REFORMING THE DELIVERY OF PUBLIC DENTAL SERVICES IN IRELAND: POTENTIAL COST IMPLICATIONS. ESRI RESEARCH SERIES NUMBER 80 APRIL 2019

This report details the results of an analysis of the potential cost implications of proposed changes to aspects of the model of delivery of publicly-financed dental services in Ireland, as set out in the new National Oral Health Policy (Department of Health, 2018b). Currently, dental services in Ireland are financed and delivered in a mixed public-private system, with most individuals paying out-of-pocket fees to independent dental practitioners. The public system currently finances the delivery of dental healthcare services to adult medical cardholders via the Dental Treatment Services Scheme (DTSS); to non-medical cardholder eligible adults via the Treatment Benefit Scheme (TBS); and to children and adults requiring special and complex care via the Public Dental Service (PDS). This report deals with proposed changes to the delivery of preventive dental healthcare services under the DTSS and PDS

Work at Older Age in Ireland. ESRI Research Bulletin 2019/16

It is well established that population ageing will put upward pressure on the costs of public programmes such as pensions, healthcare and long-term care. One proposed route through which the sustainability of these public programmes can be enhanced is through extended working lives. In 2016 in Ireland nearly 17 per cent of men aged 65+ were working, and 5 per cent of women. A notable feature of older age working in Ireland and other countries is the large share of employment, particularly male employment, that is comprised of the self-employed (over half of men aged 65-74 in employment in Ireland are self-employed). The decision to continue to work in older age involves a complex interaction between health, family and caring responsibilities, and financial resources. Here, we summarise the findings of two recent papers that examined the role of financial resources, and in particular, supplementary pension cover, in determining work at older ages in Ireland

Car Ownership and Mode of Transport to Work in Ireland

Rapid economic and demographic change in Ireland over the last decade, with associated increases in car dependence and congestion, has focused policy on encouraging more sustainable forms of travel. In this context, knowledge of current travel patterns and their determinants is crucial. In this paper, we extend earlier Irish research to examine the joint decision of car ownership and mode of transport to work. We employ cross-section micro-data from the 2006 Census of Population to estimate discrete choice models of car ownership and commuting mode choice for four sub-samples of the Irish population, based on residential location. Empirical results suggest that travel and supply-side characteristics such as travel time, costs, work location and public transport availability, as well as demographic and socio-economic characteristics such as age and household composition have significant effects on these decisions.

GP Reimbursement and Visiting Behaviour in Ireland

In Ireland, approximately 30 per cent of the population (“medical cardholders”) receive free GP services while the remainder (“non-medical cardholders”) must pay for each visit. In 1989, the manner in which GPs were reimbursed by the State for their medical cardholder patients was changed from fee-for-service to capitation while other patients continued to pay on a fee-for-service basis. Concerns about supplier-induced demand were in part responsible for this policy change. The purpose of this paper is to examine the extent to which the utilisation of GP services is influenced by the reimbursement system facing GPs, by comparing visiting rates for the two groups before and after this change. Using a difference-in-differences approach on pooled micro-data from 1987, 1995 and 2000, we find that medical card eligibility exerts a consistently positive and significant effect on the utilisation of GP services. However, the differential in visiting rates between medical cardholders and others did not narrow between 1987 and 1995 or 2000, as might have been anticipated if supplier-induced demand played a major role prior to the change in reimbursement system.GP Utilisation; Reimbursement; Supplier-Induced Demand; Difference-in-Differences

A Panel Data Analysis Of The Utilisation Of GP Services In Ireland: 1995-2001. ESRI Working Paper No. 13, n.d.

The extent to which the cost of obtaining health care influences the utilisation of GP and other health services is a frequently analysed topic. A key issue concerns the extent to which access to private health insurance and/or eligibility for free public health services results in differences in utilisation that cannot be explained by differences in need factors such as age, gender or health status. Ireland is an interesting case study in this regard as only 30 per cent of the population are eligible for free GP consultations; the remainder of the population must pay the full price. Using panel data from 1995 to 2001 on GP visits in Ireland, this paper applies a random effects approach to count data in an attempt to determine the factors influencing GP visiting patterns, with a particular focus on the role of eligibility for free public health services

The Role of Self-Employment in Ireland’s Older Workforce. ESRI DISCUSSION PAPER SERIES IZA DP No. 11663, July 2018

