Eilish O'Regan: 'The biggest losers in our two-tier health system may not always be the poorest on the lowest incomes'
You can be bottom of the health pile and not necessarily the poorest.
Many people who are squeezed out of eligibility for a medical card but do not have the funds to pay for private health insurance may fit that description.
We already know the rich-poor divide means the lower socio-economic groups get sicker and can die earlier. But within that health gap are thousands who cannot afford to go to their GP or pay for medicines.
If they get sick they will be on a public waiting list.
It's near the end of 2018 now and back in 2011 we were told the most harmful effects of our two-tier health system would be fixed at this stage.
Instead, health analysts will gather in Dublin today to discuss a report by TASC, the Think-tank for Action on Social Change, and FEPS, the Foundation for European Progressive Studies.
Sláintecare, the latest Government blueprint for a form of universal healthcare, is just in its infancy and is already under-funded.
The authors of today's report refer to those who do not have a medical card or private health insurance as being in a "twilight zone".
Health Minister Simon Harris (inset) will point to the relaxation in income rules for GP visit cards which should benefit around 100,000 next year. It is a welcome but small step. If we believed the promises seven years ago, we should all have free GP care now.
The authors of the report point to countries in Europe such as France where the population is insured and there is no discrimination on accessing vital health services.
They also point to the adverse health consequences which cause people to have worse self-reported health and more physical and mental health problems.
As a nation, we must also take more responsibility for our bad habits and lifestyles.
We need to tackle the ticking time bomb that is the rising prevalence of chronic diseases that can be prevented, such as diabetes.