Putting Ireland's health spending into perspective

The Irish Taoiseach (Prime Minister) Leo Varadkar recently stated that Ireland spends the fifth highest amount on health in the world, therefore citizens should expect the fifth best health system in the world.1 Meanwhile, the European Commission has expressed concerns about the cost-effectiveness and sustainability of the Irish health system.2 However, these observations fail to take into account the fact that the Irish health system is only now recovering from historic long-term underfunding, the effects of which are still being felt. Using health spending per capita (in US$ on a purchasing power parity basis-in other words adjusting for exchange rates and purchasing power) might be a better indicator. During the late 1980s and early 1990s, severe cutbacks in health expenditure led to the closure of thousands of hospital beds, with the number of beds per 1000 people now substantially below the OECD average (3·0 vs 4·7 in 2015).4 However, additional beds will also require additional doctors and nurses to staff them, with Ireland facing a relative shortage of doctors per 1000 people (2·9 vs 3·3 in 2015).4 Another issue relevant to Ireland's health spending is the public-private mix.