The impact of user charges on patient choice of healthcare services in Ireland

This research assesses the impact of user charges in the context of consumer choice to ascertain how user charges in healthcare impact on patient behaviour in Ireland. Quantitative data is collected from a subset of the population in walk-in Urgent Care Clinics and General Practitioner surgeries to assess their responses to user charges and whether user charges are a viable source of part-funding healthcare in Ireland. Examining the economic theories of Becker (1965) and Grossman (1972), the research has assessed the impact of user charges on patient choice in terms of affordability and accessibility in healthcare. The research examined a number of private, public and part-publicly funded healthcare services in Ireland for which varying levels of user charges exist depending on patients’ healthcare cover. Firstly, the study identifies the factors affecting patient choice of privately funded walk-in Urgent Care Clinics in Ireland given user charges. Secondly, the study assesses patient response to user charges for a mainly public or part-publicly provided service; prescription drugs. Finally, the study examines patients’ attitudes towards the potential application of user charges for both public and private healthcare services when patient choice is part of a time-money trade-off, convenience choice or preference choice. These services are valued in the context of user charges becoming more prevalent in healthcare systems over time. The results indicate that the impact of user charges on healthcare services vary according to socio-economic status. The study shows that user charges can disproportionately affect lower income groups and consequently lead to affordability and accessibility issues. However, when valuing the potential application of user charges for three healthcare services (MRI scans, blood tests and a branded over a generic prescription drug), this research indicates that lower income individuals are willing to pay for healthcare services, albeit at a lower user charge than higher income earners. Consequently, this study suggests that user charges may be a feasible source of part-financing Irish healthcare, once the user charge is determined from the patients’ perspective, taking into account their ability to pay.

Nanostructured materials for Lithium-ion battery technology

The Li-ion battery has for several years been at the forefront of powering an ever-increasing number of modem consumer electronic devices such as laptops, tablet PCs, cell phones, portable music players etc., while in more recent times, has also been sought to power a range of emerging electric and hybrid-electric vehicle classes. Given their extreme popularity, a number of features which define the performance of the Li-ion battery have become a target of improvement and have garnered tremendous research effort over the past two decades. Features such as battery capacity, voltage, lifetime, rate performance, together with important implications such as safety, environmental benignity and cost have all attracted attention. Although properties such as cell voltage and theoretical capacity are bound by the selection of electrode materials which constitute its interior, other performance makers of the Li-ion battery such as actual capacity, lifetime and rate performance may be improved by tailoring such materials with characteristics favourable to Li+ intercalation. One such tailoring route involves shrinking of the constituent electrode materials to that of the nanoscale, where the ultra-small diameters may bestow favourable Li+ intercalation properties while providing a necessary mechanical robustness during routine electrochemical operation. The work detailed in this thesis describes a range of synthetic routes taken in nanostructuring a selection of choice Li-ion positive electrode candidates, together with a review of their respective Li-ion performances. Chapter one of this thesis serves to highlight a number of key advancements which have been made and detailed in the literature over recent years pertaining to the use of nanostructured materials in Li-ion technology. Chapter two provides an overview of the experimental conditions and techniques employed in the synthesis and electrochemical characterisation of the as-prepared electrode materials constituting this doctoral thesis. Chapter three details the synthesis of small-diameter V2O5 and V2O5/TiO2 nanocomposite structures prepared by a novel carbon nanocage templating method using liquid precursors. Chapter four details a hydrothermal synthesis and characterisation of nanostructured β-LiVOPO4 powders together with an overview of their Li+ insertion properties while chapter five focuses on supercritical fluid synthesis as one technique in the tailoring of FeF2 and CoF2 powders having potentially appealing Li-ion 'conversion' properties. Finally, chapter six summarises the overall conclusions drawn from the results presented in this thesis, coupled with an indication of potential future work which may be explored upon the materials described in this work.

Career choice in medicine

Background: Career Choice in Medicine is an important and problematic topic. Medical education has been framed as professional identity development, yet career choice has not been viewed as a matter of identity. My primary aim was to offer new insights by exploring career choice using Figured Worlds theory, a socio-cultural theory of identity. Graduate retention is a challenge for many countries, including Ireland. My secondary aim was to address a gap in the data on postgraduate trainees in Ireland and to use the Irish case to illustrate points transferable to other contexts. Methodology & Methods: This was a predominantly qualitative Mixed Methods programme of research. My qualitative studies were oriented towards social constructionism. I collated existing data from the Royal College of Physicians of Ireland (RCPI) and HSE-MET to describe trainees and their career paths. I surveyed Basic Specialist Training trainees (n=333) about their career plans. I surveyed new trainees (n=527) about their expectations of training and all RCPI trainees about their experiences of training (n=1246). I conducted semi-structured interviews with 18 medical students and doctors. A subgroup (n=6) provided longitudinal data. Figured Worlds theory and Gee’s discourse tools were used for analysis. Results: I have used the case of medical training and career choice in Ireland to explain how social, political and cultural context, and day to day experiences in the cultural world of medicine, shaped doctors’ career choices. My qualitative findings described a unifying model of career choice, consisting of priming, exposure, positioning and open-endedness, which can guide the design of interventions to shape and support career choice. Conclusion: My original contribution has been to demonstrate the fruitfulness of framing career choice in terms of identity development. This represents a turn in the conversation about career choice, which brings new starting points and moves the dialogue forward.