Humes, Ha y; Ba e , Michelle; Walsh, B endan
Resea ch Repo
E ec s o new esiden ial de elopmen s on local
heal hca e demand and wo k o ce: E idence om p ima y
and acu e public hospi al ca e in I eland
Resea ch Se ies, No. 181
P o ided in Coope a ion wi h:
The Economic and Social Resea ch Ins i u e (ESRI), Dublin
Sugges ed Ci a ion: Humes, Ha y; Ba e , Michelle; Walsh, B endan (2024) : E ec s o new
esiden ial de elopmen s on local heal hca e demand and wo k o ce: E idence om p ima y and
acu e public hospi al ca e in I eland, Resea ch Se ies, No. 181, The Economic and Social Resea ch
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EFFECTS OF NEW RESIDENTIAL DEVELOPMENTS
ON LOCAL HEALTHCARE DEMAND AND
WORKFORCE: EVIDENCE FROM PRIMARY AND
ACUTE PUBLIC HOSPITAL CARE IN IRELAND
HARRY HUMES, MICHELLE BARRETT AND BRENDAN WALSH
RESEARCH
SERIES
NUMBER 181
APRIL 2024
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EFFECTS OF NEW RESIDENTIAL DEVELOPMENTS
ON LOCAL HEALTHCARE DEMAND AND
WORKFORCE: EVIDENCE FROM PRIMARY AND
ACUTE PUBLIC HOSPITAL CARE IN IRELAND
Ha y Humes
Michelle Ba e
B endan Walsh
Ap il 2024
RESEARCH SERIES
NUMBER 181
A ailable o download om www.es i.ie
© 2024 The Economic and Social Resea ch Ins i u e
Whi ake Squa e, Si John Roge son’s Quay, Dublin 2
h ps://doi.o g/10.26504/ s181
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ABOUT THE ESRI
The mission o he Economic and Social Resea ch Ins i u e (ESRI) is o ad ance
e idence-based policymaking ha suppo s economic sus ainabili y and social
p og ess in I eland. ESRI esea che s apply he highes s anda ds o academic
excellence o challenges acing policymake s, ocusing on 10 a eas o c i ical
impo ance o 21s cen u y I eland.
The Ins i u e was ounded in 1960 by a g oup o senio ci il se an s led by
D T.K. Whi ake , who iden i ied he need o independen and in-dep h esea ch
analysis o p o ide a obus e idence base o policymaking in I eland.
Since hen, he Ins i u e has emained commi ed o independen esea ch and i s
wo k is ee o any exp essed ideology o poli ical posi ion. The Ins i u e publishes
all esea ch eaching he app op ia e academic s anda d, i espec i e o i s
indings o who unds he esea ch.
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sec ion o ESRI membe s om academia, ci il se ices, s a e agencies, businesses
and ci il socie y. The Ins i u e ecei es an annual g an -in-aid om he Depa men
o Public Expendi u e and Re o m o suppo he scien i ic and public in e es
elemen s o he Ins i u e’s ac i i ies; he g an accoun ed o an a e age o 30 pe
cen o he Ins i u e’s income o e he li e ime o he las Resea ch S a egy. The
emaining unding comes om esea ch p og ammes suppo ed by go e nmen
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Fu he in o ma ion is a ailable a www.es i.ie.
THE AUTHORS
Ha y Humes and Michelle Ba e we e Resea ch Assis an s a he ESRI. B endan
Walsh is a Senio Resea ch O ice a he ESRI and Adjunc Associa e P o esso a
T ini y College Dublin.
ACKNOWLEDGEMENTS
This esea ch was comple ed unde he Join Resea ch P og amme on Housing
Economics be ween he Economic and Social Resea ch Ins i u e and he
Depa men o Housing, Local Go e nmen and He i age (DHLGH). The iews
exp essed in his pape a e hose o he au ho s and hey should no be ega ded
as an o icial posi ion o he DHLGH. We acknowledge ha he au ho s bea sole
esponsibili y o he analysis and in e p e a ions p esen ed. We a e g a e ul o he
Cen al S a is ics O ice, he Heal hca e P icing O ice and he Depa men o
Heal h o acili a ing access o he da a u ilised in he epo . The au ho s would
like o hank Pauline Rio dan, S ewa Logan and Alma Walsh (DHLGH) o help ul
commen s on his esea ch. Thanks also o he membe s o he Resea ch
P og amme S ee ing Commi ee as well as he anonymous ex e nal and in e nal
e iewe s o hei help ul commen s and guidance.
This epo has been accep ed o publica ion by he Ins i u e, which does no i sel ake ins i u ional
policy posi ions. All ESRI Resea ch Se ies epo s a e pee e iewed p io o publica ion. The au ho s
a e solely esponsible o he con en and he iews exp essed.
Table o con en s| i
TABLE OF CONTENTS
ABBREVIATIONS .....................................................................................................................................
EXECUTIVE SUMMARY ......................................................................................................................... ii
CHAPTER 1 INTRODUCTION ................................................................................................................ 1
1.1 In oduc ion ...................................................................................................................... 1
1.2 In eg a ing housing and heal h planning in I eland ......................................................... 2
1.3 Housing and heal hca e planning model.......................................................................... 5
1.4 Resea ch objec i es .......................................................................................................... 6
1.5 S uc u e o he epo ..................................................................................................... 7
CHAPTER 2 HOUSING AND HEALTHCARE IN IRELAND ........................................................................ 8
2.1 In oduc ion ...................................................................................................................... 8
2.2 Housing in I eland ............................................................................................................. 8
2.3 The I ish heal hca e sys em............................................................................................ 10
CHAPTER 3 INTEGRATING HOUSING AND HEALTHCARE PLANNING ................................................ 15
3.1 In oduc ion .................................................................................................................... 15
3.2 Impac o housing on heal h........................................................................................... 15
3.3 Housing, heal h and heal hca e in I eland ..................................................................... 17
3.4 Housing and heal h planning in e na ionally ................................................................. 17
3.5 Planning amewo k in I eland ....................................................................................... 22
CHAPTER 4 HOUSNG AND HEALTHCARE PLANNING MODEL AND DATA ......................................... 24
4.1 In oduc ion .................................................................................................................... 24
4.2 Modelling heal hca e demand and supply ..................................................................... 24
4.3 Da a and sou ces ............................................................................................................ 29
4.4 Benchma k de elopmen s .............................................................................................. 36
CHAPTER 5 RESULTS: DEMOGRAPHIC PROFILES OF HEALTHCARE UTILISATION .............................. 39
5.1 In oduc ion .................................................................................................................... 39
5.2 P ima y ca e u ilisa ion .................................................................................................. 39
5.3 Acu e public hospi al ca e u ilisa ion ............................................................................. 41
5.4 P ima y ca e u ilisa ion p o iles by enu e ype ............................................................. 48
5.5 Acu e public hospi al u ilisa ion p o iles by enu e ype ............................................... 49
ii | Residen ial de elopmen s and heal hca e
CHAPTER 6 RESULTS: HEALTHCARE DEMAND BY DEVELOPMENT TYPE ........................................... 54
6.1 In oduc ion .................................................................................................................... 54
6.2 P ima y ca e ................................................................................................................... 54
6.3 Acu e public hospi al demand and supply ..................................................................... 56
6.4 Conclusions ..................................................................................................................... 59
CHAPTER 7 SUMMARY AND CONCLUSIONS ...................................................................................... 60
7.1 In oduc ion .................................................................................................................... 60
7.2 Key indings .................................................................................................................... 60
7.3 Fu u e ex ensions o he HHP model ............................................................................. 61
7.4 Conclusions and e lec ions ............................................................................................ 65
REFERENCES ........................................................................................................................................ 68
APPENDIX ........................................................................................................................................ 74
A.1 P ima y Ca e Demand P o iles ac oss Benchma k De elopmen s ................................. 74
A.2 Acu e Public Hospi al Demand P o iles ac oss Benchma k De elopmen s ................... 76
A.3 Policy Changes Example – Uni e sal P ima y Ca e ........................................................ 81
Lis o ables / igu es |iii
LIST OF TABLES
Table 3.1 LTRC bed changes by owne ship ype, Feb ua y 2020–Decembe 2022 ....................... 12
Table 4.1 A e age household size by enu e ype (2021) .............................................................. 31
Table 4.2 Gende b eakdown by enu e ype and age .................................................................. 32
Table 4.3 Medical ca d co e age by age, sex and enu e ype ...................................................... 33
Table 4.4 Demand–supply a ios employed in he HHP model ..................................................... 36
Table 4.5 Tenu e composi ions in epo ’s benchma k de elopmen s ......................................... 38
Table 5.1 A e age annual GP and PN isi a es ............................................................................ 39
Table 5.2 A e age annual acu e public hospi al u ilisa ion a es .................................................. 43
Table 5.3 A e age inpa ien leng h o s ay pe admission ............................................................. 44
Table 6.1 Compa ison o GP demand and supply in benchma k de elopmen ypes ................... 55
Table 6.2 Compa ison o PN demand and supply in benchma k de elopmen ypes ................... 55
Table 6.3 Compa ison o ED a endances in benchma k de elopmen ypes ............................... 57
Table 6.4 Compa ison o day pa ien admissions, bed days and equi ed beds in
benchma k de elopmen ypes...................................................................................... 57
Table 6.5 Compa ison o elec i e inpa ien admissions, bed days and equi ed beds in
benchma k de elopmen ypes...................................................................................... 58
Table 6.6 Compa ison o eme gency inpa ien admissions, bed days and equi ed beds in
benchma k de elopmen ypes...................................................................................... 59
Table A.1 Compa ison o o al inpa ien (elec i e + eme gency) admissions, bed days and
equi ed beds in benchma k de elopmen ypes .......................................................... 80
Table A.2 Inc ease in GP isi s pe pe son on eceip o a medical ca d o GP isi ca d .............. 81
Table A.3 Compa ison o he implica ions o GP demand and supply in a 1,000-uni HFA
de elopmen wi h and wi hou uni e sal p ima y ca e ................................................. 82
i | Residen ial de elopmen s and heal hca e
LIST OF FIGURES
Figu e 1.1 ‘Which o he ollowing issues will ha e he mos in luence on which pa y o
independen candida e you o e o in he upcoming elec ion?’ .................................... 2
Figu e 3.1 Pe cen age o indi iduals wi h good o e y good sel - epo ed heal h by
enu e ype and age g oup, 2021 (aged 18+) ................................................................. 18
Figu e 3.2 Pe cen age o indi iduals wi h a epo ed ch onic illness o condi ion by enu e
ype and age g oup, 2021 (aged 18+) ............................................................................ 18
Figu e 3.3 Pe cen age o indi iduals wi h a medical ca d by enu e ype, 2007–2021 (aged
18+) ................................................................................................................................. 20
Figu e 4.1 Simpli ied diag amma ic ep esen a ion o he model .................................................. 26
Figu e 4.2 Age dis ibu ion o popula ion by enu e ype............................................................... 32
Figu e 5.1 A e age GP isi s pe annum by age, sex and public heal hca e co e age ................... 41
Figu e 5.2 A e age PN isi s pe annum by age, sex and public heal hca e co e age ................... 41
Figu e 5.3 A e age annual eme gency depa men a endances in public hospi als by age
and medical ca d s a us .................................................................................................. 45
Figu e 5.4 A e age annual day pa ien admissions in public hospi als by age and medical
ca d s a us ...................................................................................................................... 46
Figu e 5.5 A e age LOS o elec i e inpa ien s in public hospi als by single yea o age and
public heal hca e co e age s a us .................................................................................. 47
Figu e 5.6 A e age LOS o eme gency inpa ien s in public hospi als by single yea o age
and public heal hca e co e age s a us ........................................................................... 48
Figu e 5.7 Dis ibu ion o GP isi s ac oss enu e ypes ................................................................. 49
Figu e 5.8 Dis ibu ion o PN isi s ac oss enu e ypes ................................................................. 49
Figu e 5.9 Dis ibu ion o eme gency depa men a endances ac oss enu e ypes .................... 50
Figu e 5.10 Dis ibu ion o day pa ien ca e ac oss enu e ypes ..................................................... 51
Figu e 5.11 Dis ibu ion o elec i e inpa ien ca e ac oss enu e ypes ........................................... 52
Figu e 5.12 Dis ibu ion o eme gency inpa ien ca e ac oss enu e ypes ...................................... 53
Figu e A.1 GP isi s by age in benchma k de elopmen ypes ........................................................ 74
Figu e A.2 PN isi s by age in benchma k de elopmen ypes ........................................................ 75
Figu e A.3 Eme gency depa men a endances by age in benchma k de elopmen ypes .......... 76
Figu e A.4 Day pa ien admissions by age in benchma k de elopmen ypes ................................ 77
Figu e A.5 Elec i e inpa ien admissions by age in benchma k de elopmen ypes ...................... 78
Figu e A.6 Eme gency inpa ien admissions by age in benchma k de elopmen ypes ................. 79
Figu e A.7 Compa ison o GP isi s in 1,000-uni HFA de elopmen wi h and wi hou
uni e sal p ima y ca e .................................................................................................... 82
2 | Residen ial de elopmen s and heal hca e
p e e ence, and 32 pe cen chose housing. The wo issues we e lis ed subs an ially
highe han he nex highes anking issue, he economy, which ell a 8 pe cen .
