Area level deprivation and funding equity in public hospitals in Ireland: An examination of hospital groups and activity based funding

Reducing health inequalities is a priority of the Irish Government. Therefore, any changes to the health system should consider issues including fairness. A new method to fund public patient inpatient and day-case services in acute hospitals is currently being introduced in Ireland. This new funding model known as activity based funding (ABF) aims to help ensure sustainability and increase efficiency within our hospitals. Using ABF, hospitals will be paid a fixed amount for each activity undertaken. ABF payments for each activity are calculated based on factors including average length of stay (LOS) with adjustment for case complexity and for high LOS. Some research suggests that area level deprivation may impact on LOS and consequently on cost though this has not been examined in Ireland. This project aims to examine if the socio-economic profile of hospital groups (HGs) in Ireland vary and if socio-economic factors are associated with LOS and other health care measures. For this, we will define each HG area and describe the demographic and socio-economic characteristics of each population. Using microdata, we will then examine if population characteristics including deprivation are associated with health care measures including LOS. Finally, should we find evidence to suggest that unfair funding allocation to HGs is possible using ABF due to an association between socio-economic deprivation and health care measures, we will propose a solution to enhance the current methods for allocation of funding. This project will provide a timely, practical and relevant examination on key factors which may lead to unfair funding allocation in Ireland when using an ABF model. Should evidence of unfair funding allocation associated with socio-economic deprivation be identified, we will propose a solution that can be used nationally by those responsible for ensuring that hospitals are funded fairly to provide the best care possible.

Award Date
29 September 2017
Award Value
Principal Investigator
Professor Cathal Walsh
Host Institution
University of Limerick
Applied Partnership Awards