http://hdl.handle.net/10468/761 Mon, 16 Oct 2017 07:22:57 GMT 2017-10-16T07:22:57Z http://hdl.handle.net/10468/4693 A cost-benefit analysis of two alternative models of maternity care in Ireland Fawsitt, Christopher G.; Bourke, Jane; Murphy, Aileen; McElroy, Brendan; Lutomski, Jennifer E.; Murphy, Rosemary; Greene, Richard A. Background: The Irish government has committed to expand midwifery-led care alongside consultant-led care nationally, although very little is known about the potential net benefits of this reconfiguration. Objectives: To formally compare the costs and benefits of the major models of care in Ireland, with a view to informing priority setting using the contingent valuation technique and cost-benefit analysis. Methods: A marginal payment scale willingness-to-pay question was adopted from an ex ante perspective. 450 pregnant women were invited to participate in the study. Cost estimates were collected primarily, describing the average cost of a package of care. Net benefit estimates were calculated over a 1-year cycle using a third-party payer perspective. Results: To avoid midwifery-led care, women were willing to pay €821.13 (95% CI 761.66–1150.41); to avoid consultant-led care, women were willing to pay €795.06 (95% CI 695.51–921.15). The average cost of a package of consultant- and midwifery-led care was €1,762.12 (95% CI 1496.73–2027.51) and €1018.47 (95% CI 916.61–1120.33), respectively. Midwifery-led care ranked as the best use of resources, generating a net benefit of €1491.22 (95% CI 989.35–1991.93), compared with €123.23 (95% CI −376.58 to 621.42) for consultant-led care. Conclusions: While both models of care are cost-beneficial, the decision to provide both alternatives may be constrained by resource issues. If only one alternative can be implemented then midwifery-led care should be undertaken for low-risk women, leaving consultant-led care for high-risk women. However, pursuing one alternative contradicts a key objective of government policy, which seeks to improve maternal choice. Ideally, multiple alternatives should be pursued. Mon, 21 Aug 2017 00:00:00 GMT http://hdl.handle.net/10468/4693 2017-08-21T00:00:00Z http://hdl.handle.net/10468/3987 Addressing market segmentation and incentives for risk selection: how well does risk equalisation in the Irish private health insurance market work? Keegan, Conor; Teljeur, Conor; Turner, Brian; Thomas, Steve This study assesses the efficacy of Ireland’s recently introduced risk equalisation scheme in its voluntary health insurance market. Robust risk equalisation is especially important in an Irish context given acute risk segmentation and incentives for risk selection that have evolved within the market. Using uniquely acquired VHI data (N=1,235,922) this analysis assesses the predictive efficacy of both current and alternative risk equalisation specifications. Results suggest that the low predictive power of the current risk equalisation design (R2 = 6.8 per cent) is not appropriately correcting for anti-competitive incentives and asymmetries in the market. Improvements to the current design could be achieved through the introduction of diagnosis-based risk adjusters. Wed, 01 Mar 2017 00:00:00 GMT http://hdl.handle.net/10468/3987 2017-03-01T00:00:00Z http://hdl.handle.net/10468/3474 A cost-analysis of complex workplace nutrition education and environmental dietary modification interventions Fitzgerald, Sarah; Kirby, Ann; Murphy, Aileen; Geaney, Fiona; Perry, Ivan J. Background: The workplace has been identified as a priority setting to positively influence individuals’ dietary behaviours. However, a dearth of evidence exists regarding the costs of implementing and delivering workplace dietary interventions. This study aimed to conduct a cost-analysis of workplace nutrition education and environmental dietary modification interventions from an employer’s perspective. Methods: Cost data were obtained from a workplace dietary intervention trial, the Food Choice at Work Study. Micro-costing methods estimated costs associated with implementing and delivering the interventions for 1 year in four multinational manufacturing workplaces in Cork, Ireland. The workplaces were allocated to one of the following groups: control, nutrition education alone, environmental dietary modification alone and nutrition education and environmental dietary modification combined. A total of 850 employees were recruited across the four workplaces. For comparison purposes, total costs were standardised for 500 employees per workplace. Results: The combined intervention reported the highest total costs of €31,108. The nutrition education intervention reported total costs of €28,529. Total costs for the environmental dietary modification intervention were €3689. Total costs for the control workplace were zero. The average annual cost per employee was; combined intervention: €62, nutrition education: €57, environmental modification: €7 and control: €0. Nutritionist’s time was the main cost contributor across all interventions, (ranging from 53 to 75% of total costs). Conclusions: Within multi-component interventions, the relative cost of implementing and delivering nutrition education elements is high compared to environmental modification strategies. A workplace environmental modification strategy added marginal additional cost, relative to the control. Findings will inform employers and public health policy-makers regarding the economic feasibility of implementing and scaling dietary interventions. Trial registration: Current Controlled Trials: ISRCTN35108237. Date of registration: The trial was retrospectively registered on 02/07/2013. Mon, 09 Jan 2017 00:00:00 GMT http://hdl.handle.net/10468/3474 2017-01-09T00:00:00Z http://hdl.handle.net/10468/4016 The decision to study abroad: evidence from international students based in Ireland Xiong, Wei Foreign study is an emerging trend in the education market. Increasingly, students choose to leave their home country to study abroad. This decision is not only coupled with financial and time costs, but also involves the challenges of new cultures. This thesis examined push and pull factors, investments and expected returns on foreign education, and parental influences on the decision to study abroad for international students in one Irish university. A concurrent triangulation design was used to collect data, which involved quantitative and qualitative data collection and analysis at the same time. To collect quantitative data, the research used an online questionnaire with 216 responses. In-depth semi-structured interviews were used to collect qualitative data. 24 international students agreed to be interviewed. Quantitative data results indicated that personal factors, which included satisfying language and academic requirements, were the most important factor in international students’ foreign study decision. Destination university’s programme availability was also a popular factor influencing the foreign study decision. Qualitative data showed that the push factors discussed most frequently in the interviews were, lack of programme availability in the home country, and the length of time to study for certain programmes in the home country. The thesis explored factors that were not present in previous literature, such as international students’ attitudes towards competition and university’s ranking. Destination universities should promote their high ranking, as many students preferred high but not top-ranking universities, as they felt that their applications would more successful. The results also showed that destination universities should consider parents’ role in the foreign study decision when promoting programmes in Asian, and particularly, East Asian countries. Moreover, the thesis showed the different priorities for international students from different regions. Destination universities should tailor their promotions to the region/continent that they wish to target. Sun, 01 Jan 2017 00:00:00 GMT http://hdl.handle.net/10468/4016 2017-01-01T00:00:00Z