While he impo ance o housing and heal h o I ish socie y is o en no ed, Figu e
1.1 p o ides clea e idence o he join salience o he wo issues in I eland. The
con inued s uc u al p oblems acing he housing and heal h sec o s also mean
ha he impo ance o hese wo issues will emain a he o e on o na ional and
local policy discussion.
FIGURE 1.1 ‘WHICH OF THE FOLLOWING ISSUES WILL HAVE THE MOST INFLUENCE ON WHICH PARTY OR
INDEPENDENT CANDIDATE YOU VOTE FOR IN THE UPCOMING ELECTION?’
Sou ce: I ish Times/Ipsos MRBI opinion poll, Gene al Elec ion 2020.
This epo , and he de elopmen o he HHP model speci ically, a e he e o e
impo an in he con ex o he impo ance o housing and heal hca e as public
policy conce ns. G ea e alignmen o planning ac oss housing and heal hca e can
help o educe he exis ing issues in hese sec o s and help o ensu e ha new
esiden ial de elopmen s alle ia e, a he han exace ba e, heal hca e supply and
accessibili y issues a bo h he na ional and local le el.
1.2 INTEGRATING HOUSING AND HEALTH PLANNING IN IRELAND
The link be ween housing and heal h ou comes is now well es ablished in he
in e na ional li e a u e. The WHO lis s ‘housing, basic ameni ies and he
en i onmen ’ as one o he key social de e minan s o heal h. Access o adequa e
housing and heal hca e a e undamen al o a good quali y o li e, and he lack o
ei he can ha e signi ican implica ions o he o he . The planning o housing and
heal hca e is o cen al impo ance o na ional and local policymake s, and he
bene i s o g ea e in eg a ion o housing and heal hca e planning ha e become
inc easingly clea . Be e in eg a ion o housing and heal hca e planning can help
ensu e ha housing policy can ocus on heal h ou comes.
0%
10%
20%
30%
40%
Heal h Housing Economy Clima e Public
spending
B exi O he
% esponden s
In oduc ion | 3
Poo quali y housing, such as housing ha su e s om dampness, cold o
o e c owding, can nega i ely impac men al and physical heal h ou comes and
childhood de elopmen (Howden-Chapman e al., 2007; Rol e e al., 2020).
The e o e, housing and planning policies ha a ge hese nega i e a ibu es o
housing quali y can ha e signi ican posi i e impac s on heal h. Fu he mo e,
policies designed o comba nega i e en i onmen al ex e nali ies can g ea ly
in luence heal h ou comes. Fo example, adequa e ba ie s o adon, a signi ican
heal h conce n in I eland (Dempsey e al., 2018a), may help educe he incidence
o lung cance . Thus, egula ions and policies o new housing in I eland can be
designed o di ec ly imp o e heal h ou comes. O he o ms o housing and
planning policies ha p io i ise social ameni ies and en i onmen al ac o s, such
as g een space wi hin esiden ial de elopmen s, may u he imp o e he o e all
public heal h o a local popula ion (Dempsey e al., 2018b).
Adequa e heal hca e supply planning in egions whe e popula ion inc eases will
occu ia new esiden ial de elopmen s is essen ial o gua an ee access o
necessa y heal hca e and ea men s bo h o new esiden s and people al eady
esiding in he su ounding communi ies. Ul ima ely, ailu e o accoun o
inc eases in heal hca e demand d i en by new de elopmen s, wi hou a
commensu a e heal hca e supply inc ease, leads o o e c owding in heal hca e
acili ies such as hospi al EDs and longe wai ing imes o o e bu dened GPs.
Policymake s and na ional and egional planne s he e o e equi e in o ma ion on
he likely impac s new housing de elopmen s may ha e on heal hca e demand and
supply. Cu en ly, he e exis s an in o ma ion gap on his issue in I eland. The HHP
model has been de eloped o in o m he p ocess o ma ching heal hca e supply o
local popula ion changes esul ing om new esiden ial de elopmen s.
The impo ance o in eg a ing housing and heal hca e planning is pa icula ly
ele an in he cu en con ex . I eland is expe iencing se e e sho ages in housing,
especially a o dable housing (Russell e al., 2021). P ojec ed popula ion inc eases
in he coming yea s a e likely o exace ba e his p oblem. Sho ages also cu en ly
exis o a ious heal hca e se ices. Howe e , plans ha can e ec i ely inc ease
supply o bo h housing and heal hca e se ices ha e he abili y o empe supply
sho age and wai ing lis issues. In addi ion, plans o inc ease housing supply may
also ha e downs eam impac s on heal hca e supply.
E idence om he ESRI highligh s ha inc easing annual housing ou pu om
25,000 comple ions pe annum o 30,000 pe annum could educe housing p ices
by 12 pe cen by 2030 (Egan e al., 2022). This, in u n, would imp o e access o
a o dable housing. Howe e , such inc eases in housing ou pu could po en ially
ha e a di e en e ec on heal hca e, as hey could inc ease demand o heal hca e
se ices in hose a eas whe e housing ou pu inc eases. The po en ial downs eam
e ec s o his on heal hca e accessibili y should be accoun ed o in he
cons uc ion o new esiden ial de elopmen s.
4 | Residen ial de elopmen s and heal hca e
Cu en ly, heal hca e in I eland is acing s a ing and capaci y sho ages,
pa icula ly in he public heal hca e sys em. The public acu e hospi al sys em is
es ima ed o ha e a sho all o 1,000 inpa ien beds in 2023 (Walsh and B ick,
2023). These sho alls esul in long wai ing lis s o a ious se ices due o
insu icien supply. Addi ionally, heal hca e supply in I eland is o en cha ac e ised
by geog aphic inequali ies, wi h la ge a ia ions in pe capi a heal hca e supply
ac oss coun ies (Smi h e al., 2019). Resea ch shows ha he g ea e Dublin
commu e bel coun ies, such as Kilda e, Mea h and Wicklow, ha e he lowes le el
o pe capi a heal hca e p o ision (Smi h e al., 2019). I has also been shown ha
hese coun ies ha e expe ienced he la ges inc eases in popula ion in ecen
decades (Mo gen o h, 2018; Be gin and Ga cía-Rod íguez, 2020). These indings
indica e a lack o planning o heal hca e se ices, bo h a he local le el and wi hin
he heal hca e sys em, as he planning o app op ia e heal h and social ca e
se ices o mee new demand has o en lagged behind demog aphic shi s and
apid popula ion g ow h in ce ain egions.
A c ucial de e minan o he unequal dis ibu ion o heal hca e esou ces ac oss
a ious egions in I eland is he absence o a esou ce alloca ion mechanism wi hin
he heal hca e sys em. In con as o many heal hca e sys ems, such as he UK’s
Na ional Heal h Se ice (NHS), he I ish heal hca e sys em has no implemen ed a
mechanism o appo ion esou ces o heal h and social ca e se ices based on
a eas wi h he highes demand. The necessi y o such a mechanism was an
impo an ou come highligh ed by he Sláin eca e epo (Bu ke e al., 2018). In
2023, he Depa men o Heal h published a epo ou lining a PBRA c i e ia o
heal hca e (O’Malley e al., 2023). The p oposed PBRA c i e ia ecommends he
equi able dis ibu ion o Heal h Se ice Execu i e (HSE) expendi u e ac oss six
newly c ea ed HSE Heal h Regions based on hei espec i e heal hca e
equi emen s. The PBRA mechanism will alloca e esou ces based on popula ion
size, as well as o he socio-demog aphic ac o s such as age, gende , a es o
dep i a ion and he u ali y o each Heal h Region’s popula ion. The
implemen a ion o his p oposed mechanism is an icipa ed o commence in 2024.
The implemen a ion o a PBRA mechanism could po en ially enhance he
e ec i eness and equali y o heal hca e supply. I would also unde sco e he
po en ial bene i s o a ool such as he HHP model in p o iding e idence o na ional
and local planne s on how bes o mee he heal hca e demand o new housing
de elopmen s in p ac ice. In his con ex , PBRA could augmen he HHP model’s
capaci y o di ec ly in o m local heal hca e planning policies. Gi en he g owing
popula ion o I eland and escala ing demand o housing and heal hca e,
coo dina ed hinking ac oss bo h domains will p omo e ai and e icien alloca ion
o esou ces ac oss a ious geog aphic egions and socioeconomic g oups. Ou pu s
om he HHP model ha e he po en ial o aid his coo dina ed hinking.
In oduc ion | 5
1.3 HOUSING AND HEALTHCARE PLANNING MODEL
Heal hca e demand is d i en by socio-demog aphic ac o s such as age, sex and
socioeconomic s a us (W en e al., 2017). Simila ly, housing de elopmen s
in a iably di e by hei socio-demog aphic p o ile as well as hei a ibu es,
speci ically hei size, loca ion and enu e composi ion. The e o e, he HHP model
es ima es heal hca e demand acco ding o unde lying socio-demog aphic ac o s
and he enu e composi ion o he de elopmen s. In pa icula , HHP model ou pu s
a e es ima ed a he enu e le el o h ee di e en enu e ypes: homes occupied
by homeowne s (‘owne ’ – owned ou igh o h ough a mo gage); homes ha
a e p i a ely en ed (‘p i a e en e s’); and homes occupied by en e s ecei ing
s a e suppo (‘suppo ed en e s’). The model also p oduces esul s acco ding o
de elopmen size, which we ela e o he geog aphic loca ion o he de elopmen
( u al/subu ban/u ban).
The model is pa ame e ised using demog aphic in o ma ion o each enu e ype,
including age and sex composi ion, household size and public heal hca e co e age
(medical ca d o GP isi ca d) s a us. The la e pa ame e , as demons a ed in he
epo , is i al o include o accoun o he cen al ole played by medical ca ds
and GP isi ca ds in imp o ing accessibili y and inc easing heal hca e u ilisa ion in
he I ish heal hca e sys em. The majo i y o he model’s demog aphic da a a e
de i ed om he Su ey on Income and Li ing Condi ions (SILC).
This epo p oduces demand and supply es ima es o key p ima y ca e se ices,
namely GP and PN ca e, as well as public acu e hospi al ca e se ices, including ED,
day pa ien , elec i e inpa ien and eme gency inpa ien ca e. These heal hca e
se ices we e chosen owing o hei cen al ole in mee ing heal hca e needs
ac oss all age g oups, and he in o ma ion a ailable on he supply o such se ices
in I eland. Fu u e de elopmen s o he HHP model will endea ou o inco po a e a
wide ange o heal hca e se ices, as well as social ca e se ices designed o
suppo speci ic subg oups such as olde people and people li ing wi h a disabili y.
