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Conflicting Financial Incentives in the Irish Health-Care System

Author

Listed:
  • AOIFE BRICK

    (Economic and Social Research Institute, Dublin Trinity College Dublin)

  • ANNE NOLAN

    (Economic and Social Research Institute, Dublin Trinity College Dublin)

  • JACQUELINE O’REILLY

    (Economic and Social Research Institute, Dublin Trinity College Dublin)

  • SAMANTHA SMITH

    (Economic and Social Research Institute, Dublin Trinity College Dublin)

Abstract

In health care, there is extensive empirical evidence that the behaviour of both providers and users is affected by the financial incentives that they face. In this paper, we adopt a systemwide perspective and develop a conceptual framework to examine how current financial incentives in Irish health care conflict along four dimensions: provider versus user, user across type of provider, provider versus provider, and provider across type of user. We highlight areas within each of these four dimensions where current financial incentive structures are incompatible with existing policy priorities. The analysis in the paper also provides a framework to assess the effects of proposed policy changes on financial incentives within the health-care system using a joint analytic approach.

Suggested Citation

  • Aoife Brick & Anne Nolan & Jacqueline O’Reilly & Samantha Smith, 2012. "Conflicting Financial Incentives in the Irish Health-Care System," The Economic and Social Review, Economic and Social Studies, vol. 43(2), pages 273-301.
    • Handle: RePEc:eso:journl:v:43:y:2012:i:2:p:273-301
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    References listed on IDEAS

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    1. Michel Grignon & Marc Perronnin & John N. Lavis, 2008. "Does free complementary health insurance help the poor to access health care? Evidence from France," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 203-219, February.
    2. Ellis, Randall P. & McGuire, Thomas G., 1996. "Hospital response to prospective payment: Moral hazard, selection, and practice-style effects," Journal of Health Economics, Elsevier, vol. 15(3), pages 257-277, June.
    3. Smith, Samantha & Normand, Charles, 2009. "Analysing equity in health care financing: A flow of funds approach," Social Science & Medicine, Elsevier, vol. 69(3), pages 379-386, August.
    4. Nolan, Anne & O'Reilly, Jacqueline & Smith, Samantha & Brick, Aoife, 2011. "The Potential Role of Pay-for-Performance in Irish Health Care," Papers EC4, Economic and Social Research Institute (ESRI).
    5. Moreno-Serra, Rodrigo & Wagstaff, Adam, 2010. "System-wide impacts of hospital payment reforms: Evidence from Central and Eastern Europe and Central Asia," Journal of Health Economics, Elsevier, vol. 29(4), pages 585-602, July.
    6. Siciliani, Luigi & Hurst, Jeremy, 2005. "Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries," Health Policy, Elsevier, vol. 72(2), pages 201-215, May.
    7. Jegers, Marc & Kesteloot, Katrien & De Graeve, Diana & Gilles, Willem, 2002. "A typology for provider payment systems in health care," Health Policy, Elsevier, vol. 60(3), pages 255-273, June.
    8. David Madden & Anne Nolan & Brian Nolan, 2005. "GP reimbursement and visiting behaviour in Ireland," Health Economics, John Wiley & Sons, Ltd., vol. 14(10), pages 1047-1060, October.
    9. Hausman, Dan & Le Grand, Julian, 1999. "Incentives and health policy: primary and secondary care in the British National Health Service," Social Science & Medicine, Elsevier, vol. 49(10), pages 1299-1307, November.
    10. Brick, Aoife & Nolan, Anne & O'Reilly, Jacqueline & Smith, Samantha, 2010. "Resource Allocation, Financing and Sustainability in the Health Sector," Papers RB2010/3/1, Economic and Social Research Institute (ESRI).
    11. Dhaval Dave & Robert Kaestner, 2009. "Health insurance and ex ante moral hazard: evidence from Medicare," International Journal of Health Economics and Management, Springer, vol. 9(4), pages 367-390, December.
    12. Nolan, Anne & Nolan, Brian, 2007. "The Utilisation of GP Services," Book Chapters, in: Nolan, Brian (ed.),The Provision and Use of Health Services, Health Inequalities and Health and Social Gain, Economic and Social Research Institute (ESRI).
    13. Louis F. Rossiter & Gail R. Wilensky, 1984. "Identification of Physician-Induced Demand," Journal of Human Resources, University of Wisconsin Press, vol. 19(2), pages 231-244.
    14. Jason Shafrin, 2010. "Operating on commission: analyzing how physician financial incentives affect surgery rates," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 562-580, May.
    15. Tussing, A. Dale, 1985. "Irish Medical Care Resources: An Economic Analysis," Research Series, Economic and Social Research Institute (ESRI), number GRS126.
    16. Ellis, Randall P., 1998. "Creaming, skimping and dumping: provider competition on the intensive and extensive margins1," Journal of Health Economics, Elsevier, vol. 17(5), pages 537-555, October.
    17. Gorecki, Paul K. & Nolan, Anne & Brick, Aoife & Lyons, Seán, 2012. "Pharmaceuticals Delivery in Ireland. Getting a Bigger Bang for the Buck," Research Series, Economic and Social Research Institute (ESRI), number RS24.
    18. Kutzin, Joseph, 2001. "A descriptive framework for country-level analysis of health care financing arrangements," Health Policy, Elsevier, vol. 56(3), pages 171-204, June.
    19. Samantha Smith, 2010. "The Irish ‘health basket’: a basket case?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(3), pages 343-350, June.
    20. Deininger, Klaus & Mpuga, Paul, 2004. "Economic and Welfare Effects of the Abolition of Health User Fees : Evidence from Uganda," Policy Research Working Paper Series 3276, The World Bank.
    21. Normand, Charles, 2008. "Health economics made easy: guiding the initiated and uninitiated," Health Economics, Policy and Law, Cambridge University Press, vol. 3(2), pages 213-218, April.
    22. Gannon, Brenda & Layte, Richard & McGregor, Pat & Madden, David & Nolan, Anne & O'Neill, Ciaran & Smith, Samantha, 2007. "The Provision and Use of Health Services, Health Inequalities and Health and Social Gain," Research Series, Economic and Social Research Institute (ESRI), number BMI196 edited by Nolan, Brian.
    23. Grytten, Jostein & Sorensen, Rune, 2001. "Type of contract and supplier-induced demand for primary physicians in Norway," Journal of Health Economics, Elsevier, vol. 20(3), pages 379-393, May.
    24. Colm Harmon & Brian Nolan, 2001. "Health insurance and health services utilization in Ireland," Health Economics, John Wiley & Sons, Ltd., vol. 10(2), pages 135-145, March.
    25. Joseph P. Newhouse, 1996. "Reimbursing Health Plans and Health Providers: Efficiency in Production versus Selection," Journal of Economic Literature, American Economic Association, vol. 34(3), pages 1236-1263, September.
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    Cited by:

