Smith Samantha, Walsh Brendan, Wren Maev-Ann, Barron Steve, Morgenroth Edgar, Eighan James, Lyons Seán
Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Ireland.
Economic and Social Research Institute, Sir John Rogerson's Quary, Whitaker Square, Dublin 2, Ireland.
HRB Open Res. 2021 Oct 4;4:111. doi: 10.12688/hrbopenres.13412.1. eCollection 2021.
Recent reforms in Ireland, as outlined in Sláintecare, the report of the cross-party parliamentary committee on health, are focused on shifting from a hospital-centric system to one where non-acute care plays a more central role. However, these reforms were embarked on in the absence of timely and accurate information about the capacity of non-acute care to take on a more central role in the system. To help address this gap, this paper outlines the most comprehensive analysis to date of geographic inequalities in non-acute care supply in Ireland. Data on the supply of 10 non-acute services including primary care, allied health, and care for older people, were collated. Per capita supply for each service is described for 28 counties in Ireland (Tipperary and Dublin divided into North and South), using 2014 supply and population data. To examine inequity in the geographic distribution of services, raw population in each county was adjusted for a range of needs indicators. The findings show considerable geographic inequalities across counties in the supply of non-acute care. Some counties had low levels of supply of several types of non-acute care. The findings remain largely unchanged after adjusting for need, suggesting that the unequal patterns of supply are also inequitable. In the context of population changes and the influence of non-need factors, the persistence of historical budgeting in Ireland has led to considerable geographic inequities in non-acute supply, with important lessons for Ireland and for other countries. Such inequities come into sharp relief in the context of COVID-19, where non-acute supply plays a crucial role in ensuring that acute services are preserved for treating acutely ill patients.
正如跨党派议会健康委员会的报告《Sláintecare》中所概述的，爱尔兰最近的改革重点是从以医院为中心的体系转向非急症护理发挥更核心作用的体系。然而，这些改革是在缺乏关于非急症护理在该体系中发挥更核心作用能力的及时准确信息的情况下展开的。为了填补这一空白，本文概述了迄今为止对爱尔兰非急症护理供应方面地理不平等现象最全面的分析。收集了包括初级护理、专职医疗和老年人护理在内的10项非急症服务的供应数据。利用2014年的供应和人口数据，描述了爱尔兰28个郡（蒂珀雷里郡和都柏林郡分为北部和南部）每项服务的人均供应量。为了研究服务地理分布的不公平性，根据一系列需求指标对每个郡的原始人口进行了调整。研究结果表明，各郡在非急症护理供应方面存在相当大的地理不平等。一些郡的几种非急症护理供应水平较低。在根据需求进行调整后，研究结果基本保持不变，这表明供应的不平等模式也是不公平的。在人口变化和非需求因素的影响背景下，爱尔兰历史预算编制的持续存在导致了非急症供应方面相当大的地理不平等，这对爱尔兰和其他国家都有重要的启示。在新冠疫情背景下，这种不平等现象凸显出来，在确保为治疗急症患者保留急症服务方面，非急症供应起着至关重要的作用。
