The Irish health-care system and austerity: sharing the pain

Thomas, Stephen; Burke, Sara; Barry, Sarah

doi:10.1016/s0140-6736(14)60744-3

Cited by 58 publications

(46 citation statements)

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“…4 While many of these changes are global phenomena, the situation in Ireland has been compounded by recent drastic cuts in expenditure resulting in reduced staffing levels while patient numbers and demands increase. 5 These workplace changes set the scene for a challenging psychosocial environment at work and the risk of impaired wellbeing and psychological distress.…”

Section: Introductionmentioning

confidence: 99%

What’s up doc? A national cross-sectional study of psychological wellbeing of hospital doctors in Ireland

et al. 2017

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ObjectivesTo measure levels of psychological distress, psychological wellbeing and self-stigma in hospital doctors in Ireland.DesignNational cross-sectional study of randomised sample of hospital doctors. Participants provided sociodemographic data (age, sex, marital status), work grade (consultant, higher/basic specialist trainee), specialty and work hours and completed well-being questionnaires (the Depression Anxiety Stress Scale, WHO Well-being Index, General Health Questionnaire) and single-item scales on self-rated health and self-stigma.SettingIrish publicly funded hospitals and residential institutions.Participants1749 doctors (response rate of 55%). All hospital specialties were represented except radiology.ResultsHalf of participants were men (50.5%). Mean hours worked per week were 57 hours. Over half (52%) rated their health as very good/excellent, while 50.5% reported positive subjective well-being (WHO-5). Over a third (35%) experienced psychological distress (General Health Questionnaire 12). Severe/extremely severe symptoms of depression, anxiety and stress were evident in 7.2%, 6.1% and 9.5% of participants (Depression, Anxiety, Stress Scale 21). Symptoms of distress, depression, anxiety and stress were significantly higher and levels of well-being were significantly lower in trainees compared with consultants, and this was not accounted for by differences in sociodemographic variables. Self-stigma was present in 68.4%.ConclusionsThe work hours of doctors working in Irish hospitals were in excess of European Working Time Directive’s requirements. Just over half of hospital doctors in Ireland had positive well-being. Compared with international evidence, they had higher levels of psychological distress but slightly lower symptoms of depression and anxiety. Two-thirds of respondents reported self-stigma, which is likely to be a barrier to accessing care. These findings have implications for the design of support services for doctors, for discussions on quality of patient care and for future research.

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Section: Introductionmentioning

confidence: 99%

What’s up doc? A national cross-sectional study of psychological wellbeing of hospital doctors in Ireland

et al. 2017

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“…While certain existing commitments in other priority areas were being met, for example the development of symptomatic breast services, there was little new investment of resources in the health system at the time. The emphasis was on cost saving, reducing staff numbers, and doing more with less [23]. The EAG process was ultimately superseded by these priorities.…”

Section: Discussionmentioning

confidence: 99%

“…Ireland was one of the countries worst affected by the recent global economic crisis, entering an economic recession in 2008 [22]. This had a significant impact on health care spending and the provision of services [23]. In 2009, a moratorium on recruitment in the health sector was introduced.…”

Section: Methodsmentioning

confidence: 99%

Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis

Hugh

Perry

Bradley

et al. 2014

Health Res Policy Sys

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BackgroundIn 2006, the Health Service Executive (HSE) in Ireland established an Expert Advisory Group (EAG) for Diabetes, to act as its main source of operational policy and strategic advice for this chronic condition. The process was heralded as the starting point for the development of formal chronic disease management programmes. Although recommendations were published in 2008, implementation did not proceed as expected. Our aim was to examine the development of recommendations by the EAG as an instrumental case study of the policy formulation process, in the context of a health system undergoing organisational and financial upheaval.MethodsThis study uses Kingdon’s Multiple Streams Theory to examine the evolution of the EAG recommendations. Semi-structured interviews were conducted with a purposive sample of 15 stakeholders from the advisory group. Interview data were supplemented with documentary analysis of published and unpublished documents. Thematic analysis was guided by the propositions of the Kingdon model.ResultsIn the problem stream, the prioritisation of diabetes within the policy arena was a gradual process resulting from an accumulation of evidence, international comparison, and experience. The policy stream was bolstered by group consensus rather than complete agreement on the best way to manage the condition. The EAG assumed the politics stream was also on course to converge with the other streams, as the group was established by the HSE, which had the remit for policy implementation. However, the politics stream did not converge due to waning support from health service management and changes to the organisational structure and financial capacity of the health system. These changes trumped the EAG process and the policy window remained closed, stalling implementation.ConclusionsOur results reflect the dynamic nature of the policy process and the importance of timing. The results highlight the limits of rational policy making in the face of organisational and fiscal upheaval. Diabetes care is coming on to the agenda again in Ireland under the National Clinical Care Programme. This may represent the opening of a new policy window for diabetes services, the challenge will be maintaining momentum and interest in the absence of dedicated resources.Electronic supplementary materialThe online version of this article (doi:10.1186/1478-4505-12-53) contains supplementary material, which is available to authorized users.

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“…The economic and financial crisis is believed to be taking its toll on the health of Europeans and on their health systems [1–3], although recent studies are emerging on health systems’ resilience in times of economic crisis [4–6]. Because of the decrease in consumers’ disposable income, raising unemployment, and controversial austerity measures introduced to ration demand and balance budgets, there are signs that population health status, demand for health care and health policies are beginning to be affected, particularly in Southern European countries like Greece [2, 7], Italy [8, 9], Spain [10–12] and Ireland [13].…”

Section: Introductionmentioning

confidence: 99%

Exploring public sector physicians’ resilience, reactions and coping strategies in times of economic crisis; findings from a survey in Portugal’s capital city area

Russo

Pires

Perelman

et al. 2017

BMC Health Serv Res

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BackgroundEvidence is accumulating on the impact of the recent economic crisis on health and health systems across Europe. However, little is known about the effect this is having on physicians - a crucial resource for the delivery of healthcare services. This paper explores the adaptation to the crisis of public sector physicians and their ability to keep performing their functions, with the objective of gaining a better understanding of health workers’ resilience under deteriorating conditions.MethodsWe conducted a survey among 484 public primary care and hospital physicians in Portugal’s capital city area and explored their perceptions of the crisis, adaptation and coping strategies. We used ordinal and logistic regression models to link changes in hours worked and intentions to migrate with physicians’ characteristics and specific answers.ResultsWe found little evidence of physicians changing their overall allocation of working time before and after the crisis, with their age, types of specialisation, valuation of job flexibility and independence significantly associated with changes in public sector hours between 2010 and 2015. Being divorced, not Portuguese, of younger age, and working a high number of hours per week, were found to increase the probability of physicians considering migration, the same as having a poor opinion of recent government health policies. On the other hand, enjoying their current working environment, not wanting to disrupt provision of service, and leisure time were found to protect against scaling down public sector hours or considering migration.ConclusionsOur work on Portuguese physicians contributes to the debate on health workers’ resilience, showing the value of understanding the influence of personal characteristics and opinions on their adaptation to changing circumstances, before designing policies to improve their working conditions and retention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2151-1) contains supplementary material, which is available to authorized users.

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The Irish health-care system and austerity: sharing the pain

Cited by 58 publications

References 1 publication

What’s up doc? A national cross-sectional study of psychological wellbeing of hospital doctors in Ireland

What’s up doc? A national cross-sectional study of psychological wellbeing of hospital doctors in Ireland

Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis

Exploring public sector physicians’ resilience, reactions and coping strategies in times of economic crisis; findings from a survey in Portugal’s capital city area

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