Geographic inequalities in non-acute healthcare supply: evidence from Ireland

Abstract

Background: Recent reforms in Ireland, as outlined in Sláintecare, the report of the cross-party parliamentary committee on health, are focused on shifting from a hospital-centric system to one where non-acute care plays a more central role. However, these reforms were embarked on in the absence of timely and accurate information about the capacity of non-acute care to take on a more central role in the system. To help address this gap, this paper outlines the most comprehensive analysis to date of geographic inequalities in non-acute care supply in Ireland. Methods: Data on the supply of 10 non-acute services including primary care, allied health, and care for older people, were collated. Per capita supply for each service is described for 28 counties in Ireland (Tipperary and Dublin divided into North and South), using 2014 supply and population data. To examine inequity in the geographic distribution of services, raw population in each county was adjusted for a range of needs indicators. Results: The findings show considerable geographic inequalities across counties in the supply of non-acute care. Some counties had low levels of supply of several types of non-acute care. The findings remain largely unchanged after adjusting for need, suggesting that the unequal patterns of supply are also inequitable. Conclusions: In the context of population changes and the influence of non-need factors, the persistence of historical budgeting in Ireland has led to considerable geographic inequities in non-acute supply, with important lessons for Ireland and for other countries. Such inequities come into sharp relief in the context of COVID-19, where non-acute supply plays a crucial role in ensuring that acute services are preserved for treating acutely ill patients.

Long-term residential care in Ireland: Developments since the onset of the COVID-19 pandemic

“…Another key issue highlighted is geographic inequality of supply. This issue has been highlighted previously (Smith et al, 2019), but the location of new private LTRC homes in Ireland adds to these inequalities. Driven by profit motives, private providers are likely to establish homes in high-demand areas and where NHSS payments are highest, thereby exacerbating existing inequalities in LTRC supply.…”

“…While the previous figure shows that there are some differences in the relative ranking of counties according to the age group denominator chosen, for the sake of brevity and in line with previous research (OECD statistics and Smith et al, 2019), beds per 1,000 aged 65+ will be used through the remainder of this report. Figure 3.6 underpins this decision.…”

“…In LTRC research, beds per population aged 65+ is commonly used to compare difference in bed supply (see OECD figures above and Smith et al, 2019). However the average age of LTRC residents in Ireland is over 83 (Collins, 2019), with many residents aged 85+.…”

Place of Death for Adults Receiving Specialist Palliative Care in Their Last 3 Months of Life: Factors Associated With Preferred Place, Actual Place, and Place of Death Congruence

“…This is further supported by the finding that older patients were significantly less likely to achieve congruence consistent with known gaps and inequalities in community-based supports for older people. 30 , 31 , 34 …”

“…This is further supported by the finding that older patients were significantly less likely to achieve congruence consistent with known gaps and inequalities in community-based supports for older people. 30,31,34 -Thus, while these patterns are likely capturing unobserved needs to some extent, when taken altogether they also consistently point to under-resourced community-based supports for older people in Ireland and it is likely that both factors are at play. These findings further strengthen the call for progress in Irish policy reforms to enhance community-based care.…”