Equity in the Utilisation of Hospital Inpatient Services in Ireland? An Improved Approach to the Measurement of Health Need

The complex interweaving of public and private provision in Irish hospitals has led to concerns that hospital care is not available to all on the basis of need alone. Previous research on Irish hospitals found that utilisation was neutral across the income distribution controlling for health status – i.e., there was essentially equal treatment for equal need irrespective of income. However, the health indicator used in these analyses may not consistently measure health status across income groups. In this paper we combine multiple indicators into a composite "Ill Health Index" and find that the measure used for standardisation has important consequences.

SPORTING LIVES: AN ANALYSIS OF A LIFETIME OF IRISH SPORT. RESEARCH SERIES NUMBER 2 APRIL 2008

This report analyses participation in sport over the lifetimes of the current generation of Irish adults. It reveals strong trends. Compared with older generations, current young adults played more sport as children and are continuing to play more as adults. The mix of sports people play is changing too, with particularly strong increases in individual sports and exercise activities (swimming, gym, jogging etc.) relative to traditional team sports. In particular, Gaelic games are in relative decline – participation is merely steady, while for most other sports it is growing substantially. Looking at participation right across the lifespan also sheds light on the gender and socio-economic gaps in participation. Given similar childhood experience, men and women are as likely to take up or drop out from sport as adults. The gender gap has its roots in childhood, where boys play much more sport from a very young age. Contrastingly, the socio-economic gap also starts young but continues to widen in adulthood. Those of lower educational attainment and income are more likely to drop out and less likely to take up new sports. These differences matter, as the analysis shows that health benefits accrue to those who play sport and to a significant degree are retained by those who used to play but no longer do. Overall, the strong trends identified suggest that sports policy needs to adapt if it is keep up with the changes occurring in grassroots Irish sport

Unemployment, Welfare Benefits and the Financial Incentive to Work

Although disincentive effects associated with payments have been regulaly found in research in the US and UK, the UK research is disputed and effects have been notable by their absence in studies from Continental Europe. However, much of this research has been hindered by inadequate models of the structure of payments and estimates of in work incomes. In this paper we explicitly model the structue of benefit payments over time and estimate in work income using the SWITCH tax/benefit model. We find that the hazard of exit from unemployment is negatively related to unemployment payments, but distinctive effects appear to influence only those receiving Unemployment Benefts (UB) and are small when compared internationally. Moreover, the exit rate increases for this group as exhaustion approaches at 15 months duration. We find no significant distinctive effects amongst those receiving Unemployment Assistance (UA).

Did the Celtic Tiger Decrease Socio-Economic Differentials in Perinatal Mortality in Ireland?

Irish perinatal mortality rates have been falling steadily for a number of decades but evidence from the 1980s showed pronounced differentials in mortality rates across socio-economic groups. Between 1995 and 2006 Irish gross national product increased from 60 per cent of the EU average to 110 per cent. Real incomes increased across the income distribution during this period but income inequality between the top and bottom income deciles increased marginally. This paper examines whether socio-economic differentials in Irish perinatal mortality rates changed between the 1980s and 2000s. This task is complicated by demographic change in Ireland since the 1980s and its interaction with the birth registration process. Overall perinatal mortality rates have fallen from 14 per 1,000 in 1984 to 7 per 1,000 in 2006. Without adjusting for demographic change, differentials between professional and unskilled/unemployed groups have decreased from 1.99 to 1.79. Adjusted estimates suggest the real differential has decreased to 1.88.

Equity in the Utilisation of Health Care in Ireland

This paper analyses the extent of equity of health service delivery across the income distribution in Ireland – that is the extent to which there is equal treatment for equal need irrespective of income. We find that almost all services, apart from dental and optician services, are used more by those at the lower end of the income distribution, but that this group also have the greatest need for health care. The comparison of health need to health care delivery across the income distribution without standardising for confounding factors suggests that those in higher income groups receive more health care for a given health status indicating inequity. However, need for health care is highest among the elderly and this group also tend to be at the bottom of the income distribution. Once we standardise for age, sex and location we find that hospital services are distributed equitably across the income distribution, whereas GP and prescription services tend to be pro-poor (used more by those with lower incomes for a given health status) and dental and optician services tend to be pro-rich (used more by those with higher incomes for a given health status).

Economic Boom and Social Mobility: The Irish Experience

In this paper we examine the consequences for social mobility patterns of the unprecedented period of economic growth experienced in Ireland over the 1990s and the implications of developments for current theories of social fluidity. Contrary to suggestions that the ?Celtic Tiger? experience has been associated with a deepening problem of marginalization we found evidence for a substantial upgrading of the class structure and increased levels of social mobility. We also found evidence for increased social fluidity in relation to long-range hierarchical mobility. Such increased openness could not be explained by changes in the manner in which education mediates the relationship between origins and destinations. There is no necessary relationship between economic growth and social fluidity. However, the pattern of change over time in the Irish case suggests that both long-term factors associated with the upgrading of the class structure and short-term factors reflected in the unprecedented tightness of the labour market have produced a situation where employers have increasingly applied criteria other than education in a manner that has facilitated increased social fluidity. The Irish case provides further support to the argument for reconsidering the balance that mobility research has struck between social fluidity and absolute mobility and encouraging increased attention to the evolution of firms and jobs. It also provides support for the conclusion, that in circumstances where policies in advanced industrial societies have shown an increasing tendency to diverge, increased social fluidity may come about as a consequence of very different economic and social policies.

COPING WITH POPULATION CHANGE IN IRELAND: THE IMPLICATIONS FOR HEALTHCARE. ESRI Research Bulletin 2009/4/3

Health and health care are particularly sensitive to the size and make-up of the population. As in most other affluent nations, life expectancy in Ireland has been increasing strongly in recent decades. This is to be celebrated and attests to real improvements in Irish society. Nonetheless, older people require both more health care, on average, than younger people and a different combination of services. Population ageing is not the only demographic challenge we face however. Relatively high numbers of births and recent inward migration have led to a larger population, and in combination with increased life expectancy, will lead to further increases in population in the future. This will exert increasing pressure on Irish health care resources. Effective planning for the consequences of these trends will be crucial in determining how successful we are in coping with the associated challenges

A GOOD NEWS STORY ABOUT IRISH HEALTH CARE. ESRI Research Bulletin 2010/4/1

Life expectancy for older people in Ireland has been increasing steadily since the 1980s. Despite this, Irish life expectancies for the over 65s lagged seriously behind the EU average as recently as the mid 1990s. But Irish death rates for the over 65s dropped dramatically between 2000 and 2005, moving Ireland closer to the European average. Whereas between 1996 and 1999 death rates (from all causes) in Ireland had fallen by just over 5%, between 2000 and 2004 the decrease was over 26%. What lies behind this rare and welcome good news story? An article** by researchers from the ESRI and the Department of Pharmacology and Therapeutics at Trinity College Dublin sets out the background to this sharp fall in death rates, and examines how the greater use of effective drug therapies contributed to this result

Temporary Jobs in Ireland: Does Class Influence Job Quality?

Fixed term and casual employment have become increasingly common in OECD countries in the last decade. Research suggests that non-permanent contracts are associated with lower job quality. This paper examines differentials in three indicators of job quality in Ireland: hourly wage, probability of training and level of autonomy. The paper also examines four hypotheses on job quality derived from transaction cost and insider-outsider theories which suggest an important interaction between social class position, non-permanent employment and job quality. Results show that fixed term and casual contracts are associated with lower earnings, less training and lower autonomy.