Now showing 1 - 6 of 6
  • Publication
    GP reimbursement and visiting behaviour in Ireland
    (University College Dublin. School of Economics, 2004-12) ; ;
    In Ireland, approximately 30 per cent of the population (“medical cardholders”) receive free GP services while the remainder (“non-medical cardholders”) must pay for each visit. In 1989, the manner in which GPs were reimbursed by the State for their medical cardholder patients was changed from fee-for-service to capitation while other patients continued to pay on a fee-for-service basis. Concerns about supplier-induced demand were in part responsible for this policy change. The purpose of this paper is to examine the extent to which the utilisation of GP services is influenced by the reimbursement system facing GPs, by comparing visiting rates for the two groups before and after this change. Using a difference-in-differences approach on pooled micro-data from 1987, 1995 and 2000, we find that medical card eligibility exerts a consistently positive and significant effect on the utilisation of GP services. However, the differential in visiting rates between medical cardholders and others did not narrow between 1987 and 1995 or 2000, as might have been anticipated if supplier-induced demand played a major role prior to the change in reimbursement system.
      884
  • Publication
    A panel data analysis of the utilisation of GP services in Ireland : 1995-2001
    (ESRI, ISSC & University of Ulster, 2004-11) ;
    The extent to which the cost of obtaining health care influences the utilisation of GP and other health services is a frequently analysed topic. A key issue concerns the extent to which access to private health insurance and/or eligibility for free public health services results in differences in utilisation that cannot be explained by differences in need factors such as age, gender or health status. Ireland is an interesting case study in this regard as only 30 per cent of the population are eligible for free GP consultations; the remainder of the population must pay the full price. Using panel data from 1995 to 2001 on GP visits in Ireland, this paper applies a random effects approach to count data in an attempt to determine the factors influencing GP visiting patterns, with a particular focus on the role of eligibility for free public health services.
      285
  • Publication
    A cross-sectional analysis of the utilisation of GP services in Ireland : 1987- 2001
    (ESRI, ISSC and University of Ulster, 2003-11) ;
    This paper examines the determinants of general practitioner (GP) utilisation patterns in Ireland over the period 1987-2001. Using three different micro-data sets, the influence of socio-economic factors as well as health status variables on the demand for GP visits is analysed. A particular focus of this paper is an examination of the impact of economic incentives as represented by medical card eligibility. While medical cardholders are entitled to free GP consultations, nonmedical cardholders must pay for each visit. In addition, it is important to analyse the impact of the 1989 change in the reimbursement system for GPs with medical cardholder patients from fee for service to capitation. A variety of cross-sectional econometric methodologies are considered with the two-step hurdle negative binomial model found to be the most appropriate. The empirical results confirm the results of earlier studies about the effects of socio-economic characteristics such as age, sex and income on GP utilisation patterns and also confirm the highly significant effects of health status. While medical card eligibility is consistently positive and significant across the years of our analysis (1987, 1995, 2000, 2001), there is no evidence to show that this effect diminished in importance between 1987 and 1995.
      310
  • Publication
      441
  • Publication
    Ireland's health care system : some issues and challenges
    (ESRI, ISSC and University of Ulster, 2004-11) ;
    A variety of recent reports and strategy documents have highlighted the intimidating range of challenges facing Ireland's health system as it seeks to improve its performance. In this short paper we cannot deal with these in any comprehensive fashion, but instead focus on three specific issues. First, we illustrate the value of trying to benchmark performance against other countries, as well as some of the difficulties that arise in such an exercise. Secondly, with primary care a central focus of official strategies we look at the use of general practitioner services by people at different income levels and in particular by those with and without entitlement to free GP care. Finally, we discuss the complex web of issues in relation to both equity and efficiency that arise from the unique role which private health insurance plays in the Irish healthcare system.
      3190