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.

Finding optimal alternatives based on efficient comparative preference inference

Choosing the right or the best option is often a demanding and challenging task for the user (e.g., a customer in an online retailer) when there are many available alternatives. In fact, the user rarely knows which offering will provide the highest value. To reduce the complexity of the choice process, automated recommender systems generate personalized recommendations. These recommendations take into account the preferences collected from the user in an explicit (e.g., letting users express their opinion about items) or implicit (e.g., studying some behavioral features) way. Such systems are widespread; research indicates that they increase the customers' satisfaction and lead to higher sales. Preference handling is one of the core issues in the design of every recommender system. This kind of system often aims at guiding users in a personalized way to interesting or useful options in a large space of possible options. Therefore, it is important for them to catch and model the user's preferences as accurately as possible. In this thesis, we develop a comparative preference-based user model to represent the user's preferences in conversational recommender systems. This type of user model allows the recommender system to capture several preference nuances from the user's feedback. We show that, when applied to conversational recommender systems, the comparative preference-based model is able to guide the user towards the best option while the system is interacting with her. We empirically test and validate the suitability and the practical computational aspects of the comparative preference-based user model and the related preference relations by comparing them to a sum of weights-based user model and the related preference relations. Product configuration, scheduling a meeting and the construction of autonomous agents are among several artificial intelligence tasks that involve a process of constrained optimization, that is, optimization of behavior or options subject to given constraints with regards to a set of preferences. When solving a constrained optimization problem, pruning techniques, such as the branch and bound technique, point at directing the search towards the best assignments, thus allowing the bounding functions to prune more branches in the search tree. Several constrained optimization problems may exhibit dominance relations. These dominance relations can be particularly useful in constrained optimization problems as they can instigate new ways (rules) of pruning non optimal solutions. Such pruning methods can achieve dramatic reductions in the search space while looking for optimal solutions. A number of constrained optimization problems can model the user's preferences using the comparative preferences. In this thesis, we develop a set of pruning rules used in the branch and bound technique to efficiently solve this kind of optimization problem. More specifically, we show how to generate newly defined pruning rules from a dominance algorithm that refers to a set of comparative preferences. These rules include pruning approaches (and combinations of them) which can drastically prune the search space. They mainly reduce the number of (expensive) pairwise comparisons performed during the search while guiding constrained optimization algorithms to find optimal solutions. Our experimental results show that the pruning rules that we have developed and their different combinations have varying impact on the performance of the branch and bound technique.

Users & use: An exploration of the interaction between the user and the digital archive

This thesis will examine the interaction between the user and the digital archive. The aim of the study is to support an in-depth examination of the interaction process, with a view to making recommendations and tools, for system designers and archival professionals, to promote digital archive domain development. Following a comprehensive literature review process, an urgent requirement for models was identified. The Model of Contextual Interaction presented in this thesis, aims to provide a conceptual model through which the interaction process, between the user and the digital archive, can be examined. Using the five-phased research development framework, the study will present a structured account of its methods, using a multi-method methodology to ensuring robust data collection and analysis. The findings of the study are presented across the Model of Contextual Interaction, and provide a basis on which recommendations and tools for system designers have been made. The thesis concludes with a summary of key findings, and a reflective account of how the findings and the Model of Contextual Interaction have impacted digital provision within the archive domain and how the model could be applied to other domains.

MyRoom: A user-centred model of affective responsive architecture

Can my immediate physical environment affect how I feel? The instinctive answer to this question must be a resounding “yes”. What might seem a throwaway remark is increasingly borne out by research in environmental and behavioural psychology, and in the more recent discipline of Evidence-Based Design. Research outcomes are beginning to converge with findings in neuroscience and neurophysiology, as we discover more about how the human brain and body functions, and reacts to environmental stimuli. What we see, hear, touch, and sense affects each of us psychologically and, by extension, physically, on a continual basis. The physical characteristics of our daily environment thus have the capacity to profoundly affect all aspects of our functioning, from biological systems to cognitive ability. This has long been understood on an intuitive basis, and utilised on a more conscious basis by architects and other designers. Recent research in evidence-based design, coupled with advances in neurophysiology, confirm what have been previously held as commonalities, but also illuminate an almost frightening potential to do enormous good, or alternatively, terrible harm, by virtue of how we make our everyday surroundings. The thesis adopts a design methodology in its approach to exploring the potential use of wireless sensor networks in environments for elderly people. Vitruvian principles of “commodity, firmness and delight” inform the research process and become embedded in the final design proposals and research conclusions. The issue of person-environment fit becomes a key principle in describing a model of continuously-evolving responsive architecture which makes the individual user its focus, with the intention of promoting wellbeing. The key research questions are: What are the key system characteristics of an adaptive therapeutic single-room environment? How can embedded technologies be utilised to maximise the adaptive and therapeutic aspects of the personal life-space of an elderly person with dementia?.

User experience of mobile cloud applications - current state and future directions

The increasing penetration rate of feature rich mobile devices such as smartphones and tablets in the global population has resulted in a large number of applications and services being created or modified to support mobile devices. Mobile cloud computing is a proposed paradigm to address the resource scarcity of mobile devices in the face of demand for more computing intensive tasks. Several approaches have been proposed to confront the challenges of mobile cloud computing, but none has used the user experience as the primary focus point. In this paper we evaluate these approaches in respect of the user experience, propose what future research directions in this area require to provide for this crucial aspect, and introduce our own solution.

Practice-based personas: integrated user and practice models

Practices are routinised behaviours with social and material components and complex relationships over space and time. Practice-based design goes beyond interaction design to consider how these components and their relationships impact on the formation and enactment of a practice, where technology is just one part of the practice. Though situated user-centred design methods such as participatory design are employed for the design of practice, demand exists for additional methods and tools in this area. This paper introduces practice-based personas as an extension of the persona approach popular in interaction design, and demonstrates how a set of practice-based personas was developed for a given domain – academic practice. The three practice-based personas developed here are linked to a catalogue of forty practices, offering designers both a user perspective and a practice perspective when designing for the domain.

Delivering mobile cloud services to the user: description, discovery, and consumption

The mobile cloud computing paradigm can offer relevant and useful services to the users of smart mobile devices. Such public services already exist on the web and in cloud deployments, by implementing common web service standards. However, these services are described by mark-up languages, such as XML, that cannot be comprehended by non-specialists. Furthermore, the lack of common interfaces for related services makes discovery and consumption difficult for both users and software. The problem of service description, discovery, and consumption for the mobile cloud must be addressed to allow users to benefit from these services on mobile devices. This paper introduces our work on a mobile cloud service discovery solution, which is utilised by our mobile cloud middleware, Context Aware Mobile Cloud Services (CAMCS). The aim of our approach is to remove complex mark-up languages from the description and discovery process. By means of the Cloud Personal Assistant (CPA) assigned to each user of CAMCS, relevant mobile cloud services can be discovered and consumed easily by the end user from the mobile device. We present the discovery process, the architecture of our own service registry, and service description structure. CAMCS allows services to be used from the mobile device through a user's CPA, by means of user defined tasks. We present the task model of the CPA enabled by our solution, including automatic tasks, which can perform work for the user without an explicit request.