Barriers and Facilitators to National UHC Health Reform Implementation: A Qualitative Case Study of Sláintecare in Ireland

Farsaci, Liz; Guy, Mary; Thomas, Steve

Barriers and Facilitators to National UHC Health Reform Implementation: A Qualitative Case Study of Sláintecare in Ireland

Articles in Press

Document Type : Original Article

Authors

Liz Farsaci ¹

Mary Guy ²

Steve Thomas ²

¹ School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland

² Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland

Abstract

Background
While universal health coverage (UHC) is at the fore of contemporary international health system discourses, its introduction often necessitates far-reaching reforms and countries face a number of challenges to implementation. Ireland is one country that has introduced a national health reform policy, Sláintecare, which aims to achieve UHC. The purpose of this paper is to examine the case study of Ireland, utilising findings from our realist review on international reform implementation as a conceptual framework, thus deepening our understanding of the barriers and facilitators to implementation.

Methods
This paper examines the case study of health reform implementation in Ireland, drawing on qualitative data collected through semi-structured elite interviews with 16 senior Irish health system leaders, healthcare workers, political advisors, union representatives, and private sector stakeholders. Following ethical approval, interviews took place from July 2024-April 2025. With our realist review providing an analytic framework, NVivo 12 qualitative analysis software was used to conduct thematic analysis, deductively in the first instance using a predetermined coding tree and then inductively based on emerging themes.

Results
Participants highlighted a number of factors that acted as barriers or facilitators to implementation. Barriers included a lack of capacity and infrastructure, challenges around financing and a lack of clarity around universalism and universal healthcare. Additional barriers included a lack of public engagement with Sláintecare as well as challenges around priority setting. Meanwhile, political commitment, as well as a programmatic approach, facilitated reform implementation, while the COVID-19 pandemic both stymied and enabled reforms.

Conclusion
Through using this framework to test the Irish experience, the authors provide further evidence regarding the barriers and facilitators to implementation of UHC, adding to the international discourse and work being done on these important reforms. These learnings have implications for workforce capacity development, digital health infrastructure and health financing, amongst other policies.

Keywords

Universal Health Coverage

UHC

Health Reform

Health Policy

Ireland

Slá

intecare

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