The HHP model is a cell-based mac osimula ion model. This modelling app oach
was chosen as he analyses build upon he Hippoc a es model o heal hca e
demand, supply and expendi u e ha was de eloped a he ESRI (W en e al.,
2017). Such models in ol e g ouping indi iduals in o s a a – known as ‘cells’ –
acco ding o ce ain demog aphic cha ac e is ics. In he case o he HHP model,
cells a e g ouped by age, sex and public heal hca e co e age s a us. The bene i o
his app oach is ha heal hca e demand can be ‘cons uc ed’ acco ding o
popula ion demog aphics, such as age and sex. I he eby enables us o model
demand ac oss housing de elopmen s ha a y by size and enu e composi ion.
Addi ionally, while he Hippoc a es model p ojec s heal hca e demand a a
na ional o agg ega ed egional le el, such as he HSE Heal h Regions (Keegan e
al., 2020; Keegan e al., 2022), he HHP model is mo e localised in na u e,
examining he heal hca e needs o popula ions in new esiden ial de elopmen s.
6 | Residen ial de elopmen s and heal hca e
This enables a highe deg ee o disagg ega ion o p e iously p ojec ed demand,
wo k o ce and capaci y equi emen s. Fu he mo e, i p o ides planning
au ho i ies wi h a use ul ool o gauging how hei planning decisions will in e ac
wi h he heal hca e sys em a he local le el.
Building on p e ious wo k (Humes e al., 2023), analyses in his epo also examine
he ela ionship be ween housing and heal h in I eland. Housing and
neighbou hood cha ac e is ics ha e been iden i ied as key social de e minan s o
heal h by he WHO. Despi e housing and heal h being consis en ly highligh ed as
key conce ns o he I ish popula ion, he e has o da e been li le coo dina ed
planning in he deli e y o hese se ices. The epo also explo es he ela ionship
be ween housing, heal h and heal hca e co e age, and he nuances ha exis as a
esul o a agmen ed, wo- ie heal hca e sys em in I eland. This analysis
con ibu es new e idence o ou limi ed exis ing knowledge base on hese
ela ionships. The esul s om ou ea ly analyses and Humes e al. (2023) a e
subsequen ly used o p ecisely pa ame e ise he HHP model.
This epo p esen s he i s indings om he HHP model. Subsequen esea ch
employing he HHP model is expec ed o o ecas u u e heal hca e demands as
esiden ial de elopmen s and communi ies e ol e, and as he demog aphic p o ile
o esiden s shi s. Addi ionally, i is en isaged ha u u e esea ch using he model
will examine he speci ic in as uc u e equi emen s esul ing om inc eased
heal hca e demand. Gi en ha bo h housing and heal h policies a e p one o
change, he model has been cons uc ed o accommoda e his po en ial a iabili y
and enable he s udy o eme ging policies in bo h he housing and heal h sec o s.
1.4 RESEARCH OBJECTIVES
The o e all objec i es o he epo a e o:
• p o ide comp ehensi e es ima es o he po en ial heal hca e demand
implica ions o new housing de elopmen s using benchma k examples;
• p o ide es ima es o he heal hca e wo k o ce and capaci y supply ha may
be equi ed o mee inc eased demand;
• examine how enu e composi ion o de elopmen s, in he con ex o he HFA
policy, impac s heal hca e demand and supply;
• examine in g ea e de ail he ela ionship ha exis s be ween housing, heal h
and heal hca e co e age in I eland. In pa icula , he epo aims o inc ease
unde s anding o how wo a ms o he social wel a e sys em (housing suppo s
and medical ca ds/GP isi ca ds) a e ela ed and can indi ec ly impac
heal hca e demand; and
• inally, o de elop a modelling amewo k ha allows policymake s o analyse
he impac o policy changes such as hose ou lined in Sláin eca e and HFA on
heal hca e equi emen s, and in o m u u e planning amewo ks de eloped
in I eland.
In oduc ion | 7
1.5 STRUCTURE OF THE REPORT
Chap e 2 p o ides an o e iew o he I ish housing and heal hca e sys ems.
Chap e 3 ou lines he ela ionship be ween housing, heal h and heal hca e
demand and supply. This chap e also p o ides de ail on o he ju isdic ions ha
ha e implemen ed some deg ee o in eg a ion be ween housing and heal hca e
planning. Chap e 4 gi es an o e iew o he HHP model, including i s cons uc ion
and da a inpu s. Chap e s 5 and 6 p esen ou pu s om he HHP model,
highligh ing how a ia ion in he size and enu e composi ion o new esiden ial
de elopmen s will ha e implica ions o heal hca e need and supply in a gi en
locali y. Chap e 7 summa ises he esul s and o e s concluding ema ks and
e lec ions.
8 | Housing and heal hca e in I eland
CHAPTER 2
Housing and heal hca e in I eland
2.1 INTRODUCTION
This chap e examines he housing and heal hca e sys ems in I eland, wi h a ocus
on hei in eg a ion, o lack he eo , in he cu en planning landscape. The chap e
p o ides a sho o e iew o he housing and heal hca e sys ems in place. I also
discusses he ela ionship be ween heal h and housing in I eland.
2.2 HOUSING IN IRELAND
2.2.1 Cu en challenges
The housing sec o in I eland aces a mul i ude o challenges, including in ela ion
o a o dabili y, quali y and supply. In ecen yea s, he coun y has expe ienced a
housing c isis ma ked by a lack o a o dable and sui able homes. While many
ac o s unde pin hese issues, he oo cause can be a ibu ed o he g owing
popula ion and changes in demog aphic p o iles (Be gin and Ga cía-Rod íguez,
2020), which ha e led o a signi ican sho all in he supply o a o dable and
sui able homes (Russell e al., 2021; Egan e al., 2022). The cu en le el o new
housing supply in I eland is signi ican ly below his o ical le els (Slaymake e al.,
2022). Policies a e now ocused on add essing he challenges o supply and
a o dabili y.
The challenges acing housing a e also e lec ed in enu e composi ion changes.
Recen yea s ha e seen changes in he enu e composi ion o households in
I eland. In 2000, only 18 pe cen o households we e en ed (p i a ely o
suppo ed), wi h 82 pe cen o households being homeowne -occupied dwellings.
Howe e , in 2020, 29 pe cen o households we e en ed (Doolan e al., 2022).
This change in enu e composi ion has been u he illus a ed in Census 2022,
whe e 66 pe cen o households we e ound o be homeowne occupied.
1
This
end owa ds en ing and away om homeowne ship is likely o con inue o
u u e gene a ions (Slaymake e al., 2022).
2.2.2 Housing go e nance
Go e nance o housing policy in I eland is spli be ween na ional and local le els.
A he na ional le el, he DHLGH is esponsible o de eloping and implemen ing
na ional policies and s a egies ela ed o housing and planning. I also plays a ole
1
See h ps://www.cso.ie/en/ eleasesandpublica ions/ep/p-cps /censuso popula ion2022-
summa y esul s/dwellingcha ac e is ics/#:~: ex =Housing%20Tenu e& ex =The%20p opo ion%20o %20
owne %2Doccupied,o %20loan%20inc eased%20by%2011%25.
Residen ial de elopmen s and heal hca e | 9
in suppo ing sus ainable de elopmen and he p o ec ion o he en i onmen . The
DHLGH o e sees he planning sys em, including he de elopmen and
implemen a ion o he Na ional Planning F amewo k (NPF) and he Na ional
De elopmen Plan (NDP). Th ough hese oles, he DHLGH suppo s he deli e y o
in as uc u e p ojec s and p omo es sus ainable u ban and u al de elopmen .
The DHLGH adminis e s a ious housing- ela ed schemes including he Housing
Assis ance Paymen (HAP) and he Rebuilding I eland Home Loan (O’Toole and
Slaymake , 2022). I is esponsible o se ing na ional housing s anda ds,
egula ing he p i a e en al sec o and add essing homelessness h ough
ini ia i es such as he Housing Fi s p og amme.
A he local le el, local au ho i ies (i.e., coun y and ci y councils) a e esponsible
o he deli e y o housing wi hin hei own elec o al bounda ies. Ac oss many
s a e p og ammes, local au ho i ies a e empowe ed o ake a mo e p oac i e
app oach o housing supply and planning. They also ha e some au onomy o e
income h esholds o s a ewide p og ammes like HAP. The g owing ecogni ion o
he need o a mo e coo dina ed and in eg a ed app oach o housing policy has
esul ed in he es ablishmen o bodies such as he Land De elopmen Agency
(LDA) and he Housing Agency. These a e s a e bodies es ablished o aid in he
planning, coo dina ion and deli e y o housing in I eland.
In he pas , housing policy in I eland was p ima ily ocused on homeowne ship
(Co igan e al., 2019), wi h go e nmen suppo s o he cons uc ion o new
homes and he p o ision o a o dable mo gages. Howe e , he inc eased shi
owa ds p i a e en ing in I eland (Slaymake e al., 2022) has esul ed in policies
ocused on inc easing he supply o a o dable housing, imp o ing he quali y and
s anda ds o en al accommoda ion and add essing homelessness. The
Go e nmen has in oduced a ange o measu es o suppo hese objec i es.
F om a supply iewpoin , he LDA p o ides inance o housing de elopmen s and
Local Housing In as uc u e Ac i a ion Funds o educe cons uc ion cos s. F om
an a o dabili y aspec , he Help o Buy scheme and he Rebuilding I eland Home
Loan we e in oduced o suppo homeowne s. Schemes such as he HAP suppo
and he Ren al Accommoda ion Scheme p o ide addi ional housing o s a e-
suppo ed enan s by con ac ing p i a e en al accommoda ion and subsidising
he en al paymen s, while Ren P essu e Zones seek o place a p ice ceiling on
en al p ope ies mo e gene ally by capping any en inc eases a 2 pe cen pe
annum. Finally, a dedica ed p og amme o add ess homelessness in I eland –
Housing Fi s – has been es ablished o aid hose whose access o housing is
impeded by challenges hey ace in ela ion o hei men al heal h, physical heal h,
subs ance misuse, social o beha iou al issues.
Despi e hese schemes, housing p o ision in I eland emains a majo policy
challenge, wi h signi ican p essu e on he en al ma ke and many households
10 | Housing and heal hca e in I eland
s uggling o a o d sui able accommoda ion. The e also exis conce ns abou he
quali y (i.e., o e c owding) and s anda ds o housing in some pa s o he coun y,
pa icula ly in u ban a eas and in homes en ed om local au ho i ies (G o i e al.,
2018).
2.3 THE IRISH HEALTHCARE SYSTEM
The I ish heal hca e sys em is cha ac e ised by a mix u e o public and p i a e
heal hca e co e age and unding. The wo key s akeholde s in he I ish heal h
sys em a e he Depa men o Heal h and he HSE. Public heal hca e policy
c ea ion, de elopmen and implemen a ion is o e seen by he Depa men o
Heal h. I p o ides o e sigh o public heal h bodies, moni o ing hei pe o mance
o ensu e e iciency, cos e ec i eness and quali y o ca e. The Depa men o
Heal h has de eloped inc eased o e sigh o he social de e minan s o heal h and
p o ides public heal h in o ma ion. In ecen yea s, i has o e seen b oade
policies ha o en in eg a e wi h housing and planning, including he Heal hy
I eland amewo k and he Ageing in Place policy.
