It’s the economy, stupid! When economics and politics override health policy goals – the case of tax reliefs to build private hospitals in Ireland in the early 2000s [version 2; referees: 2 approved]

Objectives: To analyse the policy process that led to changes to the Finance Acts in 2001 and 2002 that gave tax-reliefs to build private hospitals in Ireland.

Methods: Qualitative research methods of documentary analysis and in-depth semi-structured interviews with elites involved in the policy processes, were used and examined through a conceptual framework devised for this research.

Results: This research found a highly politicised and personalised policy making process where policy entrepreneurs, namely private sector interests, had significant impact on the policy process. Effective private sector lobbying encouraged the Minister of Finance to introduce the tax-reliefs for building private hospitals despite advice against this policy measure from his own officials, officials in the Department of Health and the health minister. The Finance Acts in 2001 and 2002 introduced tax-reliefs for building private hospitals, without any public or political scrutiny or consensus.

Conclusion: The changes to the Finance Acts to give tax-reliefs to build private hospitals in 2001 and private for-profit hospitals 2002 is an example of a closed, personalised policy making process. It is an example of a politically imposed policy by the finance minister, where economic policy goals overrode health policy goals. The documentary analysis and elite interviews examined through a conceptual framework enabled an in-depth analysis of this specific policy making process. These methods and the framework may be useful to other policy making analyses.