Republic of Ireland
Considering its shared land border with the UK, the Republic of Ireland has a strikingly dissimilar healthcare system and structure to Britain's NHS. The new Irish NHS (as it is known) was launched at the start of 2005, as a result of the Health Act 2004, and is controlled by the Health Service Executive (HSE).
While state-subsidised healthcare is universal, it is subsidised in two tiers. Waged citizens earning below a certain threshold, currently about 200 euros a week (£177), are entitled to a medical card from the HSE. This allows the holder to receive many health services, including GP visits, free of charge. Generally, a dependent spouse or partner and/or children are also entitled to receive free services, and British citizens with a free Ehic card receive the same benefits as an HSE medical card holder.
Funding for healthcare in Ireland is made through a Universal Social Charge, normally deducted from wages at 2% for the first 10,000 euros a year, 4% on the next 6,000 euros and 7% above that.
Hospital stays cost 100 euros per night, capped at 1,000 euros each year, with A&E visits charged at 100 to 120 euros a time, although GP referrals to emergency departments are normally given rebates of between 25% and 50%. Maternity care is free, up to the point where baby reaches six months of age.
GP visits are subsidised, but chargeable at the point of care, typically 60 euros per visit. There is a GP visit card system, with income limits of around 300 euro a week, and which offers free GP treatment. Prescriptions are 50% subsidised, subject to a complex means-tested (sliding scale) monthly cap per family.
Most Irish hospitals are HSE-run, although there are some voluntary units with hybrid state/charitable funding. As in the UK, there is a booming private healthcare market with a number of private hospitals - mostly because insured patients are usually reimbursed with HSE co-payment (excess) fees. Outside of cities, most GP/hospital out-patient services are offered by health centres, which have a much greater importance than in the UK.
United States of America
While most American hospitals are privately-run, around 70% are non-profit or charitable. There are many federal, state, county and city-run hospital campuses. There are many speciality state-wide hospitals, such as 'surgicentres' and hospices for the terminally ill.
Many maternity services are government-run, and there is increasing use of nurse practitioners – this appears to be due to cost savings, although patient reaction to nurse practitioners is also highly favourable.
Co-ordination in US hospitals is very limited for commercial reasons. Fierce competition helps to keep prices down in city areas, with self-pay fixed-price healthcare deals common.
The situation with US healthcare insurance is famously messy. Approaching 85% of citizens have health insurance – in other words, 15% do not. However, around half of this 15% are covered by government programmes for the elderly, disabled people, children, military veterans and some poor people in special needs categories. But even with insurance, many citizens have to pay $1,000 (£610) or even $5,000 excesses.
Government programmes are many and varied, depending on individual state. Although the elderly and disabled are generally covered under the national Medicare scheme, with low income citizens are covered by the parallel Medicaid plan. Other programmes include state Children's Health Insurance Program (CHIP) and Tricare for military personnel (outside of military bases).
Most insurance schemes require pre-approval for treatment, as do most government programs. Even then, a hefty deposit is often required. Repeated claims can often result in hikes in excesses or even expulsion from insurance schemes.
A 2001 study in five US states revealed that medical debt contributed to 46% of bankruptcies, and by 2007 this had reached 62%. The USA has highest infant mortality rate amongst industrialised nations, according to the World Health Organisation, and life expectancy is 42nd in the world, after Chile and Cuba.