Economic essays on the impact of health insurance on healthcare utilisation and costs for older people in Ireland

Abstract

This thesis explores the drivers of healthcare utilisation and healthcare costs among older people in the Republic of Ireland, and, in particular, provides estimates for the impact of health insurance on utilisation, costs and informal care. This thesis is informed by projected changes in key policy and contextual factors that will pose questions for the future financing, delivery of and access to formal healthcare services in the Republic of Ireland. First, the complex, tiered nature of the Irish healthcare system and the role that health insurance plays in enabling access to formal healthcare services will change if government proposals for a more universal model of health insurance coverage comes into effect. Second, demographic trends indicate that the proportion of older individuals in the population, who tend to be the highest users of healthcare services, is increasing year on year. It is likely that both of these factors will lead to increasing pressures being placed on already capacity constrained formal healthcare systems to meet these demands. Additionally, such demand side pressures will increase the importance of informal care in the Irish healthcare system, both as a supplement to and a substitute for formal care. Furthermore, the impact of the proposed policy changes will likely influence the existing interactions between the formal and informal care systems. Within this context, the overarching motivation of the thesis is to expand knowledge and understanding of the role of health insurance, both public and private, and informal care in determining the use and cost of formal care services for older people in the Republic of Ireland. To this end, three sets of empirical econometric analyses were undertaken. The first empirical analysis examined the associations between health insurance status and utilisation of a range of hospital and community healthcare services. The findings suggest that higher levels of health insurance coverage impacted positively on healthcare utilisation generally. The second empirical analysis examined associations between health insurance status and healthcare costs. The findings suggest that higher levels of health insurance coverage impacted positively across the full distribution of healthcare costs. The third empirical analysis examined the associations between informal care and the utilisation and cost of healthcare services. The findings suggest that being in receipt of informal care impacted positively upon healthcare utilisation and costs. The analysis also showed that health insurance increased the likelihood of receiving informal care, although not of providing such care. Taken together, the findings suggest that projected changes to key policy and contextual factors relating to older Irish people will have important implications for both the formal and informal care systems and may be expected to lead to significant increases in healthcare utilisation and costs. Such evidence may be of interest to those charged with the design and delivery of formal healthcare services for older people and their carers in the Republic of Ireland. Policy-makers should be aware of the potential financial consequences of the proposed changes to the Irish healthcare system and put in place measures to control utilisation and costs in any new system.