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Failure to take-up public healthcare entitlements: Evidence from the Medical Card system in Ireland

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  • Keane, Claire
  • Regan, Mark
  • Walsh, Brendan

Abstract

While population health and welfare can be improved through the provision of non-cash benefits, such as free healthcare, many welfare improving schemes have low rates of take up amongst those eligible for such a benefit. One interesting example of this is the Medical Card scheme in Ireland. Medical Cards are a non-cash benefit that provide free primary, community, and hospital care, as well as heavily subsidised prescriptions drugs, for those below specific income means-test threshold. However, despite the significant benefits afforded by a Medical Card, many people forego entitlement. While this has been of concern to policymakers, the prevalence of, and reason for, non-take up, have to date not been examined in-depth. Using detailed household demographic, healthcare, income and expenditure data, this paper estimates the Medical Card take-up rate, examines the reasons for non-take, and estimates the additional healthcare cost burden to individuals due to non-take-up. The paper estimates that 31% of eligible individuals do not take up a Medical Card. Private health insurance coverage, receipt of social welfare, employment status and health status are all strongly correlated with take up. Results suggest that of a lack of information about eligibility status and social stigma are key factors driving non take up. The paper estimates that families who forego their entitled Medical Card typically spend an additional €202 annually on healthcare. Furthermore, as a consequence of higher purchase rates of, perhaps unnecessary, private health insurance, families not taking up their entitlement spend an additional €489 per annum on PHI premia. Welfare losses are likely to be even higher if forgoing medical care due to cost results in future negative health outcomes.

Suggested Citation

  • Keane, Claire & Regan, Mark & Walsh, Brendan, 2021. "Failure to take-up public healthcare entitlements: Evidence from the Medical Card system in Ireland," Social Science & Medicine, Elsevier, vol. 281(C).
    • Handle: RePEc:eee:socmed:v:281:y:2021:i:c:s0277953621004019
    DOI: 10.1016/j.socscimed.2021.114069
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    Cited by:

    1. Connolly, Sheelah & Brick, Aoife & O'Neill, Ciarán & O'Callaghan, Michael, 2022. "An analysis of the primary care systems of Ireland and Northern Ireland," Research Series, Economic and Social Research Institute (ESRI), number RS137.
    2. Walsh, Brendan & Mac Domhnaill, Ciarán & Mohan, Gretta, 2021. "Developments in healthcare information systems in Ireland and internationally," Research Series, Economic and Social Research Institute (ESRI), number SUSTAT105.
    3. Claire Keane & Karina Doorley & Theano Kakoulidou & Seamus O’Malley, 2023. "SWITCH: A Tax-Benefit Model for Ireland Linked to Survey and Register Data," International Journal of Microsimulation, International Microsimulation Association, vol. 16(1), pages 65-88.
    4. Keane, Claire & Doolan, Claire, 2023. "Cliff edges in the Irish Tax-Benefit system," Papers BP2024/1, Economic and Social Research Institute (ESRI).
    5. Diego Muñoz-Higueras & Stephan Köppe & Rafael Granell & Amadeo Fuenmayor, 2024. "Non-take-up of in-work benefits: determinants, benefit erosion and indexing," Journal for Labour Market Research, Springer;Institute for Employment Research/ Institut für Arbeitsmarkt- und Berufsforschung (IAB), vol. 58(1), pages 1-19, December.
    6. Walsh, Brendan & Keegan, Conor & Brick, Aoife & Connolly, Sheelah & Bergin, Adele & Wren, Maev-Ann & Lyons, Seán & Hill, Leonie & Smith, Samantha, 2021. "Projections of expenditure for primary, community and long-term care Ireland, 2019–2035, based on the Hippocrates model," Research Series, Economic and Social Research Institute (ESRI), number RS126.
    7. Keane, Claire & Seán Lyons & Mark Regan & Walsh, Brendan, 2022. "Home support services in Ireland: Exchequer and distributional impacts of funding options," Research Series, Economic and Social Research Institute (ESRI), number SUSTAT111.

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