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Migrants in Europe are shown to have consistently lower uptake of preventive healthcare compared to European host populations. This paper examines how the transnational preventive care use of Eastern European migrants in their country of origin may be associated with preventive care uptake in their European host country. Preventive care use data in Ireland was collected on 119 Polish migrants and 123 native Irish from June 2018 to September 2019. Preventive care use data was also collected on the Polish migrant group in Poland during the same period. Preventive care use was captured by examining general practitioner visits, blood or urine test uptake, and cancer screening uptake. Probit models were first estimated to examine whether the Polish migrants were more or less likely to have used each service in Ireland than the native Irish. Second, three bivariate probit models were estimated to examine the use of each service by the Polish migrants only in Ireland and Poland as the two dependant variables. The Polish migrants are less likely to have GP visits, blood or urine test uptake, and cancer screening uptake in Ireland compared to the native Irish. The Polish migrants from this study are also shown to potentially substitute blood or urine test uptake in Ireland for uptake in Poland. Transnational ties can determine the preventive care utilisation of migrants in Europe.

IntroductionMigrants have different utilisation of healthcare services and health-related behaviours than host populations. A potential factor that may contribute to the notable differences in healthcare use and health-related behaviours between migrants and host populations is how these groups value health. Those who place a high value on health have greater healthcare-seeking practices than those who do not.ObjectiveThe aim of this study was to examine how Polish migrants and native Irish differ in health state utility valuations using a novel application of a smaller design EQ-5D-5L valuation study.MethodsThis study uses health preferences as a predictor of how one values health. We examined the EQ-5D-5L health preferences of 119 Polish migrants and 123 native Irish, both residing full-time in Ireland. To do so, we used a novel application of a smaller design EQ-5D-5L valuation study that consisted of 30 health states and a targeted sampling strategy coupled with a Bayesian statistical nonparametric model. We collected data from June 2018 to September 2019.ResultsOur results highlight that Polish migrants and native Irish differ in their health preferences for and valuation of severe health states. Polish migrants place meaningfully higher utility valuations of 0.1 or more on the three most severe health states compared with the native Irish.ConclusionThis study can provide an understanding of a potential new factor underpinning some of the disparities in healthcare utilisation and health-related behaviours among migrants and host populations in Europe. This study also provides proof of principle for using a smaller design EQ-5D-5L valuation study to explore differences in health preferences among other minority subgroups, which can otherwise be hard to uncover when using the secondary analysis of national EQ-5D-5L valuation studies.

Objective To estimate the budget impact from the perspective of the Irish health-care system attributable to a reconfiguration in the diagnostic care pathway for patients with suspected RA by adopting an early identification and referral model (EIM). Methods The budget impact model evaluated the total health-care use and costs attributable to an EIM to diagnose patients with suspected RA relative to the reference scenario of current practice. The modelling also assessed a primary outcome of effect, which examined how many patients can be diagnosed by a rheumatologist within 3 months of symptom onset. The budget impact analysis model was estimated over a 5-year time frame. Results The EIM generated a cost saving for the Irish health-care system of €237 547 over the time frame relative to current practice. The cost savings were realized owing to a reduction in the number of general practitioner (GP) visits of 18 790 and a reduction in diagnostic tests carried out by GPs. The results showed that 1027 (510%) more patients were diagnosed within 3 months of symptom onset in the EIM compared with current practice. Conclusion This paper has presented an alternative rheumatologist-led service design that can be used in diagnosing patients with suspected RA. The rheumatologist-led service provision detailed in this study has the potential simultaneously to reduce demand for primary care services and to improve the health outcomes of patients. The use of an EIM sees rheumatologist activity incorporate patient demand.

BACKGROUND: Differences in healthcare use could relate to differences in the values assigned health as well as to differences in access. We sought to establish whether there existed evidence of differences in values assigned health states between individuals with and without insurance in Ireland.METHODS: Using the EuroQol Valuation Technology (EQ-VT), EQ-5D-5 L valuation tasks were administered to a sample of 1160 residents of Ireland in 2015/16. Censored panel regression analyses were used to estimate the values assigned health states. Private insurance was entered among a range of covariates to explain health preferences as a binary variable. A range of confirmatory analyses were undertaken.RESULTS: In the primary analysis, possession of private health insurance was not a significant determinant of health preferences. Across a range of confirmatory analyses limited evidence of any difference in values related to health insurance emerged.CONCLUSIONS: Insurance status has been shown to be a significant determinant of healthcare utilization in Ireland after need has been controlled for. Our analysis provides no compelling evidence that meaningful differences exist in the values accorded health between those with and without health insurance.