The HSE is unded by he Depa men o Heal h and adminis e s and o ganises all
publicly unded heal h and social ca e se ices. The HSE eplaced he o me
egional heal h boa ds (es ablished in he 1970 Heal h Ac ), and a numbe o
eo ganisa ions o he HSE ha e occu ed since i s es ablishmen (Smi h e al.,
2019). In ecen yea s, esponsibili y o he deli e y o p ima y and communi y
ca e se ices has allen o local heal h o ices (LHOs) and communi y heal hca e
o ganisa ions (CHOs). Fu he o his, se en egional Hospi al G oups we e
es ablished o o ganise and p o ide acu e ca e se ices a a egional le el. Fu he
subs an ial changes o he HSE a e planned ollowing p oposals ou lined in he
Sláin eca e epo . G ea e au onomy is planned o local heal h policymake s in
new HSE Heal h Regions, a change ha will be impo an o conside when
designing in eg a ed housing and heal hca e policy. PBRA, as discussed in Chap e
1, will be adminis e ed a he Heal h Region le el.
2.3.1 Heal hca e co e age
While I eland does ha e a public heal hca e sys em i does di e ge somewha om
many o he Eu opean coun ies in ha he p i a e sec o also plays a signi ican
ole in he inancing and deli e y o heal hca e (Connolly and W en, 2019). As a
esul , a ‘ wo- ie ed’ heal hca e sys em has eme ged, wi h sepa a e s eams o
unding and go e nance.
Public heal hca e co e age
Access o public heal hca e is mainly based a ound he medical ca d scheme.
Medical ca ds a e issued by he HSE and en i le he holde and hei immedia e
amily o ee heal hca e se ices in p ima y ca e and communi y ca e (e.g.,
occupa ional he apy), and in acu e public hospi als. In addi ion, medical ca ds
Residen ial de elopmen s and heal hca e | 11
p o ide ee access o den al, op ical and au al se ices, as well as educed
p esc ip ion cha ges. En i lemen o a medical ca d is de e mined a he le el o
he amily o household and is p edominan ly con ingen upon an income means
es adminis e ed a he household le el. The income h esholds a y based on age,
wi h households wi h he lowes income and hose elian on social wel a e
gene ally mee ing he c i e ia o eligibili y. Fo he majo i y o households, he
means es pe mi s deduc ions o expenses such as childca e and housing cos s.
Howe e , households wi h a membe aged 70+ a e subjec o an income means
es based solely on g oss income. A small pe cen age o indi iduals holding a
medical ca d also quali y on a disc e iona y basis i hey ha e a diagnosed ch onic
heal h condi ion o when hei medical cos s a e deemed o be excessi ely
inancially bu densome. As o Ma ch 2024, 1.6 million indi iduals we e medical
ca dholde s, ep esen ing app oxima ely 31 pe cen o he popula ion. A de ailed
b eakdown o he scheme can be ound elsewhe e (Keane e al., 2021).
The HSE also issues GP isi ca ds, which en i le holde s o ee GP isi s. Eligibili y
o a GP isi ca d is p ima ily based on a means es , wi h income h esholds se
app oxima ely 50 pe cen highe han o a medical ca d. Eligibili y o a GP isi
ca d is es ablished a he indi idual a he han he amily/household le el. In
addi ion, all child en aged unde 8 yea s and adul s aged o e 70 yea s and a e
au oma ically en i led o a GP isi ca d (i hey do no al eady possess a medical
ca d). In Ma ch 2024, o e 640,000 people held a GP isi ca d, app oxima ely 14
pe cen o he popula ion.
In he case o a small numbe o public heal hca e se ices, access o ca e is also
dependen upon illness (e.g., he Long-Te m Illness Scheme) o need ( he Nu sing
Home Suppo Scheme, also known as he ‘Fai Deal’ Scheme).
P i a e heal hca e co e age
The majo i y o he popula ion wi hou a medical ca d possess supplemen a y
p i a e heal h insu ance (PHI). This co e age is a olun a y insu ance-based
sys em, wi h h ee majo p o ide s o e ing a ange o PHI plans.
2
PHI ypically
en i les he holde o a ange o bene i s no a ailable o hose wi h public
co e age, such as a p i a e oom in hospi al o mo e apid access o elec i e ca e.
Indi iduals pu chase PHI o a numbe o easons. All indi iduals wi hou a medical
ca d (o GP isi ca d in he case o gene al p ac ice) mus pay ou -o -pocke o
p ima y ca e, communi y ca e and some public acu e hospi al se ices such as ED
a endances. PHI ypically p o ides co e age o mos , o in some cases all, o he
cos o ecei ing his ca e. Howe e , he abili y o access elec i e and ou pa ien
ca e in p i a e hospi als (o as p i a e pa ien s in public hospi als) mo e quickly is
2
The e we e o e 320 indi idual PHI plans a ailable in 2023; see h ps://www.hia.ie/si es/de aul / iles/
2023-10/ inal_annual- epo _2022_english.pd .
18 | Housing and heal hca e in I eland
highligh a consis en ela ionship be ween heal h and enu e ype. These esul s
ollow closely hose ound in he in e na ional li e a u e (Digenis-Bu y e al., 2008;
Kand e al., 2016).
FIGURE 3.1 PERCENTAGE OF INDIVIDUALS WITH GOOD OR VERY GOOD SELF-REPORTED HEALTH BY TENURE
TYPE AND AGE GROUP, 2021 (AGED 18+)
Sou ce: Humes e al. (2023)
FIGURE 3.2 PERCENTAGE OF INDIVIDUALS WITH A REPORTED CHRONIC ILLNESS OR CONDITION BY TENURE
TYPE AND AGE GROUP, 2021 (AGED 18+)
Sou ce: Humes e al. (2023)
The ela ionship be ween housing and heal hca e in I eland is shaped in pa by
he close associa ion be ween hese wo issues and he social wel a e sys em. As
bo h suppo ed housing and public heal hca e co e age all unde his sys em, i
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
18-34 35-49 50-64 65+
% epo ing good o e y good heal h
Owne s P i a e en e s Suppo ed en e s
0%
10%
20%
30%
40%
50%
60%
70%
18-34 35-49 50-64 65+
% epo ing a ch onic condi ion
Owne s P i a e en e s Suppo ed en e s
In eg a ing housing and heal hca e planning | 19
may be assumed ha he e is a deg ee o consis ency ac oss hese a eas. Howe e ,
his is no always he case. Income h esholds o wel a e bene i s a y, and while
housing assis ance is managed locally by local au ho i ies, policies conce ning
public heal hca e co e age a e de e mined a he na ional le el by he HSE and he
Depa men o Heal h. Consequen ly, dispa i ies can eme ge. Fo example, he
income limi s o social housing and HAP di e ac oss local au ho i ies, while he
income h eshold o medical ca ds emains cons an ac oss he coun y ( hough
cos s included in he means es may di e ac oss egions). Households wi h low
income in ce ain a eas may quali y o housing suppo , bu may no be eligible
o a medical ca d due o he na ionally ixed income h eshold.
Gi en he complexi ies ha o en exis a ound access o public suppo s, a clea e
unde s anding o he in e play be ween housing enu e and public heal hca e
co e age is c ucial. The housing ac o s ha impac poo e heal h ou lined abo e
disp opo iona ely a ec indi iduals and households wi h low o mode a e
incomes. Mo eo e , hose who a e cu en ly in he p i a e en al ma ke , and who
a e mo e likely o belong o his income b acke , ace addi ional challenges due o
escala ing en al cos s and inc eased ulne abili y o unexpec ed heal hca e
expenses. These challenges ha e signi ican implica ions o household disposable
income and long- e m heal h ou comes, pa icula ly o wel a e.
Figu e 3.3 shows a clea ela ionship be ween medical ca d s a us and suppo ed
housing. Suppo ed en e s ha e by a he highes a es o medical ca d co e age
a almos 75 pe cen . These highe a es a e likely due o a combina ion o ac o s,
bu mainly o suppo ed en e s ha ing a lowe household income and/o ecei ing
all hei income om social wel a e,
9
compa ed o o he enu e ypes. P i a e
en e s (19 pe cen ) and homeowne s (24 pe cen ) ha e simila medical ca d
a es.
9
Those who ecei e all o hei income om social wel a e au oma ically quali y o a medical ca d.
20 | Housing and heal hca e in I eland
FIGURE 3.3 PERCENTAGE OF INDIVIDUALS WITH A MEDICAL CARD BY TENURE TYPE, 2007–2021 (AGED 18+)
Sou ce: Humes e al. (2023)
This igu e once mo e highligh s he necessi y o including medical ca d co e age
(and GP isi ca d co e age o p ima y ca e) as a key pa ame e in he HHP model.
Va ia ion in public heal hca e co e age ac oss enu e ypes means ha he enu e
composi ion o a gi en new de elopmen will ha e a signi ican impac on he
heal hca e demand induced by ha de elopmen .
3.4 HOUSING AND HEALTH PLANNING INTERNATIONALLY
In a numbe o o he coun ies he e ha e al eady been mo emen s made owa ds
g ea e coo dina ion o planning o housing and heal hca e se ices. The
cons uc ion o new housing de elopmen s in many coun ies has begun o be
mo e ocused a ound he e hos o building ‘heal hy communi ies’. This includes,
al hough is no limi ed o, he expansion o g een spaces, educ ion o pollu ion,
acili a ion o heal hie modes o anspo (i.e., walking and cycling) and g ea e
in eg a ion wi h local heal h and social ca e sys ems. In his sec ion, we p o ide
some pe inen examples o e o s made in o he ju isdic ions o be e ailo
planning policy owa ds he goal o imp o ing heal h ou comes and heal hca e
accessibili y.
England has a guably been a he o e on o e o s o in eg a e housing and
heal hca e planning. Some o his may be due o he ac ha a esou ce alloca ion
mechanism has been in place in NHS England o a numbe o decades (Ca -Hill e
al., 1994), aiding he abili y o iden i y heal hca e demands om new housing
de elopmen s.
0%
10%
20%
30%
40%
50%
60%
70%
80%
Owne s P i a e en e s Suppo ed en e s
% wi h a medical ca d
In eg a ing housing and heal hca e planning | 21
English policymake s ha e in oduced he Na ional Planning Policy F amewo k
(NPPF) and he Planning P ac ice Guidance policy o be e in eg a e heal h and
wellbeing in de elopmen planning. The NPPF b ough oge he planne s wi h local
NHS o icials, public heal h p o essionals, and heal h and wellbeing bodies. To aid
he unde s anding o hese policies and os e in eg a ed housing and heal hca e
planning, he NHS published A guide o he heal hca e sys em in England o local
planning au ho i ies (LPAs).
10
A co e planning p inciple ou lined in hese policies
was he necessi y o accoun o local s a egies o imp o e heal h and social and
cul u al wellbeing o local popula ions in addi ion o deli e ing su icien supply o
mee local needs.
The collabo a ion be ween local heal h au ho i ies (known as in eg a ed ca e
sys ems in England) and NHS England was o p o ide in o ma ion o local planning
au ho i ies on heal hca e supply and in as uc u e needs, pa icula ly in e ms o
how hese would need o de elop o accoun o a g owing popula ion and
changing demog aphics. De eloping a simila ‘guide’ be ween na ional and local
planning au ho i ies and local and na ional heal h au ho i ies in I eland would
p o ide signi ican bene i s. To his end, he HHP modelling ool would be in a
posi ion o p o ide in o med es ima es o heal hca e demand and supply
equi emen s in a gi en local a ea. In ecen yea s, NHS England has collabo a ed
wi h p ope y de elope s and local councils on he Heal hy New Towns ini ia i e
o ‘c ea e heal hie and connec ed communi ies wi h in eg a ed and high-quali y
se ices’.
11
In China, ci ies a e being adap ed and buil a ound he goal o imp o emen o
ou comes ega ding social conce ns such as heal h and heal hca e accessibili y (He
e al., 2018). So-called low-ca bon eco-ci ies a e cons uc ed wi h a iew o achie e
maximum in eg a ion o communi y ameni ies in esiden ial a eas, wi h all
necessa y se ices a ailable wi hin a 15-minu e walk o e e y home (Weng e al.,
2019). The idea o he 15-minu e ci y has since been b ough o li e elsewhe e,
no ably in Bogo á (Columbia), Pa is (F ance) and Melbou ne (Aus alia)
(Pozoukidou and Cha ziyiannaki, 2021).
