New Report on the Use of Health Care System by Older People in Ireland

Posted on: 14 March 2013

Pressure to Mount on Social Care Services with ageing population – Report Finds

A report on the use of health services by older people in Ireland has found that social care services are likely to face rapidly growing pressures with ageing. As part of The Irish Longitudinal Study on Ageing (TILDA), the report was launched today on the occasion of a conference also hosted by TILDA on ‘Meeting the challenge of an ageing Ireland’ for policy makers and researchers in ageing. The report was written by authors, Aoife McNamara, Prof. Charles Normand and Prof. Brendan Whelan.

The study focused on the drivers of service use in hospital, primary, community and social care services. These include age, whether you work, whether you live alone or with others, the presence of chronic diseases, having a medical card or having private insurance and measures of capacity to undertake everyday tasks.  Although chronic diseases and frailty increase with age, this relationship is changing and it is important to understand if age in itself is an important driver of use. The makeup of households is changing as more men are living into older age, with life expectancy between men and women converging.

At the time of the survey almost 70% of the population were paying out of pocket costs for primary and secondary care services. About 30% of the population had medical cards, providing free access to these services.

Use of GP services rises slowly with age, but there is no rise in use of outpatient or emergency department use between people in their sixties and those over 80.  Similarly hospital admissions are no higher for the older old, but the stay in hospital tends to be longer. This suggests that at least part of the higher use of services in hospitals is coming from the lack of support facilities and services to allow people to be discharged from hospital care into step down care or support for care at home.

In contrast to hospital and GP care, where age in itself is not a significant driver, the report found that community and social care services were likely to face rapidly growing pressures with ageing.  Even when other factors are taken into account age plays an important role in the use of public health nurse, home help and chiropody services.

It is also clear that entitlements to free services can be very important.  Despite being the wealthiest part of the elderly population, older people without medical cards are not using a range of important community services – they are less likely to see a chiropodist or a physiotherapist or a dentist.  This suggests that it is not simply financial barriers that are important in people getting access to services.

The data  used for the report was drawn from the first wave of The Irish Longitudinal Study on Ageing TILDA  a study of 8,175 participants representative of the community-living population aged 50 and over in Ireland.

Key findings of the study are:

• Age in itself is not a significant driver of health service use.  Factors related to age such as declining health or higher levels of entitlement are more important.
• Those who possess a medical card, on average, make two additional visits to their GP annually, even when health status and other factors are taken into account. This finding has important implications for the cost of introducing GP services which are universally free at point of use.
• Age is not strongly associated with use of outpatient services or the likelihood of being admitted to hospital, but older people do have longer hospital stays.
• Having a medical card increases the number of days in hospital, as does having medical insurance.
• Usage of GP service and numbers of nights spent in hospital are strongly affected by poor health (as indicated by self-rating, number of reported diseases and measures of disability).
• Living alone is not a major driver of the use of GP or hospital services. Married people have longer hospital stays than single people, which may be because single people are more likely to be discharged to other types of institutional care.
• Age is independently important in explaining the patterns of use of community and social care services. In particular, the use of home helps is concentrated in the older age groups. Use of social care services also increases with levels of disease and disability.
• Some service use decreases with age, in particular dental care. Other services, such as physiotherapy, are not affected significantly by age.
• Those without medical cards are low users of community services, especially those over 70.  This suggests that practical as well as financial barriers reduce use of services such as chiropody, physiotherapy among others.

Commenting on the importance of the findings, Prof.Charles Normand said:  “To a significant extent, this report is encouraging, as it shows that in many instances services are focused on those most likely to need them e.g., visits from public health nurses and home help are focused on those over 80 years. However, there are some disturbing messages.  Recent budget cuts have tended to fall heavily on precisely the services that are likely to be most under pressure, especially those that support people to remain at home or to leave hospital when their treatment is complete.  At times or rapid retrenchment there is a tendency to cut where you can and not where you should. It is also disturbing to see the extent to which those without medical cards are not using important services”.

The authors of the report ‘Patterns and Determinants of Health Care Utilisation in Ireland’ are Aoife McNamara, Health Research Board Scholar and Charles Normand, Edward Kennedy Professor of Health Policy and Management of TCD’S Centre for Health Policy and Management and Brendan Whelan of the Irish Longitudinal Study on Ageing (TILDA). For copy of report click on: