Variation in resource allocation in urgent and emergency care systems in Ireland

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dc.contributor.authorThomas, Steve
dc.contributor.authorFoley, Conor
dc.contributor.authorKane, Bridget
dc.contributor.authorJohnston, Bridget M.
dc.contributor.authorLynch, Brenda
dc.contributor.authorSmith, Susan
dc.contributor.authorHealy, Orla
dc.contributor.authorDroog, Elsa
dc.contributor.authorBrowne, John P.
dc.contributor.funderHealth Research Boarden
dc.date.accessioned2019-10-15T05:52:33Z
dc.date.available2019-10-15T05:52:33Z
dc.date.issued2019-09-11
dc.description.abstractBackground: A key challenge for most systems is how to provide effective access to urgent and emergency care across rural and urban populations. Tensions about the placement and scope of hospital emergency services are longstanding in Irish political life and there has been recent reform to centralise hospital services in some regions. The focus of this paper is a system approach to examine the geographic variation in resourcing and utilisation of such care across GP practices, out-of-hours care, ambulance services, Emergency Departments and Local Injury Units in Ireland. Methods: We used a cross-sectional study design to evaluate variation in resource allocation by aggregating geographic funding to various elements of the urgent and emergency care system and assessing patterns in hospital resource utilisation across the population. Expenditure, staffing, access and activity data were gathered from government sources, individual facilities and service providers, health professional bodies, private firms and central statistics. Data on costs and activity in 2014 are collated and presented at both county and regional levels. Analyses focus on resources spent on urgent and emergency care across geographic areas, the role of population concentration in allocation, the relationship between pre-hospital spending and in-hospital spending, and the utilisation of hospital-based emergency care resources by residents of each county. Results: An array of funding mechanisms exists, resulting in a fragmented approach to the resourcing of urgent and emergency care. There are large differences in spending per capita at the county-level, ranging from between €50 and €200 per capita; however, these are less pronounced regionally. Distribution of hospital emergency care resources is highly skewed to the North East of the country, and away from the recently reconfigured South and Mid-West regions. Conclusions: This analysis advances the traditional approach of evaluating individual services or hospital resourcing. There are notable differences in utilisation of hospital-based emergency care resources at the regional level, indicating that populations within those regions which have been reconfigured have lower utilisation of hospital resources. There is a clear case for more integration in decision-making around funding and consideration of key principles, such as equity, to guide that process.en
dc.description.sponsorshipHealth Research Board (SIREN study)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleid657en
dc.identifier.citationThomas, S., Foley, C., Kane, B., Johnston, B. M., Lynch, B., Smith, S., Healy, O., Droog, E. and Browne, J. (2019) 'Variation in resource allocation in urgent and emergency Care Systems in Ireland', BMC Health Services Research, 19(1), 657 (11pp.). DOI: 10.1186/s12913-019-4504-4en
dc.identifier.doi10.1186/s12913-019-4504-4en
dc.identifier.eissn1472-6963
dc.identifier.endpage11en
dc.identifier.issued1en
dc.identifier.journaltitleBMC Health Services Researchen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/8767
dc.identifier.volume19en
dc.language.isoenen
dc.publisherSpringer Natureen
dc.relation.urihttps://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4504-4
dc.rights© The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectEmergency careen
dc.subjectHealth systemen
dc.subjectResource allocationen
dc.subjectUniversal health careen
dc.subjectUrgent careen
dc.subjectIrelanden
dc.titleVariation in resource allocation in urgent and emergency care systems in Irelanden
dc.typeArticle (peer-reviewed)en
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