In Aus alia and New Zealand (Rose e al. 2023) he ocus has been on imp o ing
in eg a ed models o ca e o olde people, wi h a ange o new de elopmen s
being cons uc ed ha co-loca e housing and heal hca e acili ies speci ically
ca e ing o he needs o olde inhabi an s. In he Ne he lands, policies seek o deal
wi h he heal hca e needs o an ageing popula ion mo e sys ema ically, while
gi ing olde people he au onomy o ‘ageing in place’. Long- e m ca e unding is
a ailable o und no jus adi ional home suppo o esiden ial ca e, bu also o
ully adap a home o mee he needs o people wi h unc ional limi a ions, o
10
See h ps://www.england.nhs.uk/wp-con en /uploads/2021/05/hbn08-addend1.pd .
11
See h ps://www.england.nhs.uk/ou wo k/inno a ion/heal hy-new- owns/.
22 | Housing and heal hca e in I eland
mo e o senio li ing complexes close o heal h and social ca e se ices (Bakx e
al., 2023). The e is now clea e idence ha such ageing in place policies,
pa icula ly hose ha ocus on allowing people li e in mo e accessible homes, help
slow educ ions in physical heal h and educe admission in o nu sing homes.
These in eg a ed app oaches o housing and heal hca e planning in o he coun ies
o e models o pu suing a simila app oach in I eland. Howe e , as has been
discussed, he s uc u al di e ences be ween housing and heal hca e sec o s
in e na ionally should be conside ed when a emp ing o supplan such models o
he I ish con ex .
3.5 PLANNING FRAMEWORK IN IRELAND
The planning p ocess in I eland is go e ned by he Planning and De elopmen Ac
2000, which seeks o ‘p o ide, in he in e es s o he common good, o p ope
planning and sus ainable de elopmen ’. Pa III o ha legisla ion is conce ned wi h
he p o ision and si ing o se ices and acili ies necessa y o he communi y in
planning, wi h hospi als and o he heal hca e acili ies lis ed as cen al. The Ac has
mos ecen ly been amended by he Planning and De elopmen (Amendmen ) Ac
2018, which upda es he legisla ion o accoun o new de elopmen s in planning
ushe ed in by he in oduc ion o he NPF, also known as P ojec I eland 2040 and
he NDP.
P ojec I eland 2040 was launched in 2018 wi h he s a ed ambi ion o ‘p o id[ing]
a comp ehensi e social, economic and cul u al in as uc u e o all ou people o
lou ish, so ha oge he we can build a be e socie y’. The plan ep esen s he
i s ime ha planning and in es men ha e been explici ly linked in I eland.
In e linking public planning and public in es men has been a signi ican s ep
o wa d in he de elopmen o policy, as i allows o much mo e conside ed
s a egic planning o be unde aken, maximising oppo uni ies and quali y o li e
o he I ish populace.
3.5.1 Go e nmen heal h policy and links o planning
Op imising home and communi y en i onmen s in o de o ensu e ha all
indi iduals can maximise hei heal h and wellbeing is a c ucial policy goal o any
socie y. I is ecognised ha many o he key social de e minan s o heal h ela e
o he planning o he buil and na u al en i onmen s ha people inhabi . As a
esul , i is inc easingly clea ha planning au ho i ies ha e a cen al ole o play in
achie ing his objec i e h ough ensu ing ha planning decisions cons an ly
inco po a e conside a ions o heal h and wellbeing.
Despi e his, bo h in I eland and in e na ionally, he e has o en been a lack o
coo dina ed planning a ound home and communi y de elopmen and he public
heal h and heal hca e needs o local popula ions. Ins ead, planning decisions a e
In eg a ing housing and heal hca e planning | 23
o en s ill d i en la gely by ma ke o ces, and end o place a lesse ocus on he
impo ance o quali y o li e conce ns, such as access o quali y heal hca e (Ba on
and G an , 2011). While i is app ecia ed ha a huge ange o ac o s mus be
conside ed in he planning p ocess, he e is a case o making access o quali y
heal hca e one o he o e on conside a ions.
Unde he NPF and NDP, he e a e a numbe o planned in es men p ojec s ha
will con ibu e owa ds enhancemen o popula ion heal h, ei he di ec ly o
indi ec ly. In he ecen ly published NDP 2021–2030, in es men has been
p ojec ed a €165 billion, wi h a pa icula ocus on ‘p io i y solu ions o s eng hen
housing, clima e ambi ions, anspo , heal hca e, jobs g ow h in e e y egion and
economic enewal’. A p ojec ed €35 billion expendi u e on anspo p ojec s
speci ically p io i ises walking, cycling and public anspo . This ies in o ambi ions
o a heal hie I eland, in ha i p io i ises ‘heal hie ’ means o a elling and
educes po en ial pollu ion om p i a e ehicle usage. Wi hin he heal hca e
sec o , he NDP se s ou plans o a €5.7 billion in es men in heal hca e
in as uc u e up o 2025, wi h a pa icula ocus on he de elopmen o p ima y
ca e cen es, communi y ca e and communi y nu sing uni s.
An unde s anding o he ope a ion o he heal hca e sys em among local planning
au ho i ies is c ucial o he achie emen o Na ional S a egic Ou come 10 o he
NPF, which es ablishes he need o ‘access o quali y childca e, educa ion and
heal h se ices’. Indeed, when planning o he de elopmen o new esiden ial
a eas, he heal h and wellbeing o esiden s should be a he o e on o
conside a ions. Planning decisions ough o be aken such ha hey op imise
quali y o li e among esiden s. One c ucial channel h ough which his can be
achie ed is ia he p o ision o high-quali y, accessible heal hca e. This also ies in
nea ly wi h he na ional policy objec i es (NPO) ou lined in he NPF, speci ically
NPO4, ‘P oximi y o acu e, p ima y and long- e m ca e’.
Wi h he assis ance o he HHP modelling ool, local planning au ho i ies will ha e
be e e idence o in o m hei planning decisions, speci ically in e ms o how hey
in e ac wi h he local heal hca e sys em. Such e idence is necessa y o he
planning p ocess in o de o ensu e he c ea ion and long- e m sus ainabili y o
heal hy communi ies.
24 | Housing and heal hca e planning model and da a
CHAPTER 4
Housing and heal hca e planning model and da a
4.1 INTRODUCTION
This chap e in oduces he HHP model me hodology. We i s o e a e iew o
me hodologies used o es ima e heal hca e demand and supply. Secondly, we
p o ide a de ailed discussion o he p ocess o building he HHP model and he
pa ame e s used o popula e he model. Thi dly, we ou line he se ices included
in he analyses and he da a sou ces used o heal hca e u ilisa ion. Finally, we
ou line he p o iles o h ee benchma k esiden ial de elopmen s ha o m he
basis o ou esul s p esen a ion.
4.2 MODELLING HEALTHCARE DEMAND AND SUPPLY
4.2.1 Re iew o heal hca e modelling app oaches
The e a e wo main me hodological app oaches ha can be adop ed o simula e
heal hca e demand, a bo h he na ional as well as a mo e localised le el:
mic osimula ion models and mac osimula ion models (also known as cell-based
models). The key di e ence be ween he wo is ha mic osimula ion models use
indi iduals o households as he p ima y uni o analysis, whe eas cell-based
models s a i y indi iduals in o speci ic g oups (‘cells’) based on socio-demog aphic
ea u es.
Mic osimula ion models
Mic osimula ion models a e gene ally used o simula e indi idual-le el esponses
o policy change, ei he p io o policy implemen a ion (Zucchelli e al., 2012), o
as a means o conduc ing ex-pos analysis o dis ibu ional impac s (Spielaue ,
2007; Zucchelli e al., 2012). One no able example is he Popula ion Heal h Model
(POHEM) de eloped a S a is ics Canada in he ea ly 1990s (Hennessy e al., 2015),
which has been used o model he heal hca e demand and cos implica ions o
a ious heal h policy in e en ions. Mo e ecen ly, a mic osimula ion model based
on da a om he I ish Longi udinal S udy on Ageing (TILDA) has been used o
p ojec ing u u e heal hca e se ice use among olde people in I eland (May e al.,
2022).
As analysis is unde aken wi h indi iduals as he p ima y uni o analysis, heal hca e
mic osimula ion models a e da a-in ensi e and hey equi e ich, highly g anula
and homogeneous da a sou ces o in o m p ojec ions (As ol i e al., 2012).
De elopmen o hese models ends o be complex and ime-consuming, and hei
de elopmen is o en impeded whe e da a a ailabili y is cons ained (Ringel e al.,
Residen ial de elopmen s and heal hca e | 25
2010). This la e poin is pe inen o he ela i ely limi ed heal h and social ca e
landscape in I eland.
Cell-based mac osimula ion models
The mos common app oach o p ojec ing heal hca e demand in ol es cell-based
mac osimula ion models (Ode ki k e al., 2012). Thei ad an ages o e
mic osimula ion models include he ease o de elopmen and implemen a ion o
cell-based models and he ac ha hey a e signi ican ly less da a-in ensi e han
mic osimula ion models (Ma ias e al., 2022). While cell-based models gene ally
s a i y he popula ion by a small numbe o socio-demog aphic ea u es (e.g., age
and sex), hey e ain he lexibili y equi ed o disagg ega e he popula ion u he
i da a a ailabili y allows, and also o e he abili y o model a ange o di e en
scena ios (e.g., medical ca d co e age, changing policy amewo ks, o di e en
p ojec ions o popula ion/heal hca e u ilisa ion), o o di e en ia e he popula ion
by heal hca e co e age.
Cell-based model me hodology has been used p e iously in I eland o model he
I ish heal hca e sys em (Lay e, 2009; W en e al., 2017). The mos sophis ica ed o
hese models, he Hippoc a es model (W en e al., 2017), is a cell-based
mac osimula ion model whose de elopmen was unded by he Depa men o
Heal h. This model has been used o p ojec heal hca e demand, expendi u e and
wo k o ce equi emen s a a na ional and egional le el.
In hei compa ison o models examining heal hca e demand, Ma ias e al. (2022)
ou lined ha i he objec i e o esea che s was o o ecas o p ojec heal hca e
demand (and expendi u e), mac osimula ion models a e likely o p o ide he mos
accu a e es ima es. The e o e, he HHP model has been de eloped as a cell-based
mac osimula ion model owing o i s ela i e simplici y and he he e ogenei y in
da a quali y ac oss he I ish heal hca e sys em. By agg ega ing indi idual
obse a ions o age-, sex- and public-heal hca e-co e age-speci ic cells, we can
achie e a s ong deg ee o p ecision in demand es ima es despi e da a a ailabili y
issues.
4.2.2 HHP model cons uc ion
On he basis o he bene i s ou lined abo e, a mac osimula ion modelling app oach
has been adop ed o he HHP model, ollowing a simila modelling app oach used
o cons uc he Hippoc a es model. Addi ional pa ame e s a e included o allow
o he HHP model o ocus on esiden ial de elopmen s, and accoun o
de elopmen -le el ac o s such as size and enu e composi ion, as well as
demand–supply a ios. The cell-based a chi ec u e o he HHP model he e o e is
capable o agg ega ing heal hca e demand p o iles om age, sex and public
heal hca e co e age le el o a benchma k (hypo he ical) de elopmen le el, and
26 | Housing and heal hca e planning model and da a
subsequen ly ansla ing ha demand in o commensu a e heal hca e supply
me ics.
The model has he capabili ies o inco po a ing a numbe o heal hca e se ices.
