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.
Highlights
Integration is at the centre of global health strategies to achieve people-centred health services[1,2]
It is acknowledged that there is ‘huge variety’ in access ‘depending on geographic location and existing supply in that area’, and in practice priority is often given to Medical Card (MC) holders4: . p45,35 This paper provides a more rigorous analysis of available data to move beyond this anecdotal understanding of variable access to non-acute care services in Ireland
The Gini coefficient ranges from 0.091 for long-term residential care (LTRC) to 0.615 for publicly employed podiatrists and chiropodists, indicating substantial geographic inequality in non-acute supply, and that the degree of inequality varies across the services
Summary
Integration is at the centre of global health strategies to achieve people-centred health services[1,2]. 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 nonacute care plays a more central role 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 nonacute care supply in Ireland. Such inequities come into sharp relief in the context of COVID-19, where article can be found at the end of the article
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