Overall, the health of the Irish population has improved substantially during recent decades and is quite good compared with other OECD countries. However, spending is elevated, partly reflecting a system that is strongly based on hospitals. Population ageing is exacerbating spending pressures. In addition, the health sector is dealing with past underspending, particularly in capital outlays in the years following the global financial crisis, that have constrained service delivery, contributing to substantial waiting lists and heavy pressure on staff. The government has initiated wide-ranging reforms, termed Sláintecare, with the aim of broadening the coverage of universal care, decentralising provision and enhancing the integration of primary, community and hospital care. The reforms are complicated, reflecting a healthcare system that is complex and at times opaque. This is particularly the case with the interaction of the public and private parts of the system in which private patients enjoy easier access to care, leading to concerns about a two-tier healthcare system. The creation of new regional health areas is set to support more decentralised decision-making, but information systems to track spending and reform implementation need an overhaul. The COVID-19 pandemic has diverted policy-making attention just as the reforms got underway, but stepping up the efforts to address legacy issues and move forward on the reforms is now key to meet the coming challenges while using resources effectively.