Howe e , cu en ly he e is a lack o da a on demand o many heal h and social
ca e se ices, especially o se ices p o ided in he communi y and p i a e
heal hca e (Walsh e al., 2021). Due o hese da a limi a ions, in his i s epo ,
using he HHP model, we ocus on heal hca e se ices p o ided in p ima y and
acu e ca e se ings. The model is ully au oma ed in he R p og amming language
wi h subsidia y analyses unde aken in S a a and Excel.
The ull applica ion o he HHP model is illus a ed in Figu e 4.1. The model
combines in o ma ion on he socio-demog aphic p o ile o a gi en new
de elopmen wi h he likely heal hca e demand o ha de elopmen . Heal hca e
demand (ac i i y a es) is es ima ed by combining age-, sex- and public-heal hca e-
co e age-speci ic u ilisa ion a es o each heal hca e se ice included.
Subsequen ly, a esiden ial de elopmen ’s o al heal hca e demand is ans o med
in o supply-side equi emen s. We discuss each o hese elemen s below.
FIGURE 4.1 SIMPLIFIED DIAGRAMMATIC REPRESENTATION OF THE MODEL
Heal hca e demand
Like o he cell-based models o heal hca e demand, he HHP model i s ly
es ima es heal hca e demand p o iles o each demog aphic s a um included in
Residen ial de elopmen s and heal hca e | 27
he analysis. We es ima e na ional ac i i y a es o each heal hca e se ice, H,
disagg ega ed by: age (a – whe e age may be single yea o age o age g oup
depending upon he g anula i y o he da a); sex (s); and public heal hca e
co e age (e.g., medical ca d o GP isi ca d) s a us (p):
𝐴𝑅(𝐻)𝑎,𝑠,𝑝 =𝑉(𝐻)𝑎,𝑠,𝑝
𝑃𝑎,𝑠,𝑝
whe e 𝑉(𝐻)𝑎,𝑠,𝑝 is he olume o ac i i y in he baseline yea wi hin each age, sex
and public heal hca e co e age cell, and 𝑃𝑎,𝑠,𝑝 is he co esponding popula ion. This
p oduces a ma ix o ac i i y a es o each se ice ha is age, sex and public
heal hca e co e age s a us.
Nex , we compu e he speci ic popula ion o he de elopmen being simula ed
wi hin he model. In doing so, we i s speci y he de elopmen size (in e ms o
he numbe o houses) and, secondly, appo ion he enu e composi ion o he
de elopmen .
Tenu e composi ion
De elopmen s 𝐷 di e by enu e composi ion. Le us ep esen he p opo ion o
homeowne s speci ied by he use o be Own, he p opo ion o p i a e en e s o
be PR and he p opo ion o suppo ed en e s o be SR. The o al size o he
de elopmen is ep esen ed by 𝐷 (e.g., 1,000 homes). Thus, 𝐷∗𝑂𝑤𝑛 will gi e he
numbe o owne -occupied homes, 𝐷∗𝑃𝑅 he numbe o p i a ely en ed homes
and 𝐷∗𝑆𝑅 he numbe o social houses o houses en ed wi h s a e suppo s, such
ha :
𝐷 =(𝐷∗𝑂𝑤𝑛)+(𝐷∗𝑃𝑅)+(𝐷∗𝑆𝑅)
Nex , we cons uc an age, sex and public heal hca e co e age s a us dis ibu ion
o each enu e ype. The popula ion wi hin each enu e ype is calcula ed by
mul iplying he numbe o houses wi hin ha enu e g oup by he na ional a e age
household size o ha enu e ype.
12
Thus:
𝑃𝑡𝑛 =𝐷𝑡𝑛 ∗𝜎𝑡𝑛
12
While a e age household size is ea ed as ixed wi hin he model, i can ul ima ely be a ied i desi ed. Fo example,
i a de elopmen is in ended o la ge amilies (e.g., all homes ha e a la ge numbe o bed ooms), he pa ame e
alues o household size could be adjus ed. Fo he pu pose o his epo , we use na ional a e age household size
o each enu e g oup.
34 | Housing and heal hca e planning model and da a
Gene al p ac i ione and p ac ice nu se ac i i y a e da a
Da a on annual isi s o GPs and PNs a e aken om he Heal hy I eland Su ey
(HIS) – Wa es 1, 2, 4 and 5.
16
The HIS is a la ge na ionally ep esen a i e ace- o-
ace su ey o indi iduals aged 15 yea s and o e . I cap u es in o ma ion on
heal h, heal hca e u ilisa ion and heal hca e co e age. Some wa es o he su ey
included ques ions on he use o GP and PN se ices. Responses o hese ques ions
we e used o es ima e u ilisa ion p o iles o he HHP model.
Eme gency depa men a endance ac i i y a e da a
Da a on annual a endances o EDs in public hospi als in I eland a e aken om he
Pa ien Expe ience Time (PET) da ase o 2019. PET is an adminis a i e da ase
managed by he HSE Business In o ma ion Uni . This da ase cap u es eco ds o
all ED a endances ac oss he 29 Model 3 and Model 4 EDs ope a ing in public acu e
hospi als. The da a cap u e some simple demog aphic in o ma ion including he
age and sex o a endees, allowing us o examine age and sex in he analysis.
PET does no cap u e in o ma ion on he medical ca d s a us o ED a endees.
The e o e, he HIS da a we e used o supplemen his analysis. Wi hin he HIS,
esponden s we e asked abou hei use o EDs in he p e ious 12 mon hs. We
es ima ed a e age ED isi s by medical ca d s a us by age and sex and appo ioned
hese a es on o he PET age and sex u ilisa ion p o iles. This p o ided us wi h an
es ima ed ED a e ac oss medical ca d s a us.
Day pa ien and inpa ien ac i i y a e da a
Da a on annual day pa ien admissions and elec i e and eme gency inpa ien
admissions and leng h o s ay a e aken om he Hospi al In-Pa ien Enqui y (HIPE)
da ase o 2019. HIPE is an adminis a i e da ase managed by he HSE Heal hca e
P icing O ice (HPO). I s da a cap u e eco ds o all admissions in o public acu e
hospi als. The HIPE da a also include a ange o in o ma ion on he socio-
demog aphic p o ile o pa ien s, including age, sex and medical ca d s a us, as well
as in o ma ion on he ca e p o ided o pa ien s when in hospi al.
• Day pa ien : A pa ien who is admi ed o hospi al on a scheduled/elec i e
basis o ca e ha does no equi e an o e nigh s ay. The e o e, hese
pa ien s’ leng h o s ay (LOS) is less han one. Day pa ien ca e is p o ided
wi hin a day wa d.
• Elec i e inpa ien : A pa ien who is admi ed o hospi al on a
scheduled/elec i e basis o ca e ha equi es a leas one o e nigh s ay.
Elec i e inpa ien s ays a e measu ed h ough LOS, which is he numbe o days
be ween he admission da e and discha ge da e and is also commonly e e ed
16
The HIS was conduc ed on he ollowing da es: Wa e 1, No embe 2014–Augus 2015; Wa e 2, Sep embe 2015–
May 2016; Wa e 3, Sep embe 2016–June 2017; Wa e 4, Sep embe 2017–June 2018; Wa e 5, Sep embe 2018-
Sep embe 2019.
Residen ial de elopmen s and heal hca e | 35
o as a pa ien ’s ‘bed days’ (i.e., he amoun o ime hey occupied a bed).
Elec i e inpa ien ca e is p o ided wi hin an inpa ien wa d.
• Eme gency inpa ien : A pa ien who is admi ed o hospi al on an
unscheduled/eme gency basis o ca e ha equi es a leas one o e nigh s ay
in hospi al. Mos eme gency inpa ien s a e admi ed ia he ED; howe e hey
may also be admi ed ia an Acu e Medical Assessmen Uni o an Acu e
Su gical Assessmen Uni . Eme gency inpa ien s ays a e also measu ed
h ough LOS o bed days. Eme gency inpa ien ca e is p o ided wi hin an
inpa ien wa d.
Using in o ma ion om HIPE, we es ima e he p o iles o acu e public hospi al day
pa ien s, elec i e inpa ien s and eme gency inpa ien s in e ms o age, sex and
medical ca d s a us.
4.3.3 Heal hca e supply da a
In o de o ans o m heal hca e demand in o supply equi emen s, in o ma ion
was equi ed on demand–supply a ios. A e iew o he li e a u e was unde aken
o iden i y s udies ha cap u ed in o ma ion on bo h supply and demand. Di e en
me hodology was used ac oss p ima y and acu e hospi al ca e se ices.
P ima y ca e
Fo GP and PN ca e, he HHP model equi es in o ma ion on isi s pe WTE pe
annum. No na ional da ase cu en ly exis s ha cap u es he o al numbe o GP
and PN isi s in I eland annually. Fu he mo e, he e is signi ican deba e ega ding
he numbe o GP and PN WTEs. The I ish College o Gene al P ac i ione s (ICGP)
has s a ed ha in 2022 he e we e 4,187 GPs p ac icing in I eland, which ansla ed
in o 2,807 GP WTEs (ICGP, 2022). By compa ison, as o Ma ch 2023, he P ima y
Ca e Reimbu semen Scheme epo s ha he HSE holds con ac s wi h 3,100 GPs.
While his la e es ima e discoun s he small numbe o GPs who may ope a e
en i ely p i a ely inanced p ac ices, he a ia ion be ween he numbe s aises
some conce ns o e using ei he sou ce. The e o e, o his epo we used
in o ma ion cap u ed in a su ey o ICGP- egis e ed GPs, which was conduc ed by
Collins and Homeniuk (2021).
Collins and Homeniuk’s (2021) su ey ook place in Feb ua y 2020 (no ably, be o e
he onse o he Co id-19 pandemic). I a ge ed all GPs who we e membe s o he
ICGP. The su ey solici ed esponses on he olume o GP and PN isi s eco ded
on he p e ious day in he esponden ’s p ac ice. In addi ion, in o ma ion was
ga he ed on he WTE s a le els o GPs and PNs who deli e ed hese se ices. Ou
o he o al membe ship, 507 gene al p ac ices engaged in he s udy by p o iding
he eques ed in o ma ion. Findings om he su ey ound ha , on a e age, a GP
comple ed 29 GP isi s (o consul a ions) pe wo king day. Using in o ma ion on
WTE and an es ima e ha GPs ha e 253 wo king days pe annum, his equa es o
7,337 GP isi s pe 1 GP WTE pe annum.
36 | Housing and heal hca e planning model and da a
A simila p ocess was used o es ima e PN isi s pe annum. The 510.3 PN WTEs
included in he s udy comple ed 13,161 PN isi s pe annum, o 26 isi s each pe
wo king day on a e age. Using in o ma ion on WTE, and an es ima e ha PNs ha e
253 wo king days pe annum, his equa es o 6,587 PN isi s pe 1 PN WTE pe
annum. These demand–supply a ios a e used in he HHP model o ans o m GP
and PN demand es ima es om new esiden ial de elopmen s in o wo k o ce
equi emen s.
The au ho s also ex apola ed hei indings o a na ional le el and es ima ed he e
we e o e 21.35 million GP isi s and 7.75 million PN isi s annually. This annual
es ima e o GP and PN isi s is consis en wi h ecen es ima es using he HIS
(Walsh e al., 2021; Connolly e al., 2023).
Acu e hospi al ca e
In ou acu e hospi al ca e analyses, we do no ans o m demand in o wo k o ce
equi emen s. Ca e p o ided in hospi als a ies signi ican ly ac oss pa ien s and
he ype o wo k o ce used is mo e specialised. Mo eo e , wo k o ce WTEs ha e
changed conside ably wi hin he HSE and acu e public hospi als in ecen yea s in
e ms o le els and skill mix (Fleming e al., 2022). The e o e, we ans o m acu e
hospi al ca e demand in o capaci y (i.e., hospi al beds).
