This study has three objectives: to profile Irish health and social service need, supply and utilisation by geographic area (county, major city and Dublin post-code); to use multi-variate modelling techniques to estimate the effects of supply of services outside hospitals on hospital utilisation; and, based on this analysis, to identify local areas with greater need for primary, community and long-term care services.
Within the context of reduced health expenditures and a Government policy of transferring activity and resources from acute hospitals to other settings, this analysis will seek to identify those areas in which greater resourcing of primary, community and long-term care is likely to have the greater impact on hospital length of stay. This analysis should assist policy-makers by identifying those areas in which implementation of policies to reduce acute hospital length of stay without increased resourcing of primary, community and long-term care would potentially risk placing undue burdens on informal care-givers, worsening health outcomes and causing counter-productive repeat admissions to acute hospitals. This study is designed to test the hypotheses that: in Ireland, as in other countries, acute hospital care and care in other settings are substitutes for one another (Forder 2009); and that across Ireland, in areas with a lesser supply of services outside acute hospitals, patients experience longer hospital length of stay. The analysis will provide detailed pictures by county and city outside Dublin and by post-code within Dublin of need for and supply and utilisation of health services; will estimate a multi-variate model of the determinants of acute public hospital inpatient length of stay taking into account variables for patient characteristics, hospital characteristics and the supply of care outside acute hospitals; will identify areas with greater need for primary, community and long-term care resources and will develop resource allocation recommendations by area and sector.