Beyond financial constraints: The politics of Irish health system reform in the aftermath of the great recession

Abstract

This article investigates the main factors influencing the success of welfare reforms in the context of crises. It focuses on the healthcare reform plan proposed in Ireland in the aftermath of the Great Recession, which aimed at the establishment of a universal health system but was only very partially implemented. As the plan would have required an increase in public expenditure, it may be expected that cost concerns explain the overall reform outcome in the context of an economic crisis. However, analysis of the process leading to the abandonment of a central element of the plan and the partial introduction of another component shows that, apart from financial concerns, the outcome is explained by three politicoinstitutional factors: the political orientation of the parties in government; electoral (dis)incentives in pursuing different elements of the reform; and the extent of institutional change associated with them.