Fo day pa ien ca e, we assume ha ca e p o ided o a day pa ien uses 0.5 day
wa d beds (i.e., each day wa d bed is used wice pe da a). This assump ion ollows
he app oach aken in p e ious ESRI esea ch (Keegan e al., 2022) and e lec s he
app oach applied by he HPO o day pa ien ca e. The e o e in he HHP model, a
2:1 day-pa ien - o-bed a io is included. Fo elec i e and eme gency inpa ien ca e,
we use LOS as a measu e o bed days, in line wi h Keegan e al. (2022) and he
app oach applied by he HPO o inpa ien ca e. In he HHP model, a 1:1 inpa ien -
o-bed a io is included. Fo ED ca e, as no equi alen supply o capaci y measu e
exis s, a endances a e used in he analyses.
TABLE 4.4 DEMAND–SUPPLY RATIOS EMPLOYED IN THE HHP MODEL
Se ice
Demand/supply a io
Sou ce
GP
7,337 isi s pe WTE
Collins and Homeniuk, 2021
PN
6,587 isi s pe WTE
Collins and Homeniuk, 2021
Eme gency depa men
Cell-speci ic a e age a endances
PET 2019 da a
Day pa ien
0.5 bed days pe admission
HIPE 2019 da a
Elec i e inpa ien
Cell-speci ic a e age LOS
HIPE 2019 da a
Eme gency inpa ien
Cell-speci ic a e age LOS
HIPE 2019 da a
Sou ce: Es ima es o isi s pe WTE assume a s anda d 253 wo king days pe yea .
4.4 DATA AND SOURCES
The HHP model allows us o p oduce es ima es o pa icula de elopmen s o se s
o de elopmen s – e.g., S a egic De elopmen Zones o Local A ea Plans – bu we
Residen ial de elopmen s and heal hca e | 37
do no unde ake such analyses in his epo . While his app oach can be used in
u u e ou pu s using he HHP model,
17
in his analyses esul s a e p esen ed using
example, o benchma k de elopmen s. Housing de elopmen s di e acco ding o
a ange o a ibu es, mos no ably loca ion, size, housing ype composi ion and
enu e ype composi ion. The e o e, o illus a e HHP model ou pu s, we ha e
de ined h ee di e en de elopmen ypes ha di e acco ding o enu e
composi ion. These benchma ks show he capabili ies o he HHP model and a e
closely aligned o he DHLGH’s HFA policy. These di e en de elopmen ypes
allow us o illus a e he enu e composi ion dynamics o he HHP model, as we
a y he p opo ions o each enu e ype in a hypo he ical new de elopmen and
assess he esul an heal hca e demand and supply di e ences. We p esen h ee
di e en benchma k de elopmen s: HFA de elopmen ; public housing
de elopmen ; and p i a e ma ke housing de elopmen .
(a) HFA de elopmen
The HFA de elopmen ype ollows he p oposed HFA composi ion. In
his de elopmen ype, 50 pe cen o homes a e assumed o be owne
occupied, 20 pe cen a e pa o he p i a e en al sec o and he
emaining 30 pe cen o homes a e occupied by suppo ed en e s.
18
(b) Public housing de elopmen
The ‘public housing’ de elopmen ype emphasises social housing and
suppo ed en e s. In his sense, i ollows he p oposed public housing
schemes. In his de elopmen ype, 10 pe cen o homes a e assumed o
be owne occupied, 10 pe cen o m pa o he p i a e en al sec o and
he emaining 80 pe cen o homes a e occupied by suppo ed en e s.
(c) P i a e ma ke housing de elopmen
The ‘p i a e housing’ de elopmen ype emphasises he p i a e en al
and owne occupie enu e ypes. In his de elopmen ype, 50 pe cen
o homes a e assumed o be owne occupied, 40 pe cen a e pa o he
p i a e en al sec o and he emaining 10 pe cen o homes a e
occupied by suppo ed en e s.
De elopmen size is kep ixed a 1,000 uni s ac oss benchma ks o e ain
compa abili y. We do no y o model housing size (i.e., numbe o bed ooms,
numbe o people li ing in he household) in hese chap e s, as his will a y ac oss
17
Fu u e de elopmen s o he HHP model will endea ou o include a wide ange o de elopmen cha ac e is ics, such
as composi ion o housing ype (i.e., houses s apa men s).
18
This composi ion is based on a p ojec ed supply o 33,000 homes pe yea , as ou lined by DHLGH’s Housing Need and
Demand Assessmen (HDNA) model, comp ising 11,800 new p i a e owne ship homes, 6,500 p i a e en al homes,
4,100 a o dable homes and 10,300 social housing homes. Fo he pu pose o his analysis, we combine p i a e
owne ship homes and a o dable homes in o he ‘owne s’ enu e ca ego y.
38 | Housing and heal hca e planning model and da a
de elopmen s. Ins ead, he a e age household size o each enu e ype ollows
he a e age household size es ima ed in SILC 2021.
The benchma ks a e all mixed- enu e in composi ion, wi h a ia ions in which
enu e ype is he la ges . This is in line wi h cu en go e nmen policy, wi h he
ecen HFA plan commi ing o ‘con inuing he policy o ha ing mixed- enu e
communi ies … o ensu e ha social and a o dable housing a e pa o he mix
ac oss housing de elopmen s’. Table 4.5 p esen s he speci ic enu e composi ions
o each o ou h ee benchma k scena ios.
The changes in enu e composi ion illus a e he a ious dynamics a play wi hin
he model. Gene ally speaking, de elopmen s ha con ain a younge demog aphic
( o example, de elopmen s wi h a lo o p i a e ma ke en e s) will equi e less
heal hca e. Howe e , coun e balancing his, de elopmen s wi h a high deg ee o
public heal hca e co e age – pa icula ly hose comp ised p ima ily o suppo ed
en e s – will equi e mo e heal hca e se ices on a e age due o g ea e
accessibili y and he high co ela ion be ween public heal hca e co e age and
poo e heal h ou comes. The HHP model akes all o hese ac o s in o accoun o
calcula e he mos p ecise es ima es o heal hca e u ilisa ion.
TABLE 4.5 TENURE COMPOSITIONS IN REPORT’S BENCHMARK DEVELOPMENTS
BENCHMARK
Suppo ed en e s
P i a e en e s
Owne s
(a) HFA
30%
20%
50%
(b) Public housing
80%
10%
10%
(c) P i a e housing
10%
40%
50%
Resul s: Demog aphic p o iles o heal hca e u ilisa ion | 39
CHAPTER 5
Resul s: Demog aphic p o iles o heal hca e u ilisa ion
5.1 INTRODUCTION
This chap e p esen s indings o p ima y – GP and public nu se (PN) – and acu e
public hospi al heal hca e u ilisa ion ac oss he key ac i i y pa ame e s included in
he HHP model: age, sex and public heal h insu ance (PHI) s a us. I also p esen s
heal hca e u ilisa ion ac oss ou h ee enu e g oups. Resul s om his chap e a e
used o in o m de elopmen -le el demand and supply es ima es p esen ed in
Chap e 6.
5.2 PRIMARY CARE UTILISATION
Table 5.1 p esen s a e age GP and PN isi s pe annum ac oss sex, age and medical
ca d/GP isi ca d s a us using da a om he HIS. O e all, he a e age GP and PN
isi s pe annum a e 4.1 and 1.3, espec i ely, o he en i e popula ion. Fo adul s
(18+), u ilisa ion a es a e sligh ly highe a 4.5 and 1.4, espec i ely. Resul s a e
simila o p e ious e idence (Walsh e al., 2021) using he HIS and compa e
a ou ably o calcula ions based on ecen adminis a i e da a om GP p ac ices
in Collins and Homeniuk (2021).
19
TABLE 5.1 AVERAGE ANNUAL GP AND PN VISIT RATES
GP isi s/annum
PN isi s/annum
Popula ion
To al
4.1
1.3
Excl. child en
4.5
1.4
Gende
Male
3.5
1.1
Female
4.8
1.5
Age b acke
0–14 yea s
3.3
0.7
15–24 yea s
2.9
0.7
25–49 yea s
3.5
0.9
50–64 yea s
4.6
1.5
65+ yea s
6.8
2.5
Medical ca d/GP isi ca d
Yes
6.1
2.1
No
2.6
0.7
Sou ce: Au ho s’ calcula ions using he HIS, Wa es 1, 2, 4 and 5.
GP and PN u ilisa ion a es a e on a e age highe among emales han among
males. GP and PN isi s end o inc ease wi h age and a e highes in he oldes age
g oup. Indi iduals aged 65+ epo 6.8 GP and 2.5 PN isi s pe annum on a e age.
19
The au ho s es ima e ha he a e age I ish pe son consul s a GP 4.3 imes pe yea and a PN 1.6 imes pe yea ,
based on da a om a su ey o GPs conduc ed in Feb ua y 2020.
40 | Residen ial de elopmen s and heal hca e
Young adul s (15–24 yea s) u ilise GP se ices leas equen ly, wi h a es o 2.9
and 0.7 isi s o GPs and PNs espec i ely. La ge di e ences in isi ing a es ac oss
public heal hca e co e age (medical ca d/GP isi ca d) s a us a e also e iden .
Indi iduals wi h a medical ca d/GP isi ca d epo 6.1 GP isi s pe annum,
compa ed o 2.6 isi s among hose wi hou a ca d. The di e ence is simila ly
p onounced o PN isi s: indi iduals wi h a medical ca d/GP isi ca d epo 2.5
PN isi s pe annum, compa ed o 0.7 isi s among hose wi hou public heal hca e
co e age.
Figu es 5.1 and 5.2 p esen a e age isi ing a es pe annum ac oss ages o males
and emales wi h and wi hou a medical ca d/GP isi ca d. In his analysis, o bo h
GP and PN isi s, we assume all hose unde six yea s
20
and all hose o e 70 yea s
ha e access o a GP isi ca d (i no in possession o a medical ca d) and he e o e
he a e age numbe o GP and PN isi s in hese g oups co esponds o a es
among medical ca d/GP isi ca d holde s.
In gene al, GP and PN isi ing a es inc ease ac oss age o males and emales and
o hose wi h and wi hou a medical ca d/GP isi ca d. Fo some age g oups,
pa icula ly younge adul s, emales end o ha e highe u ilisa ion a es han
males. No di e ences a e obse ed among child en. Howe e , he e is some
a ia ion in GP isi s be ween males and emales a olde ages, and we he e o e
include sepa a e male and emale isi a ion a es among hose aged 70 yea s and
olde .
20
In 2019, he ime pe iod co e ed by da a in his epo , all unde sixes we e en i led o ee GP and PN ca e ia a GP
isi ca d. Since Augus 2023, en i lemen o GP isi ca ds has been expanded o all unde eigh s. See
h ps://www.go .ie/en/p ess- elease/1b13e-minis e - o -heal h-encou ages- amilies- o- egis e - o - ee-gp-ca e-
o -child en-aged-6-and-7/.
Resul s: Demog aphic p o iles o heal hca e u ilisa ion | 41
FIGURE 5.1 AVERAGE GP VISITS PER ANNUM BY AGE, SEX AND PUBLIC HEALTHCARE COVERAGE
Sou ce: Au ho s’ calcula ions using he HIS, Wa es 1, 2, 4 and 5.
FIGURE 5.2 AVERAGE PN VISITS PER ANNUM BY AGE, SEX AND PUBLIC HEALTHCARE COVERAGE
Sou ce: Au ho s’ calcula ions using he HIS, Wa es 1, 2, 4 and 5.
42 | Residen ial de elopmen s and heal hca e
5.3 ACUTE PUBLIC HOSPITAL CARE UTILISATION
Table 5.2 p esen s annual admission a es o day pa ien and inpa ien ca e
(pa i ioned by elec i e and eme gency) in acu e public hospi als, as well as
a e age annual a endance a es a public hospi al EDs. U ilisa ion a es a e
disagg ega ed by age, sex and medical ca d s a us. Acu e public hospi al ca e
u ilisa ion di e s conside ably ac oss demog aphic g oup, while u ilisa ion a e
di e ences a e also obse ed ac oss each se ice examined.
