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.

Survey on demand side sensitivity to power quality in Ireland

Power systems require a reliable supply and good power quality. The impact of power supply interruptions is well acknowledged and well quantified. However, a system may perform reliably without any interruptions but may have poor power quality. Although poor power quality has cost implications for all actors in the electrical power systems, only some users are aware of its impact. Power system operators are much attuned to the impact of low power quality on their equipment and have the appropriate monitoring systems in place. However, over recent years certain industries have come increasingly vulnerable to negative cost implications of poor power quality arising from changes in their load characteristics and load sensitivities, and therefore increasingly implement power quality monitoring and mitigation solutions. This paper reviews several historical studies which investigate the cost implications of poor power quality on industry. These surveys are largely focused on outages, whilst the impact of poor power quality such as harmonics, short interruptions, voltage dips and swells, and transients is less well studied and understood. This paper examines the difficulties in quantifying the costs of poor power quality, and uses the chi-squared method to determine the consequences for industry of power quality phenomenon using a case study of over 40 manufacturing and data centres in Ireland.

Trends in blindness due to diabetic retinopathy among adults aged 18-69 years over a decade in Ireland

Aims: To describe trends in the incidence of visual impairment and blindness due to diabetic retinopathy among adults aged 18–69 years in Ireland between 2004 and 2013. Methods: Data on visual impairment due to diabetic retinopathy in adults aged 18–69 years or over who are registered with the National Council for the Blind of Ireland, (2004–2013) were analysed. Annual incidence rates were calculated for the adult population and the population with diagnosed diabetes. Poisson regression was used to test for changes in rates over time. The relative, attributable and population risk of blindness and visual impairment due to diabetic retinopathy were calculated for 2013. Results: Over the decade, the prevalence of diagnosed diabetes increased from 2.1% to 3.6%. Among people with diagnosed diabetes, the incidence of visual impairment due to diabetic retinopathy increased from 6.4 (95% CI 2.4–13.9) per 100,000 in 2004 to 11.7 (95% CI 5.9–21.0) per 100,000 in 2013. The incidence of blindness due to diabetic retinopathy varied from 31.9 per 100,000 (95% CI 21.6–45.7) in 2004 to 14.9 per 100,000 (95% CI 8.2–25.1) in 2013. Conclusions: Our findings indicate the need for increased attention to preventive measures for microvascular complications among adults with diabetes in Ireland. Retinopathy screening has been standardised in Ireland, these findings provide useful baseline statistics to monitor the impact of this population-based screening programme.

Progress and the Lack of Progress in Addressing Infant Health and Infant Health Inequalities in Ireland during the 20th Century

There is a growing literature which documents the importance of early life environment for outcomes across the life cycle. Research, including studies based on Irish data, demonstrates that those who experience better childhood conditions go on to be wealthier and healthier adults. Therefore, inequalities at birth and in childhood shape inequality in wellbeing in later life, and the historical evolution of the mortality and morbidity of children born in Ireland is important for understanding the current status of the Irish population. In this paper, I describe these patterns by reviewing the existing literature on infant health in Ireland over the course of the 20th century. Up to the 1950s, infant mortality in Ireland (both North and South) was substantially higher than in other developed countries, with a large penalty for those born in urban areas. The subsequent reduction in this penalty, and the sustained decline in infant death rates, occurred later than would be expected from the experience in other contexts. Using records from the Rotunda Lying-in Hospital in Dublin, I discuss sources of disparities in stillbirth in the early 1900s. Despite impressive improvements in death rates since that time, a comparison with those born at the end of the century reveals that Irish children continue to be born unequal. Evidence from studies which track people across the life course, for example research on the returns to birthweight, suggests that the economic cost of this early life inequality is substantial.

