Universal health coverage (UHC) is a key tenet of the WHO’s 2015 Sustainable
Development Goals. The health system in Ireland represents a mixed public-private
system however under Sláintecare proposals, the country would implement a system
of universal healthcare. However, this plan does not include universal entitlement to
medicines. Currently about 40% of the population in Ireland have access to
medicines with a small co-payment while the remainder pay out-of-pocket for their
medicines. Direct payment for medicines is both inefficient and inequitable as a
means of financing and can deter medicines use. Hence reducing out-of-pocket
payments is an important goal for UHC.
One route to provide universal medicines access is to develop an essential medicines
list with universal free entitlement, which would support rational, high-quality,
equitable, and affordable medicines use. Implementation of essential medicines lists
can also improve prescribing quality and health outcomes.
This project’s research question is how would publicly funding an evidence-based
essential medicines list change medicine access, appropriateness and costs in a
high-income country moving to universal healthcare? This will be addressed by
• Characterising out-of-pocket payments for medicines in terms of affordability
and equity, the relationship with health cover, multimorbidity, and sex, and
the impact on medicines adherence.
• Assessing the impact of Sláintecare proposals to change co-payments and
monthly thresholds on individuals’ and households’ out-of-pocket payments
for medicines.
• Determining the extent to which general practitioners already utilise a short
list of medicines in their prescribing, and how this utilisation differs by public
health cover.
• Adapting the WHO Essential Medicines List using a structured, stakeholderinformed
process to develop an evidence-based essential medicines list for
Ireland.
• Estimating the cost implications to the health system of implementing
universal entitlement to evidence-based essential medicines for Ireland.
The project will provide a roadmap for policy-makers to implement universal
entitlement to evidence-based essential medicines.
