Projected private hospital expenditure in Ireland, 2018-2035: What role for demographics, cost, and Sláintecare?

Despite private hospitals occupying an important role in the delivery of acute hospital care in Ireland, an understanding of future spending pressures on these services is limited. Particularly, a key dimension of Ireland's ambitious roadmap for healthcare reform (Sláintecare) seeks to remove private practice from public hospitals. However, to date, there has been no examination of how this reform could impact private hospital demand and expenditure, and ultimately, the capacity to treat public patients. Using previously unavailable administrative health insurer data and a healthcare macro-simulation projection model, we project real (volume-based) and nominal expenditure on private hospital services over the medium-term (2018-2035). We develop a number of projection scenarios that vary assumptions in relation to population growth and ageing, healthy ageing, and the future cost of care delivery. Additionally, by developing profiles of private activity in public hospitals, we examine how the removal of private practice from public hospitals could impact on demand and expenditure in private hospitals over time. Findings from this analysis have implications for capital investment and workforce planning in private hospitals, and failure to meet future demand could have implications for access to care in public hospitals. Moreover, should private practice be ended in public hospitals, most complex private in-patient and emergency care is likely to remain within the public hospitals with limited capacity benefits for the public system.

Praise and recognition from supervisors buffers employee psychological strain: A two-sample investigation with tourism workers.

BACKGROUND: Focusing on employees with psychological strain, this research draws on Fredrickson's 'undoing hypothesis' to examine praise and recognition from one's supervisor as an organizational resource. OBJECTIVE: A model is tested in which psychological strain is a mediator in the positive relationship between role demands and employees' intentions to take sick leave and seek medical advice, and positions supervisor praise and recognition as a buffer of psychological strain on such intentions. METHODS: The model was tested using two Australian samples in the tourism sector, consisting of motel workers (n = 104) and museum workers (n = 168). RESULTS: For museum workers, but not motel workers, there was a positive indirect effect of each role demand on sick leave intentions through psychological strain that weakened as a function of supervisor praise and recognition. The proposed moderated mediated model was supported for both samples in regards to intentions to seek medical advice. CONCLUSIONS: This research contributes new evidence regarding the antecedents of employees' intentions to take sick leave and seek medical advice for work stress-related problems. It also contributes to the limited evidence regarding supervisor praise and recognition as a protective factor for employees exhibiting the symptoms of psychological strain.

The great convergence? Mortality in Ireland and Europe, 1956-2014.

BACKGROUND: Until recently, Irish age-standardized mortality rates (ASMRs) were amongst the highest in the EU-15. This study examines changes in ASMRs in Ireland from 1956 to 2014. METHODS: Using data from the World Health Organization Mortality Database, we compare ASMRs in Ireland to other EU-15 countries from 1956 to 2014. ASMRS are used to plot the relative ranking of Ireland within the EU-15, and illustrate trends in which Ireland diverged with, and converged to, the EU-15 average. ASMRS are estimated across sex, age groups (15-64 and 65+ years) and cause of death. RESULTS: Between 1956 and 1999, ASMRs in Ireland were amongst the highest in the EU-15. ASMRs in Ireland saw slower improvements during this period as compared to other EU-15 countries. However, post-2000, a sharp reduction in Irish ASMRs resulted in an accelerated convergence to the EU-15 average. As a consequence of improvements in ASMRs between 2000 and 2014, there were an estimated 15 300 fewer deaths in 2014. The majority of these averted deaths were due to lower mortality rates for diseases of the circulatory system and respiratory system. CONCLUSIONS: Rather than converging to the EU-15 average during the latter half of the 20th century, there was a divergence in ASMRs between Ireland and the EU-15. However, in recent years, Ireland experienced accelerated improvements in mortality rates with large reductions in mortality observed for diseases of the circulatory system and respiratory system, especially amongst older people.

The importance of supervisor emotion recognition for praise and recognition for employees with psychological strain.

Background: The present study examined the role of praise and recognition from one's supervisor in mitigating the extent to which employees with psychological strain intend to engage in stress-related behavioral intentions. Design: Two studies, each using a cross-sectional design, are presented. Method: Both studies utilized self-report data from local government employees (n = 313 Study 1; n = 244 Study 2). Results: In Study 1, moderated regressions with bootstrapping showed a strong positive association between psychological strain and stress-related behavioral intentions for employees with low levels of supervisor praise and recognition. In contrast, this relationship was less marked at high levels of supervisor praise and recognition. Study 2 replicated these findings and further demonstrated that praise and recognition, when given by a supervisor perceived to be high in emotion recognition skills, was the optimal combination. Of particular interest was the finding that high and low combinations of these two supervisor attributes did not compensate for each other and were just as detrimental as supervisors perceived to be low in both. Conclusions: Overall, results suggest that the effectiveness of appreciative behavior from supervisors depends on their emotion recognition skills.

How many beds? Capacity implications of hospital care demand projections in the Irish hospital system, 2015-2030.

Existing Irish hospital bed capacity is low by international standards while Ireland also reports the highest inpatient bed occupancy rate across OECD countries. Moreover, strong projected population growth and ageing is expected to increase demand for hospital care substantially by 2030. Reform proposals have suggested that increased investment and access to nonacute care may mitigate some increased demand for hospital care over the next number of years, and it is in this context that the Irish government has committed to increase the supply of public hospital beds by 2600 by 2027. Incorporating assumptions on the rebalancing of care to nonhospital settings, this paper analyses the capacity implications of projected demand for hospital care in Ireland to 2030. This analysis employs the HIPPOCRATES macrosimulation projection model of health care demand and expenditure developed in the ESRI to project public and private hospital bed capacity requirements in Ireland to 2030. We examine 6 alternative projection scenarios that vary assumptions related to population growth and ageing, healthy ageing, unmet demand, hospital occupancy, hospital length of stay, and avoidable hospitalisations. We project an increased need for between 4000 and 6300 beds across public and private hospitals (an increase of between 26.1% and 41.1%), of which 3200 to 5600 will be required in public hospitals. These findings suggest that government plans to increase public hospital capacity over the 10 years to 2027 by 2600 may not be sufficient to meet demand requirements to 2030, even when models of care changes are accounted for.