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Recent reform proposals in the healthcare systems of Ireland and Northern Ireland have highlighted the need to improve population health and to deliver more care in the community. There are significant variations between the two healthcare systems, providing an opportunity to examine how different approaches and policies impact on a range of outcomes. The aim of this research study is to analyse the primary care systems of Ireland and Northern Ireland. In doing so, it seeks to inform the reform proposals for both systems. The analysis will focus on primary care due to the key differences between the primary care systems of Ireland and Northern Ireland, including the higher prevalence of user charges in the Irish healthcare system.

This report analyses changes in public current and capital healthcare expenditure (HCE) (2004 to 2017), and its components, along with trends in HSE staffing and pay expenditure (2007 to 2017). This report adopts an inclusive approach to the measurement of HCE and HCE is defined in gross terms which includes any income receipts used to fund public care. Healthcare expenditure trends are adjusted to account for population growth and ageing, and price effects, over the period of analysis. Nominal public current HCE increased by 74.2 per cent between 2004 and 2017, equating to a 4.4 per cent annual average increase. However, with adjustment for demographic and price effects, public current HCE increased by a more modest 0.2 per cent on an annual average basis. Furthermore, the introduction of the Employment Control Framework (in 2009) reduced HSE staffing levels and pay expenditure but was associated with substantial increases in agency pay and HSE superannuation expenditure. Overall, discussion and assessment of HCE would benefit from placing trends into the context of changing prices and demographics. The long-term effects of measures, such as incentivised early retirement schemes, aimed at short-term cost-saving need to be considered as they may, in fact, lead to increased expenditure over time. Insights from this analysis of historic Irish healthcare expenditure trends may prove useful to policymakers' approach to ongoing financing of the Irish healthcare system in the COVID-19 healthcare crisis.

Larger and longer waiting lists for public hospital appointments and treatment have been a significant challenge in Irish healthcare for decades. The issue has been further exacerbated by COVID-19 in 2020 with the cancellation of elective activity in public hospitals for several months. The aim of this analysis is to estimate the activity and expenditure required to clear the accumulated backlog and account for future service demand. We estimate that to clear the backlog of cases and keep pace with demand over a period of five years, additional expenditure excluding any associated capital costs of up to €1.1bn would be required.

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.

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 in-patients 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.

Clinical Codes for Risk Factor Identification. ICD-10-AM/ACHI codes for identification of clinical risk factors in the data. (DOCX 13Â kb)

The current recession dictates that large decreases in public expenditure are required. As the second largest component of public expenditure, health is particularly vulnerable to the effects of the further cuts in expenditure that are required over the period 2012-2014. In the context of diminishing financial resources, there is increasing emphasis on maximising the value of expenditure by achieving efficient delivery of high-quality health-care services. In addition, the Irish health system is characterised by a complex set of financial incentives which have important implications for efficiency and equity. This paper examines international evidence on pay for performance (P4P) schemes to inform policymakers on the potential for implementing P4P in the Irish health-care system. In P4P, payments are tied to performance. P4P is becoming increasingly common in international health-care systems despite the lack of evidence on its effectiveness and a lack of consensus on how to design and implement such programmes. It is therefore important to understand the implications of existing P4P programmes before recommending their introduction in the Irish context. We provide an overview of the literature relating to large-scale P4P schemes, focusing on programmes that have been instituted by national public sector organisations. The literature highlights the poor quality of evidence on P4P schemes, stemming partly from technical challenges inherent in evaluating P4P schemes. Notwithstanding these technical difficulties, the available evidence does not provide a clear answer to the question of whether P4P should be implemented. Limitations include difficulties in obtaining valid performance indicators, unintended consequences, and the absence of evidence on cost effectiveness of P4P schemes. We assess how a P4P scheme would interact with the payment structures already in place in the Irish health-care system. We conclude that while there is an obvious need for greater efficiency and quality in the system, there are reasons why P4P initiatives are not recommended at this stage at least until the many complexities in provider reimbursement, public/private interaction, and patient access to the system are resolved.

This paper explores levels and trends in the prevalence of caesarean section delivery in Ireland between 1999 and 2006. Over this period the caesarean section rate in Ireland increased by almost one quarter. Using data from the Irish National Perinatal Reporting System we examine the contribution of maternal, birth/infant and hospital characteristics on the rise in the caesarean section rate over the period. International evidence suggests that earlier gestational age of child, older maternal age at birth, higher socio-economic status of mother and birth within a private hospital all increase the risk of caesarean section. Controlling for changes in the prevalence of these and other risk factors between 1999 and 2006 only explains half of the increase in the caesarean section rate amongst singleton delivery first time mothers. This suggests that changes in physician behaviour over the period may well play a significant role.

The objective of this paper is to assess the currently available literature relating to the labour allocation of farm households. An overview of the theoretical model relating to joint participation and hours of labour supply decisions of farm households is presented; followed by the resulting empirical specification. A discussion of the factors affecting both the participation in an off-farm job and the level of off-farm labour supplied is then undertaken and empirical findings from a range of studies are presented. There is found to be a degree of consensus among authors in relation to the variables chosen to explain the decisions and the nature of the relationships established. Broadly speaking, household characteristics have a stronger influence on spouses decisions than on operators, and farm characteristics have a stronger impact on operators decisions than spouses. peer-reviewed

The objective of this paper is to examine the factors affecting both participation in an off-farm job and the number of hours worked off-farm by couples in farm households in an Irish region. Data from 278 farm households in Co. Mayo was analysed to this end. A multivariate examination of key characteristics, using cluster analysis, was carried out to classify households into different clusters. The analysis comes reasonably close to picking out the four regimes suggested by the presented theoretical model, that is a cluster in which neither the operator or spouse work off-farm, one in which only the spouse works off-farm, one in which only the operator works off-farm, and one in which both work off-farm. This analysis is followed by an econometric analysis of farm operator and spouse labour supply decisions. Both bivariate probit models and multivariate logit models are used to estimate the off-farm labour force participation of operators and spouses. The participation models are followed by estimations of off-farm hours of work supplied by the couple, using appropriate sample selection procedures. For operators, the driving characteristics influencing off-farm labour participation and hours supplied are farm and location characteristics. In contrast, family demographics and education level appear to influence off-farm labour participation and hours supplied by the spouse. peer-reviewed

Contents Foreword - Frances Ruane Chapter 1: Monetary Policy and Financial Stability, David Miles Chapter 2: The Stability and Growth Pact: A Fiscal Framework Whose Time Has Come?, Jim O'Leary Chapter 3: Fiscal Policy: Some Lessons from Crises of the Past, Joe Durkan Chapter 4: Restructuring Taxes, Levies and Social Insurance: What Role for Universal Social Charge?, Tim Callan, Brian Nolan, Claire Keane, John R. Walsh and Marguerita Lane Chapter 5: The Sustainability of Irish Health Expenditure, Aoife Brick and Anne Nolan