A feature of employment at older ages that has been observed in many countries, including Ireland, is the higher share of self-employment among older labour force participants. This pattern of higher self-employment rates at the end of the labour market career may reflect lower rates of retirement among the self-employed compared to employees, as well as transitions into self-employment at older ages. In this paper, we use data from four waves of the Irish Longitudinal Study on Ageing (TILDA), spanning the period 2010-2016, to examine both the characteristics of the older self-employed in Ireland and the determinants of transitions in employment states at older age. We find that the higher proportion of self-employed people at older ages in Ireland results from lower retirement rates among the self-employed and not from transitions from employment to self-employment. This is in contrast to other countries such as the US where transitions into self-employment are more prevalent. We find that the self-employed are older, more likely to be male, and significantly less likely to have any form of supplementary pension cover than the employed. These lower retirement rates and lower degrees of pension cover suggest that standard approaches to pension provision may be less effective in proving attractive to the self-employed in Ireland

Financial Literacy and Preparation for Retirement. ESRI DISCUSSION PAPER SERIES IZA DP No. 12187, February 2019

The economic and financial landscape facing individuals as they move through their life-cycle is becoming increasing complex. Internationally, declines in the coverage and generosity of public programmes mean that individuals now need to assume responsibility for a greater share of their future retirement saving and health and long-term care costs. Financial literacy, defined as knowledge of fundamental financial concepts and the ability to do simple financial calculations, is a key skill required to ensure adequate financial protection in older age. In this paper, we investigate the extent to which financial literacy is an important determinant of financial protection in the older pre-retirement population in Ireland. Using data from the Irish Longitudinal Study on Ageing (TILDA), we find significantly higher levels of financial literacy among men, those with higher levels of education and cognition, and the self-employed. Financial literacy is in turn associated with higher total household wealth, lower financial stress and higher expected retirement income. We find little evidence that those with higher levels of financial literacy are more likely to have various forms of supplementary pension cover however, which may reflect a limited role for financial literacy over and above other important determinants such as income and education

Working Beyond 65 in Ireland. ESRI DISCUSSION PAPER SERIES IZA DP No. 11664, July 2018

Extending working lives is often proposed as one route through which the costs associated with population ageing can be managed. In that context, understanding who currently works for longer can help policymakers to design policies to facilitate longer working. In particular, it is important to know if longer working is a choice or a necessity, where necessity arises from a lack of pension income. In this paper, we use data from the first four waves of the Irish Longitudinal Study of Ageing (TILDA), covering the period 2010-2016, to examine patterns of labour force participation among men and women aged 65+. We find that a lack of pension income is an important determinant of later-life working and that this applies for both men and women. Although older women are significantly less likely to work than older men, we find few differences in the pattern of determinants of longer working among older men and women. However, while women are significantly less likely to work than men, this effect is stronger among married women compared to single women. This suggests that older women without immediate access to family-provided financial support may need to work to support themselves. This adds to the picture of later life work being a necessity as opposed to a choice. However, an alternative explanation is that older married women may also have caring responsibilities that reduce their labour force participation

The determinants of mode of transport to work in the Greater Dublin Area

Rapid economic and demographic change in the Greater Dublin Area over the last decade, with associated increases in car dependence and congestion, has focused policy on encouraging more sustainable forms of travel. In this context, knowledge of current travel patterns and their determinants is crucial. Here we concentrate on travel for a specific journey purpose, namely the journey to work. We employ cross-section micro-data from the 2006 Census of Population to analyse the influence of travel and supply-side characteristics, as well as demographic and socio-economic characteristics on the choice of mode of transport to work in the Greater Dublin Area

Income-related inequity in the use of GP services: A comparison of Ireland and Scotland

Equity of access to health care is a key component of national and international health policy. The Irish health-care system is unusual in requiring the majority of the population to pay the full cost of GP care at the point of use. In contrast, all Scottish residents are entitled to free GP care at the point of use. Using nationally representative micro-data on Irish and Scottish children, we find that the distribution of GP care in Ireland favours those on lower incomes (i.e., 'pro-poor'), but that there is no significant difference in the distribution of GP care across income groups in Scotland. Focusing just on children who pay for GP care in Ireland, we find some evidence for a significant 'pro-rich' distribution of GP visits