year or two in the public system or spending a small fortune to get help quickly through a private clinic.”

The Irish hospital system operates at near-full capacity, with a critical shortage of beds. In 2022, Ireland had only 291 hospital beds per 100,000 people, 43% below the EU average of 516. This places Ireland as the 5th lowest among EU member states regarding hospital bed availability.

The situation is particularly concerning when it comes to mental health care, where Ireland has just 23.8 adult acute mental health beds per 100,000 population, compared to the EU average of 73.

Public healthcare faces numerous challenges, such as staff shortages, overcrowding, budget constraints, and the ageing population. The results were striking in 2024; people had to wait months for a specialist consultation and years for surgical procedures if they were not urgent.

As of February 2025, the statistics are striking: 700,320 patients were on the active hospital scheduled care list. About 68% of outpatients wait longer than 10 weeks for an appointment, and approximately 60% of inpatients are waiting longer than 12 weeks for treatment.

A healthcare professional who preferred to remain unnamed and work in a children’s hospital said, “I see a long wait list. No wonder they go to private healthcare. If I were doing the same job in the private sector, I would earn much more, but I help the kids. We will have new equipment using more technological systems (AI and everything), and I hope it will bring down the waiting list because people need to see someone when they have a problem now and not in a year.”

Due to this, private healthcare in Ireland is thriving, creating huge disparities between private and public healthcare. More and more people are turning to private systems, which can give them quicker access to certain services and treatments. But the prices are very high.

Consultation fees for private doctors generally start at 70 euros but can reach 120 euros for “extended consultation”, while specialists’ fees range from 150 to 300 euros. Depending on the complexity, diagnostic tests may incur additional charges, ranging from 200 to 800 euros.

These costs are often partially or fully covered by private health insurance, which costs health insurance an average of €1,685 (+4% compared to last year), according to the Health Insurance Authority (HIA).

Students on clinical placements offer nuanced perspectives. Zoe, a Trinity student, succinctly noted: “If you’re sick, go to a public hospital. If you want it done quickly, go to a private hospital.”

Her colleague Munnasib added, “The private hospital is dedicated more to time and research with the patient. They pay more attention to their cases and can deliver patient care. In a public hospital, you’re working so much that you’re unable to give the patient the time and attention they need.”

Zoe, who is doing a placement in a children’s hospital, highlighted significant challenges: “There are bed shortages, patients on wards, and doctor and nurse shortages.” The challenges are immense, especially considering the waiting lists, conflict of interest for consultants, and overall staff shortages being the more significant problems in the public system.

Hospitals also often violate working-hours rules due to staff shortages nationwide.