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146 Economic crisis, health systems and health in Europe: country experience
from 14.4 to 16.0% and the proportion of the population experiencing two or
more types of enforced deprivation (e.g. without heating in the last year, unable
to afford a hot meal, etc.) increasing from 13.8 to 24.5% over the period 2008
to 2012 (CSO, 2013c). Inflation in health prices has consistently exceeded
that of overall prices, and given the heavy reliance on OOP payments in the
Irish health system (see section 3.2), this has created an additional burden on
households. In particular, sharp increases in PHI premiums, in combination
with deteriorating household finances, have been reflected in increasing numbers
cancelling their PHI cover over the duration of the crisis (see section 3.2 for
further discussion).
2. Health system pressures prior to the crisis
Since the start of the 2000s, overall levels of public expenditure on health have
risen rapidly, albeit from a very low base (Fig. 5.1), and per capita levels are now
broadly in line with expenditure in other countries (OECD, 2012a). However
in the preceding 30 years, Ireland's health expenditure was considerably below
the EU average, particularly for capital expenditure, which amounted to just
66% of the EU average over the period 1970–1996 (Wren, 2004).
Fig. 5.1 Public health expenditure (capital plus current) in Ireland, 2000–2013
18,000
Nominal Real (2,000 = 1.0)
16,000
14,000
Expenditure (€, million)
12,000
10,000
8,000
6,000
4,000
2,000
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Note: Public health expenditure includes capital expenditure.
Sources: CSO, 2014a; Department of Public Expenditure and Reform, 2014.
As illustrated in Fig. 5.1, there have been substantial cuts in public expenditure
on health since 2008 (see also Tables 5.2 and 5.3). The total public health
budget in 2008 was €15.4 billion, that for 2013 just €13.6 billion (Department