Policy Transfer and the Sustainability of Public Private Partnership in Ireland::A conceptual analysis

There has been private sector involvement in the delivery of public services in the Irish State since its foundation. This involvement was formalised in 1998 when Public Private Partnership (PPP) was officially introduced. Ireland is a latecomer to PPP and, prior to the credit crisis, was seen as a ‘rapid follower’ relying primarily on the UK PPP model in the procurement of infrastructure in transport, education, housing/urban regeneration and water/wastewater.  PPP activity in Ireland stalled during the credit crisis, and some projects were cancelled, but it has taken off again recently with part of the Infrastructure and Capital Investment Plan 2016 – 2021 to be delivered through PPP showing continuing political commitment to PPP.  Ireland’s interest in PPP cannot be explained by economic rationale alone, as PPP was initiated during a period of prosperity. We consider three alternative explanations: voluntary adoption – where the UK model was closely followed; coercive adoption – where PPP policy was forced upon Ireland; and institutional isomorphism – where institutional creation and change was promoted to aid public sector organisations in gaining institutional legitimacy. We find evidence of all three patterns, with coercive adoption becoming more relevant in recent years. Ireland’s rapid uptake of PPP differs from other European countries, mostly because when PPP was introduced in 1998, the Irish State was in an economic position where it could have directly procured necessary infrastructure. This paper therefore asks why PPP was adopted and how this adoption pattern has affected the sustainability of PPP in Ireland.  This paper defines PPP; examines the background to the PPP approach adopted in Ireland; outlines the theoretical framework of the paper: transfer theory and institutional theory; discusses the methodology; reports on findings and gives conclusions.   

The Un-Politics of New Public Management in Ireland

Many of the principles and indeed the rhetoric of New Public Management proved attractive to both politicians and senior bureaucrats across the developed world as a remedy for problems in policy processes. Ireland shares many features of its constitutional structures and political practices with Britain, Canada, Australia, New Zealand, all of them early and enthusiastic adopters of NPM. Some of the organizational and procedural changes in Irish public administration do indeed bear similarities to those we would expect to see as a result of adopting principles of NPM. However, we contend that surface impressions are misleading. Drawing on a time-series database of Irish state institutions, we show that organizational changes were not necessarily driven by NPM. The absence of strong political drivers meant that reform initiatives did not fundamentally alter the configuration of the Irish public administration. Many of the problems that NPM was intended to address are only now coming under scrutiny.

Hate crime legislation and violence against sex workers in Ireland: Lessons in Policy and Practice

Drawing on data from UglyMugs.ie (a reporting mechanism for sex workers) this paper considers whether crimes against sex workers should be considered as hate crimes. In many ways, the debates around hate crime in the UK are more developed than in Ireland. As yet the Irish State has yet to criminalise the ‘hate’ element of crime and has been severely criticised for its relatively lacklustre approach to recording incidents of bias or hate crimes against certain social groups. The paper adopts the structural understanding of hate crime espoused by Barbara Perry (2001) who frames the dynamics of hate crime within a complex interplay of political, social and cultural factors. In our analysis we consider what is termed ‘whorephobia’ through the ambit of criminalisation and stigmatisation, gender and heteronormativity in Irish society, and the gendered nature of policing in both parts of Ireland.

Organisational factors affecting transition from children’s to adult services by young adults with life-limiting conditions in Ireland

Economic impacts of seafood production growth targets in Ireland

This paper examines the potential economic impact of the Irish government strategy for the development of the seafood sector in Ireland, Food Harvest 2020 (FH2020). The seafood industry accounts for a large proportion of income and employment in peripheral coastal areas. Many of these regions are predominantly rural and they are largely dependent on the primary fisheries sector. Moreover, the services and retail businesses in these areas are heavily dependent on direct spending from the fisheries, aquaculture and seafood processing sectors. A social accounting matrix (SAM) approach with (1) set to zero purchase coefficients for all directly impacted industries and (2) changes in output converted to final demand shocks is used to calculate the economic and employment impact on the rest of the economy from an increase in the output in the fisheries, aquaculture and seafood processing sectors in Ireland. The results suggest fisheries sectors have strong links with the rest of the economy hence an important economic impact from a policy perspective.

