Baseline utilisation of specialist disability services in Ireland. ESRI Working Paper No.644 December 2019

The objective of this paper is to analyse the data on specialist disability services available in Ireland. The paper provides a baseline utilisation profile of selected services which can be used to project future service demand and expenditure. The limitations of the currently available data in providing a comprehensive picture of specialist disability services in Ireland are also outlined

Unmet healthcare needs in Ireland. ESRI Research Bulletin 2016/06

Relatively high user charges for GP consultations (for those without a medical/GP visit card) and long waits for public hospital services can act as barriers to accessing needed care in Ireland. However, there has been relatively little research on unmet healthcare needs in Ireland. In 2014, approximately 38 per cent of the population had a medical card, while 3.5 per cent had a GP visit card. Cardholders are eligible for GP care without fees and there has been previous evidence that non-cardholders may not visit a GP because of cost (O’Reilly et al. 2007). Approximately 42 per cent of the population hold private health insurance, which is mainly used to provide cover for private or semi-private acute hospital services, thereby avoiding potentially long waits for public hospital services. While those with a medical card can purchase private health insurance, the numbers doing so are relatively small. There is also a group of people without private health insurance and/or a medical card. This paper examines how these differing levels of cover for medical care may affect the experience of unmet need for care in Ireland

BUDGET PERSPECTIVES 2017, PAPER 1. Challenges in Achieving Universal Healthcare in Ireland. June 2016

The World Health Organization has advocated universal healthcare as the best means of improving global health. However achieving universal healthcare is not without challenges: from defining the goal of universal healthcare to identifying the most appropriate methods to achieve it. Ireland is unique in the EU in not having universal coverage of primary care. In 2011, a newly-elected government committed to the development of a universal, single-tier health service, to be financed by a new system of Universal Health Insurance (UHI) provided by multiple, competing private insurers. A White Paper published in 2014 outlined the proposed UHI model. However, in 2015 in response to publication of a study of the potential cost implications of the proposed UHI model, the Government abandoned this model

How does Irish Healthcare Expenditure compare internationally? ESRI Research Series 114 October 2020.

The ESRI research report ‘How does Irish Healthcare Expenditure compare internationally?’ examines how Irish Healthcare Expenditure (HCE) compares to expenditure in other countries. Using international OECD data for 2017, this study finds that how Irish HCE compares differs depending on the expenditure measure used, the service examined and whether the comparison is adjusted for countries’ differing approaches to accounting for Social Care Expenditure

An examination of activity in public and private hospitals in Ireland, 2015. ESRI WP601, October 2018

This analysis examines the extent to which activity in public hospitals is privately financed and provides an overview of service delivery across public and private hospitals in Ireland in 2015. This analysis was conducted in light of a Sláintecare proposal to remove private practice from public hospitals and the establishment of an Independent Review group to examine this proposal in detail. Overall we find that just under 16 per cent of cases were privately financed in public hospitals in 2015. Across public and private hospitals, fewer than one-in-four private day patient episodes were estimated to have taken place in public hospitals. In comparison, over 50 per cent of private in-patient bed days were recorded in public hospitals. These findings suggest that the private hospital system appears to have primarily specialised in the delivery of elective care. It is unclear therefore whether the majority of private inpatients in public hospitals, who are emergency in-patients, could access the care they may require in private hospitals. It is acknowledged that a barrier to more detailed comparative analysis is the lack of a centralised administrative system to collect private hospital activity data

Utilisation of specialist disability services in Ireland - Baseline analysis for the Hippocrates model. ESRI Survey and Statistical Report Series 89 June 2020.

This report analyses available data on specialist disability services in Ireland to establish a baseline for inclusion in the Hippocrates Model of Healthcare Demand and Expenditure

Insurance status and waiting times for hospital-based services in Ireland. ESRI Research Bulletin 202021 September 2020.

The aim of this paper is to analyse waiting times in Ireland for hospital services for patients with and without private health insurance and to examine whether the 2008 reform reduced the differential in waiting

Covid-19 in the community and outbreaks in long-term residential care in Ireland

Context: Long-term residential care (LTRC) has been disproportionately impacted by Covid-19, with two-thirds of Covid-19 deaths occurring in LTRC homes in Ireland. Objectives: The study aims to examine the factors associated with LTRC Covid-19 outbreaks in Ireland. Methods: We merged data on Covid-19 cases and deaths in the community and LTRC homes with LTRC home characteristics across Waves 1-3 of the pandemic. Analyses examined the impact LTRC home characteristics and proximity to high community Covid-19 rates had on the likelihood of Covid-19 outbreaks and severity of outbreaks in LTRC homes. Findings: 8,502 confirmed cases of Covid-19 among LTRC home residents were recorded. Two thirds of LTRC homes had a Covid-19 outbreak across the first three waves of the pandemic. Larger LTRC homes were three times more likely to have an outbreak than smaller homes. High local community Covid-19 rates significantly increased the probability of a LTRC home outbreak. Homes in areas with the highest community Covid-19 rates were almost seven times more likely to have an outbreak than LTRC homes located in areas with the lowest community Covid-19 rates. Limitations: No centralised dataset exists in Ireland that collects information on morbidity, dementia or cognitive status of had on residents. Implications: Covid-19 had a significant impact on LTRC in Ireland with very high rates of cases and deaths. Our findings suggest that while factors such as home size may have increased the probability of an outbreak, being located in areas with high levels of community Covid-19 cases was likely the key factor explaining LTRC outbreaks

Utilisation of specialist mental health services in Ireland - Baseline analysis for the Hippocrates model. ESRI Survey and Statistical Report Series 90 June 2020.

This report analyses available data on specialist mental health services in Ireland to establish a baseline for inclusion in the Hippocrates Model of Healthcare Demand and Expenditure

Review of the Irish and international literature on health and social care unit cost methodology. ESRI WP602, October 2018

This literature review examines the methodologies used to calculate health and social care unit costs internationally and in Ireland. The purpose of this review is to identify the alternative approaches to unit costing for health and social care services in the literature and to assess the advantages and disadvantages of their use in an Irish context. The review finds that the use of bottom-up or top-down methods varied by type of study being undertaken. The proportion of studies that used unit costs calculated by applying a bottom-up approach was higher than the proportion using a top-down approach. Bottom-up approaches dominated when there was a greater need for accuracy in estimates, such as in health technology assessments, or when the extra data requirements of the bottom-up approach were not too penalising, such as with disease/setting specific studies. Top-down approaches were prevalent among studies that needed to estimate unit costs across a wide range of services and diseases. Top-down approaches were also more prevalent than bottom-up approaches for projection models of health and social care that used unit costs. At present, the Irish system suffers from the lack of a centralised unit, like the PSSRU in England, tasked with producing annual volumes of unit costs for health and social care. The development of comprehensive unit cost profiles for Irish health and social care services would be of significant benefit to researchers, policymakers and wider health system stakeholders