Ireland is ranked poorly in terms of waiting lists and waiting times in Emergency Departments, under the latest European Health Consumer Index.

The report for 2016, published today, looks at 35 countries and ranks them against various criteria.

Ireland is in 21st place out of the 35 countries examined, leaving it in the same position as in 2015.

The report says that the Irish target (at the time) of having no more than an 18-month wait for a specialist appointment, would still be "the worst waiting time in Europe".

Ireland is ranked as having poor emergency department waiting times along with six other countries - the UK, Sweden, Poland, Italy, Slovakia and Greece.

It also ranks poorly in terms of the right to a second opinion, access to online booking of appointments, direct access to a consultant, getting a planned operation within 90 days and the equity of the health system.

Ireland ranks well in terms of the decrease in cardiovascular disease deaths, decrease in deaths from strokes, infant deaths and better cancer survival.

It also scores well with regard to access to medicines.

In its response to the report, the HSE said there are ongoing and significant management challenges to balance demands and needs.

It said the health service continues to deliver its services in an environment where the population is growing, the number of people seeking to access services is higher than ever before and where public expectations for quality services continue to increase.

The HSE said that although the overall length of time people spend on waiting lists has improved in recent years, the total numbers waiting, and the numbers waiting in excess of four months for out-patient assessment and in-patient treatment, are unacceptably and unsustainably high.

It is working to ensure that no one is waiting more than 18 months for an out-patient appointment or inpatient treatment.

The HSE said that since 2014, the Health Consumer Powerhouse decided to use patient organisation feedback only to score Ireland on accessibility (waiting times) which resulted in Ireland's ranking dropping from 14 in 2013.

It has outlined its dissatisfaction that official data has been excluded by HCP.

While the HSE accepts that it has challenges in relation to data, primarily due to the lack of investment during the recession years, the Irish health system has been late introducing technology which has inhibited the ability to properly track an individual's interaction with the health service.

It said that through the eHealth project, including the Individual Health Identifier (IHI) and eReferral which is currently being rolled out, these initiatives will allow the collection of more reliable data on a patient's journey through the health system which in turn can factually inform reports such as the EHCI.

The report says that the publicly-funded health systems of Europe have steadily improved, however the performance gap between old and newer EU members remains.

The top place is held by The Netherlands, ahead of Switzerland and then Norway.

The worst ranked country is Romania.

The EHCI benchmarking reports have been published by the private Swedish firm since 2005.

The report says that The Netherlands seems to be driving home the big, final nail in the coffin of 'Beveridge' healthcare systems - those financed through general taxation, versus social insurance systems (known as Bismarck).

It says the lesson is clear - remove politicians and other 'amateurs' from operative decision-making, in what might be the most complex industry on earth.

It finds that Beveridge systems seem to be operational with good results only in small population countries like Iceland, Denmark and Norway.

It suggests that copying the most successful health systems would save European lives and money.

The report says that Ireland, the UK and Sweden had the worst patient organisation feedback on accessibility among the 35 countries.

It also says there are doubts about the validity of official statistics in Ireland.

After several years of accepting official Irish waiting time statistics, the EHCI 2016 says it has scored Ireland on patients' versions of waiting times.

It says the fact that Ireland had the highest percentage of the population purchasing duplicate healthcare insurance, also presents a problem.

The report asks if this should be regarded as an extreme case of dissatisfaction with the public system, or simply as a technical solution for progressive taxation.

In its examination of 'Bang for Buck', Ireland scores poorly, just ahead of Greece, Hungary, Bulgaria and Romania.

However, the report says this should be regarded as somewhat of an academic exercise, given the method used.

On abortion, it says that the requirement that a woman wishing to have an abortion becomes subject to judgement on if the pregnancy should be regarded as a serious health hazard, including suicide risk, is "a very minor step" towards abortion as a woman's right.

It emphasises that the overall country results should be treated with caution, as there are information quality problems, not least due to a shortage of pan-European, uniform procedures for data gathering.