Expanding Agri-Food Production and Employment in the Presence of Climate Policy Constraints: Quantifying the Trade-Off in Ireland

This chapter explores the trade-off between competing objectives of employment creation and climate policy commitments in Irish agriculture. A social accounting matrix (SAM) multiplier model is linked with a partial equilibrium agricultural sector model to simulate the impact of a number of GHG emission reduction scenarios, assuming these are achieved through a constraint on beef production. Limiting the size of the beef sector helps to reduce GHG emissions with a very limited impact on the value of agricultural income at the farm level. However, the SAM multiplier analysis shows that there would be significant employment losses in the wider economy. From a policy perspective, a pragmatic approach to GHG emissions reductions in the agriculture sector, which balances opportunities for economic growth in the sector with opportunities to reduce associated GHG emissions, may be required.

Commercial sex, clients, and Christian morals: Paying for sex in Ireland

This article reports on the results of a study on men who pay for sex across Ireland. In presenting a detailed picture of the diverse group of sex workers’ clients, their motives and attitudes, we debunk the prevalent stereotypes about men who pay for sex, as continuously used in the public discourse about sex work on both sides of the Irish border: we show that the majority of clients do not fit the image of violent, careless misogynists. We argue that these debates about commercial sex as well as the experiences of those who pay for sex are shaped and nurtured by the specific local context, by conservative Christian morals and the dominant sex-negative culture across Ireland. Finally, we argue that the criminalization of paying for sex which came into effect in Northern Ireland in 2015 and is being discussed in the Republic of Ireland will likely not stop the majority of clients from paying for sex and thus fail to achieve its aim to reduce or abolish sex work.

‘Poor prison flowers’: convict mothers and their children in Ireland, 1853-1900

Pregnant women and mothers were among the thousands of individuals who were sentenced to at least three years’ penal servitude and admitted to the nineteenth-century Irish female convict prison. While some babies were born behind bars, others were permitted to accompany their convicted mothers into the prison after the penal practice of transportation had ceased. Other dependent children were separated from their convicted mothers for years, cared for by family members or friends, or accommodated in Ireland’s growing web of institutions. Using individual case studies, this article focuses on convict mothers and their young offspring. It draws attention to the increasing restrictions on the admission of infants that were imposed as the nineteenth century progressed, the problems that children of various ages in the penal system seemed to pose for officials, and the difficulties faced by incarcerated mothers who wished to maintain communication with their offspring. This article argues that while there were benefits to parenting within the confines of the prison, sentences of penal servitude had a significant impact on the lives of dependent offspring by dislocating families, separating siblings, or initiating institutional or other care that broke familial bonds permanently. In so doing, the article reveals attitudes towards motherhood as well as female criminality and institutionalization generally during this period and sheds light on an aspect of convict life unique to the women’s prison.

Audit of mathematics learning support in Ireland in 2015 – the key findings

In 2015 the Irish Mathematics Learning Support Network (IMLSN) commissioned a comprehensive audit of the extent and nature of mathematics learning support (MLS) provision on the island of Ireland. An online survey was sent to 32 institutions, including universities, institutes of technology, further education and teacher training colleges, and a 97% response rate was achieved. While the headline figure – 84% of institutions that responded to the survey provide MLS – sounds good, deeper analysis reveals that the true state of MLS is not so solid. For example, in 25% of institutions offering MLS, only five hours per week (at most) of physical MLS are available, while in 20% of institutions the service is provided by only one or two staff members. Furthermore, training of tutors is minimal or non-existent in at least half of the institutions offering MLS. The results provide an illuminating picture, however, identifying the true state of MLS in Ireland is beneficial only if it informs developments in the years ahead. This talk will present some of the findings of the survey in more depth along with conclusions and recommendations. Key among these is the need for institutions to recognise MLS as a vital element of mathematics teaching and learning strategy at third level and devote the necessary resources to facilitate the provision of a service which can grow and adapt to meet student requirements.