The Irish healthcare system is a tax payer system providing access to hospital services free of charge. However means tested charges may apply resulting in 30 per cent of the population having free access. All public hospitals – 48 in total, organized into seven different groups – are principally funded by the state. Since 2016, the traditional block grant – based payments has been partially replaced by activity-based funding. Payment in the private sector is exclusively by way of ‘fee-per-item’. Hospital consultants are entitled to carry out private practice in the public hospital up to a limit of 20–30 per cent of their total work. Around 46 per cent of the population have private health insurance, facilitating earlier access to services. Current proposals for systemic reforms aim to reduce access inequalities and envisage a shift from hospital-centric to primary and social care settings.