Objective Our objective was to develop a value set based on Irish utility values for the EuroQol 5-Dimension, 5-Level instrument (EQ-5D-5L). Methods The research design and data collection followed a protocol developed by the EuroQol Group. The EuroQol Valuation Technology (EQ-VT) software was administered using computer-assisted personal interviews to a representative sample of adults resident in Ireland between 2015 and 2016. Utility values were elicited using two stated-preference techniques: time trade-off (TTO) and discrete-choice experiment (DCE). Each respondent completed a valuation exercise in which the EQ-VT system randomly selected one block of ten TTO questions from ten blocks relating to a possible 86 health states. One block of seven DCE pairs from 28 blocks of a possible 196 pairs of health states were randomly selected to accompany this. The relationship between utility values and health states was analysed using a hybrid regression model that combined data from the TTO and DCE techniques and expressed these as a function of the health state presented to the individual. This model estimated coefficients for 20 dummy variables that characterised each health state in the EQ-5D-5L framework, with the lowest level of severity providing the reference category in each domain. The relationship between weighted and unweighted TTO and DCE analyses of main effects was analysed separately. Results Comparison of weighted and unweighted models revealed no substantive differences in results with respect to either DCE or TTO models. The unweighted hybrid model produced estimated effects, the ordering of which was intuitively consistent within each domain: lower levels of health were associated with lower utility values. Differences were evident between domains with respect to valuations; the disutility associated with conditions related to anxiety/depression and pain/discomfort was higher than for other domains. The decrement in utility associated with movement from the highest to the lowest level of health was 0.344 for mobility, 0.287 for self-care, 0.187 for usual activities, 0.510 for pain/discomfort and 0.646 for anxiety/depression. Discussion The results present the first value set based on the EQ-5D-5L framework for a representative sample of residents in Ireland. The set reveals a higher decrement in utility associated with anxiety/depression than with other domains of health. Caution is warranted in comparisons with other value sets. That said, those in England, the Netherlands, Uruguay and China reveal that, whereas Irish values are broadly consistent with respect to mobility, self-care and usual activities, residents of Ireland attach a higher decrement to pain/discomfort and anxiety/depression than do other populations. Electronic supplementary material The online version of this article (10.1007/s40273-018-0690-x) contains supplementary material, which is available to authorized users.

Despite the economic and health benefits of preventive care being well established, the uptake of many cost-effective preventive services remains lower than desired in many cases, especially among specific sub-populations. The value an individual places on health can influence their uptake of preventive care. One way to capture the value an individual places on health and future health status is to examine their health preferences. This study used a novel use of EQ-5D-5L health preferences to determine if health preferences are associated with the uptake of a range of preventive care services, including a cancer screening, blood pressure check, cholesterol check, blood test and urine test. We collected EQ-5D-5L composite time trade-off data in 2018/2019 on 242 respondents residing in Ireland. We estimated an initial tobit model to predict an individual’s health preference to capture health preferences as a regressor. We then estimated a bivariate probit model to examine the uptake of each preventive service and GP use. Each model controlled for health preferences, education, sex, type of health coverage, self-reported health, employment status, age and marital status. Health preferences are a significant determinant of all five preventive services while controlling for other covariates. The results shows that the higher an individual values good health, the more likely they are to avail of preventive care. Health preferences can be noted as a potential determinant of preventive care use that could guide policy responses seeking to increase demand-side factors for preventive care uptake.

The concept of transnationalism may provide an alternative rationale to observed differences in patterns of migrant healthcare use and health-related behaviours. In this study, we examined the health preferences of Eastern European migrants residing in another European state relative to comparable natives through the prism of transnationalism. For the analysis, we focused on the health preferences of 87 Polish migrants living full-time in Ireland compared to 87 Irish natives. We used EQ-5D-5L composite Time Trade-Off (cTTO) utility data collected as part of the Irish value set during 2015/2016 to examine the health preferences of both groups. Propensity score matching was utilised to match comparable Irish respondents to Polish migrants with 1:1 matching. Since cTTO utility data is censored, a random effects Tobit model was used to explore differences in utility valuations, and in a secondary analysis, we examined the likelihood of applying a negative utility valuation using a random effects logit model. The results from this study demonstrate that on average Polish migrants apply a significantly greater disutility valuation to health states and are more likely to apply a negative utility valuation to a given health state when compared to comparable natives. Differences in utility valuations can be seen as indicative of time preference with a greater disutility valuation being associated with a higher rate of time preference. This finding may be suggestive of health-related behaviours, such as a greater likelihood of not engaging with preventive service use in as far as those with high rates of time preference have low uptake. Transnationalism can underpin the observed differences in health preferences between the Polish migrants and comparable Irish natives. Transnational ties shape health-related behaviours of migrants from the use of healthcare services to health preferences. The results of this study will be of interest to policymakers in Ireland and Europe.