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.

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.

The Pilot Maths Centre at the North West Regional College

This paper discusses the establishment in 2015 of the first Maths Centre in any Further and Higher Education College in Northern Ireland. In particular, it considers the rationale for its development, how it was set up and how it runs. It also presents initial figures and feedback, and plans for future developments.

Divided Conquerors: the Rump Parliament, Cromwell's Army and Ireland

This article reassesses the relationship that existed in the period 1649–53 between war in Ireland and politics in England. Drawing upon a largely overlooked Irish army petition, it seeks to remedy an evident disconnect between the respective historiographies of the Cromwellian conquest of Ireland on the one hand and the Rump Parliament on the other. The article reconstructs some of the various disputes over religion, authority and violence that undermined the unity of the English wartime regime in Ireland. It then charts the eventual spilling over of these disputes into Westminster politics, arguing that their impact on deteriorating army-parliament relations in the year prior to Oliver Cromwell’s expulsion of the Rump in April 1653 has not been fully appreciated. The key driver of these developments was John Weaver, a republican MP and commissioner for the civil government of Ireland. The article explains how his efforts both to place restraints on the excessive violence of the conquest and to exert civilian control over the military evolved, by 1652, into a determined campaign at Westminster to strengthen the powers of Ireland’s civil government and to limit the army’s share in the prospective Irish land settlement. Weaver’s campaign forced the army officers in Ireland to intervene at Westminster, thus placing increased pressure on the Rump Parliament. This reassessment also enables the early 1650s to be viewed more clearly as a key phase in the operation of the longer-term relationships of mutual influence that existed between Dublin and London in the seventeenth century.

Oliver Cromwell and the 'Cromwellian' Settlement of Ireland

Oliver Cromwell remains a deeply controversial figure in Ireland. In the past decade, his role in the conquest has received sustained attention. However, in recent scholarship on the settlement of Ireland in the 1650s, he has enjoyed a peculiarly low profile. This trend has served to compound the interpretative problems relating to Cromwell and Ireland which stem in part from the traditional denominational divide in Irish historiography. This article offers a reappraisal of Cromwell's role in designing and implementing the far-reaching ‘Cromwellian’ land settlement. It examines the evidence relating to his dealings with Irish people, both Protestant and Catholic, and his attitude towards the enormous difficulties which they faced post-conquest. While the massacre at Drogheda in 1649 remains a blot on his reputation, in the 1650s Cromwell in fact emerged as an important and effective ally for Irish landowners seeking to defeat the punitive confiscation and transplantation policies approved by the Westminster parliament and favoured by the Dublin government.

The occurrence of PAHs and faecal sterols in Dublin Bay and their influence on sedimentary microbial communities

The source, concentration, and potential impact of sewage discharge and incomplete organic matter (OM) combustion on sedimentary microbial populations were assessed in Dublin Bay, Ireland. Polycyclic aromatic hydrocarbons (PAHs) and faecal steroids were investigated in 30 surface sediment stations in the bay. Phospholipid fatty acid (PLFA) content at each station was used to identify and quantify the broad microbial groups present and the impact of particle size, total organic carbon (%TOC), total hydrogen (%H) and total nitrogen (%N) was also considered. Faecal sterols were found to be highest in areas with historical point sources of sewage discharge. PAH distribution was more strongly associated with areas of deposition containing high %silt and %clay content, suggesting that PAHs are from diffuse sources such as rainwater run-off and atmospheric deposition. The PAHs ranged from 12 to 3072 ng/g, with 10 stations exceeding the suggested effect range low (ERL) for PAHs in marine sediments. PAH isomer pair ratios and sterol ratios were used to determine the source and extent of pollution. PLFAs were not impacted by sediment type or water depth but were strongly correlated to, and influenced by PAH and sewage levels. Certain biomarkers such as 10Me16:0, i17:0 and a17:0 were closely associated with PAH polluted sediments, while 16:1ω9, 16:1ω7c, Cy17:0, 18:1ω6, i16:0 and 15:0 all have strong positive correlations with faecal sterols. Overall, the results show that sedimentary microbial communities are impacted by anthropogenic pollution.

College Lifestyle and Attitudinal National (CLAN) Survey.

The aims of the CLAN survey were to establish a national student profile of lifestyle habits. The survey was undertaken by the Department of Health and Children among undergraduate full-time students during the academic year 2002/2003 in 21 third level colleges in Ireland. The results of the study showed that cannabis was the most common illegal drugs used by students, with 37% reporting that they had used in the past 12 months, and 20% during the past 30 days. Drug use in the student population was much higher than in the 2003 NACD drug prevalence survey. The survey also measured alocohol related harm, such as effects on study and financial probles.

Law, poetry and medicine: the literate professionals in autonomous Gaelic Ireland, c.1250 - c.1630

This thesis is about a class of literate professionals that served as hereditary brehons, poets and doctors to the Gaelic aristocracy over a period from c.1250-c.1630. My investigation into these families brings together evidence from Gaelic and English sources to highlight the work these families did for their patrons, their status in society and their subsequent fall in the seventeenth century. Such a broad canvas allows us to observe the vibrancy of Gaelic literary culture as these families adapted to the changing political landscape to absorb new Anglo-Norman patrons and assimilated English and Continental ideas while maintaining their distinctive identity. I want to look beyond the ideology espoused by these families to look at the practical choices members of these families made to maintain their status and relevance in a changing social context. To do this I have chosen to focus on each of the three professions in individual chapters to highlight the continuities and changes within the professions and ultimately by comparing the three groups to gauge the success or failure of these professional families to adapt to the encroachment of the New English and the ultimate collapse of the Gaelic world. This thesis takes a holistic approach to these families by including branches of these families not engaged in the hereditary profession. It seeks to provide a broader picture of Gaelic society below the level of the aristocracy by looking at the geographic distribution of these families, their proximity to centres of power, and to land and sea routes that can indicate their involvement in alternative economic activities.