    1. Richard Layte & Anne Nolan, 2015. "Eligibility for free GP care and the utilisation of GP services by children in Ireland," International Journal of Health Economics and Management, Springer, vol. 15(1), pages 3-27, March.
    2. Nolan, Anne, 2019. "Reforming the delivery of public dental services in Ireland: potential cost implications," Research Series, Economic and Social Research Institute (ESRI), number RS80.
    3. Connolly, Sheelah & Brick, Aoife & O'Neill, Ciarán & O'Callaghan, Michael, 2022. "An analysis of the primary care systems of Ireland and Northern Ireland," Research Series, Economic and Social Research Institute (ESRI), number RS137.
    4. O’Riordan Chris, 2018. "Balancing altruism and self-interest: GP and patient implications," The Irish Journal of Management, Sciendo, vol. 37(1), pages 1-15.
    5. Richard Layte & Anne Nolan, 2015. "Income-related inequity in the use of GP services by children: a comparison of Ireland and Scotland," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(5), pages 489-506, June.
    6. Conor Keegan & Samantha Smith, 2013. "The Length of Stay of In-Patient Stroke Discharges in Irish Acute Hospitals," The Economic and Social Review, Economic and Social Studies, vol. 44(3), pages 351-370.
    7. Hudson, Eibhlin & Nolan, Anne, 2015. "Public healthcare eligibility and the utilisation of GP services by older people in Ireland," The Journal of the Economics of Ageing, Elsevier, vol. 6(C), pages 24-43.
    8. Whyte, Richard & Connolly, Sheelah & Wren, Maev-Ann, 2020. "Insurance status and waiting times for hospital-based services in Ireland," Health Policy, Elsevier, vol. 124(11), pages 1174-1181.
    9. Layte, Richard & Nolan, Anne, 2013. "Income-Related Inequity in the Use of GP Services: A Comparison of Ireland and Scotland," Papers WP454, Economic and Social Research Institute (ESRI).

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