A report has warned that people with incomes just above the medical card threshold are left in a "twilight zone" with poorer health outcomes.

It's among the findings of a Europe-wide report on healthcare published by the think tank TASC.

The report highlights potentially high levels of inequality in the 'two-tier' Irish healthcare system - noting that Ireland remains the only western European country to not have universal health coverage of primary care.

It found that people Ireland had the best self-reported health in the EU.

However, the study says Irish people in higher income groups were 21% more likely to have good health compared to those in lower income groups.

Around 45% of Irish people have private health insurance, and the report suggests they continue to enjoy "favourable conditions... even from public providers" such as faster access to hospital treatments.

It compares Ireland to France, where the authors of the report say almost everybody has access to private insurance - which reduces the 'discriminatory impact' when accessing key services. 

Shana Cohen, the director of TASC, said: “What this report makes very clear is that people with private health insurance in Ireland have a much better chance of getting the health services they need, and getting them quickly.  

"So, where you are in the job market would seem to have a significant impact on your wellbeing and health outcomes.”

Róisín Shortall is chair of the Oireachtas committee on the future of healthcare.

She says the fact that the majority of people have to pay €55-60 before they can see a GP is unheard of in most EU countries.

She observed: "At the most basic level, that restricts access to healthcare.

"If somebody is really strapped for cash, if they're struggling to meet ends meet, and they have some symptom of an illness brewing... they're far less likely to attend a GP to have that checked out at an early stage. They'll put that off because of the financial barrier."