The More Private Patients, the Fewer Public Patients? Evaluating the 2014 Hospitals Reform in Ireland

Background This study evaluates the 2014 hospital reform in Ireland, which allowed public hospitals to accommodate private patients in public wards. There were widespread concerns that this reform might incentivise public consultants to prioritise private patients over public ones. However, what was overlooked by the general public is that consultants are bound by contract terms: for every treated private patient, they must treat an additional three to four public patients. Methods We utilise nationwide administrative hospital inpatient discharge record data from 2009 to 2015, with 2,323,600 observations. We employ a difference-in-differences method to empirically evaluate the impacts of the 2014 reform on hospital admissions, the ratio of private patients, patients’ length of stay, and mortality rate. Findings Contrary to the concerns expressed by the general public and media, we do not find evidence that more proportion of private patients were treated. Actually, we demonstrate that the reform positively impacted public patients by increasing their admission rates and improving treatment efficiency. Additionally, these benefits did not come at the expense of their quality of care.