Privatization in the Irish hospital sector since 1980.

Abstract

Privatization has transformed health care systems over the last several decades. This article examines trends in bed supply in Ireland between 1980 and 2015 within the context of government policy on bed provision in a system of inequitable access to care. Ireland has not published bed data on private hospitals since the 1980s, even if they comprise about one-quarter of all hospitals. However, this article presents, for the first time, annual bed data since the 1980s collected from private hospitals and used to trace the evolution of bed supply over time. Bed data were collected for private Irish hospitals for the years 1980-2015, mainly through direct requests to hospitals. Additional sources included the Irish Medical Directory, private health insurance data, hospital company records and newspaper archives. Subject to data caveats explained in the article, between 1980 and 2015, total inpatient beds decreased by 25.5% nationally. Inpatient bed numbers in private for-profit (PFP) hospitals rose from 0 to 1075 but decreased from 9601 to 5216 in private not-for-profit (PNFP) hospitals and from 7028 to 6092 in public hospitals (using the Irish hospital classification, beds in private hospitals increased from 1518 to 1910 but decreased from 15 111 to 10 473 in public hospitals). Also, by 2015, 24.1% of PFP hospital beds were day beds, compared to 17.7% for PNFP and 15.7% for public hospitals (using the Irish classification, by 2015, day beds accounted for 23.8% of beds in private hospitals and 16.1% in public hospitals). Trends in bed supply in Ireland between 1980 and 2015 are documented empirically for all Irish acute hospitals and contextualized within government policy on bed provision. The Irish acute hospital system has experienced privatization reforms supported by the government over the last several decades.