Fo ED ca e, he e a e 0.36 a endances pe popula ion pe annum. Males epo
sligh ly highe numbe s o a endances compa ed o emales (0.37 s 0.34). While
ED a endance a es a e simila ac oss he age g oups o 0–14 yea s and 50–64
yea s, hey inc ease subs an ially a olde ages. Medical ca dholde s ha e sligh ly
highe ED a endance a es.
Fo day pa ien ca e, males ha e highe admission a es han emales (0.46 s 0.35
admissions pe annum). Admission a es inc ease signi ican ly wi h age, wi h day
pa ien admission a es among he oldes age g oup (65+) being o e 10 imes
highe han ha o young adul s. Medical ca dholde s also epo highe
admission a es han non-medical ca dholde s (0.44 s 0.37).
21
Elec i e inpa ien admission a es a e much lowe han o o he public acu e
hospi al se ices. This is a ea u e o he composi ion o elec i e ca e, he long
wai ing lis s ha exis in I eland and he high le el o elec i e ca e ha occu s in
p i a e hospi als. The la ges di e ences in elec i e inpa ien ca e is seen ac oss
age g oups, wi h he 65+ age g oup showing he highes a es o u ilisa ion.
The eme gency inpa ien u ilisa ion p o ile is simila o ha seen o ED
a endances, which ollows logically om he ac he eme gency inpa ien s a e
gene ally admi ed om an ED. Males epo sligh ly highe u ilisa ion compa ed
o emales (0.19 s 0.15). The e a e subs an ial inc eases ac oss age, wi h he
oldes age g oup (65+) ha ing admission a es o e se en imes highe han ha
o younge adul s. Medical ca dholde s epo much highe admission a es
compa ed o non-Medical ca dholde s (0.20 s 0.14).
21
This esul is in pa d i en by he ac ha many people wi hou a medical ca d, and who hold PHI, ecei e day
pa ien ca e wi hin p i a e hospi als (Keegan e al., 2020).
Resul s: Demog aphic p o iles o heal hca e u ilisa ion | 43
TABLE 5.2 AVERAGE ANNUAL ACUTE PUBLIC HOSPITAL UTILISATION RATES
ED a endances
Day pa ien
admissions
Elec i e inpa ien
admissions
Eme gency
inpa ien
admissions
Popula ion
To al
0.36
0.41
0.03
0.17
Excl. child en
0.37
0.50
0.04
0.20
Gende
Male
0.37
0.46
0.04
0.19
Female
0.34
0.35
0.03
0.15
Age B acke
0–14 yea s
0.30
0.04
0.01
0.06
15–24 yea s
0.28
0.08
0.01
0.06
25–49 yea s
0.27
0.16
0.01
0.07
50–64 yea s
0.25
0.36
0.02
0.11
65+ yea s
0.56
1.01
0.08
0.41
Medical ca d
Yes
0.37
0.44
0.04
0.20
No
0.34
0.37
0.03
0.14
Sou ce: Au ho s’ calcula ions using PET 2019, HIPE 2019.
Wi hin inpa ien se ices, o he pu pose o his esea ch, i is impo an o also
epo LOS in hospi al. This p o ides us wi h a mo e meaning ul capaci y me ic
ha can be con e ed in o inpa ien bed days, he key supply me ic in inpa ien
ca e in his analysis. Table 5.3 p esen s a e age LOS ac oss age, sex and medical
ca d s a us o elec i e and eme gency inpa ien admissions sepa a ely. A e age
LOS o elec i e inpa ien admissions is longe han o eme gency inpa ien
admissions (5.66 s 4.63). A e age LOS was sligh ly highe o males compa ed o
emales. Simila o esul s in Table 5.2, u ilisa ion (a e age LOS), inc eases wi h age
and is highe among hose wi h a medical ca d.
50 | Residen ial de elopmen s and heal hca e
5.5 ACUTE PUBLIC HOSPITAL UTILISATION PROFILES BY TENURE TYPE
This sec ion uses in o ma ion om Sec ion 5.3 o es ima e he p o ile o acu e
public hospi al u ilisa ion o each enu e ype. The p o iles combine in o ma ion
on u ilisa ion a es ac oss each demog aphic pa ame e , wi h he age, sex, medical
ca d s a us and a e age headcoun o each enu e ype being accoun ed o in he
modelling p ocess. These p o iles a e used o es ima e demand–supply a ios in
Chap e 6 o ED, day pa ien , elec i e inpa ien and eme gency inpa ien in he
HHP model. The combina ion o u ilisa ion ac oss pa ame e s wi h he
demog aphic composi ion o each enu e ype p esen s e y di e en heal hca e
u ilisa ion dis ibu ions.
5.5.1 Eme gency depa men
Figu e 5.9 p esen s he dis ibu ion o ED a endance ac oss age o each enu e
ype. Ac oss all enu e ypes, ED a endance is highes among child en aged less
han one yea old. In he homeowne enu e g oup, hose aged o e 70 yea s
comp ise he nex la ges d i e o ED demand. By compa ison, o hose in he
p i a e and suppo ed en e ca ego ies, a la ge pa o ED demand is cen ed
a ound he wo king-age adul popula ion.
FIGURE 5.9 DISTRIBUTION OF EMERGENCY DEPARTMENT ATTENDANCES ACROSS TENURE TYPES
Resul s: Demog aphic p o iles o heal hca e u ilisa ion | 51
5.5.2 Day pa ien
Figu e 5.10 p esen s he dis ibu ion o day pa ien admissions ac oss age o each
enu e ype. A di e en pa e n is obse ed compa ed o ED a endances. Ac oss
all enu e ypes, day pa ien admissions a e lowes among child en and ise s eadily
wi h age. Howe e , o bo h suppo ed en e s and p i a e en e s, he e is a d op
a olde ages, wi h he opposi e obse ed in he homeowne enu e ype. This
dis ibu ion di e ence la gely e lec s ha ac ha he majo i y o olde people
li e in owne -occupied homes.
FIGURE 5.10 DISTRIBUTION OF DAY PATIENT CARE ACROSS TENURE TYPES
5.5.3 Elec i e inpa ien
Figu e 5.11 p esen s he dis ibu ion o elec i e inpa ien LOS (bed days) ac oss age
o each enu e ype. A sligh ly di e en pa e n is obse ed as compa ed o he
dis ibu ion o day pa ien admissions seen abo e. Fi s ly, in each o he p i a e
and suppo ed en al ca ego ies, he e is a dis inc spike in demand among
child en, which is no obse ed in he homeowne enu e ype. Mo eo e , o bo h
suppo ed en e s and p i a e en e s, he highes bed days a e obse ed among
olde wo king-age adul s. By compa ison, he homeowne enu e ype sees a mo e
ypical inc ease in demand wi h age, wi h a mino dec ease owa ds he uppe mos
end o he dis ibu ion, e lec ing he ac ha he popula ion aged 80+ is ela i ely
small, e en in he homeowne enu e g oup.
52 | Residen ial de elopmen s and heal hca e
FIGURE 5.11 DISTRIBUTION OF ELECTIVE INPATIENT CARE ACROSS TENURE TYPES
5.5.4 Eme gency inpa ien
Figu e 5.12 p esen s he dis ibu ion o eme gency inpa ien LOS (bed days) ac oss
age o each enu e ype. Fo households in an owne -occupied home, he
dis ibu ion is once again la gely co ela ed wi h age, wi h olde people d i ing
mos demand. Fo he suppo ed en e s and p i a e ma ke en e s, he
dis ibu ion is mo e ola ile, hough bed day usage is highes among he wo king-
age adul popula ion. A sligh inc ease in bed day usage a he oldes ages is also
seen in he en al ca ego ies, al hough i is less p onounced he e han in he
homeowne ca ego y.
Resul s: Demog aphic p o iles o heal hca e u ilisa ion | 53
FIGURE 5.12 DISTRIBUTION OF EMERGENCY INPATIENT CARE ACROSS TENURE TYPES
54 | Resul s: Heal hca e demand by de elopmen ype
CHAPTER 6
Resul s: Heal hca e demand by de elopmen ype
6.1 INTRODUCTION
This chap e p esen s indings o p ima y ca e and acu e public hospi al heal hca e
demand, and he heal hca e supply equi emen s o mee he es ima ed demand
wi hin new esiden ial de elopmen . The esul s agg ega e he enu e-le el
demand p o iles p esen ed in Chap e 5 o de elopmen -le el demand p o iles. We
p esen h ee speci ic benchma k de elopmen ypes (HFA, public housing and
p i a e ma ke housing) wi h 1,000 homes ha di e acco ding o hei enu e
composi ion.
6.2 PRIMARY CARE
6.2.1 GP and PN demand and supply
Tables 6.1 and 6.2 p o ide es ima es o he o al numbe o GP and PN isi s, and
he WTE supply equi ed o his le el o demand, o each o ou h ee benchma k
de elopmen s. These es ima es p o ide he agg ega ed de elopmen -le el esul s
o he enu e-le el age demand dis ibu ions in Figu es A.1 and A.2.
Fo GP ca e, wi hin he 1,000-uni HFA de elopmen , we es ima e demand o
almos 11,000 GP isi s pe annum. Based upon demand–supply a io es ima es in
Collins and Homeniuk (2021), his demand would equi e an es ima ed 1.5 GP
WTEs o p o ide ca e.
Wi hin a public housing de elopmen o he same size, o al demand is highe a
o e 12,000 isi s pe annum. We highligh in Appendix Figu e A.1 ha he highe
demand in he public housing de elopmen is la gely a consequence o highe GP
demand among suppo ed en e s who, despi e ha ing a younge age p o ile han
owne s, end o ha e highe a es o ch onic illness and highe a es o public
heal hca e co e age, and hus g ea e demand o GP ca e. Such demand would
equi e he equi alen o 1.64 GP WTEs (9.3 pe cen mo e han he HFA
de elopmen ).
In he p i a e housing de elopmen , o e all demand is lowe , a app oxima ely
10,500 GP isi s pe annum, wi h a commensu a e GP WTE equi emen o 1.43
(4.6 pe cen less han HFA de elopmen ). Appendix Figu e A.1 illus a es ha he
lowe demand and supply equi emen s compa ed o he HFA de elopmen a e
due o he ypically younge age p o ile and lowe demand om p i a e en e s,
who make up a la ge sha e o he o e all de elopmen in his benchma k.
Residen ial de elopmen s and heal hca e | 55
Fo PN ca e (Table 6.2), a simila a ia ion in demand and supply equi emen s
ac oss de elopmen ypes is obse ed. Wi hin he 1,000-uni HFA de elopmen ,
he model es ima es a demand o 3,213 PN isi s, equa ing o a WTE equi emen
o 0.49 PN WTEs. The e is ela i ely li le a ia ion in PN demand and supply
equi emen s ac oss de elopmen ype: he WTE equi emen is sligh ly highe in
he public housing de elopmen and sligh ly lowe in he p i a e housing
de elopmen .
TABLE 6.1 COMPARISON OF GP DEMAND AND SUPPLY IN BENCHMARK DEVELOPMENT TYPES
Pa ame e s
(a) HFA
(b) Public
housing
(c) P i a e
housing
De elopmen size
1,000
1,000
1,000
To al popula ion
2,580
2,564
2,554
Suppo ed en e %
30
80
10
P i a e en e %
20
10
40
Owne %
50
10
50
To al GP isi s
10,979
12,014
10,514
GP WTEs equi ed
1.50
1.64
1.43
TABLE 6.2 COMPARISON OF PN DEMAND AND SUPPLY IN BENCHMARK DEVELOPMENT TYPES
Pa ame e s
(a) HFA
(b) Public
housing
(c) P i a e
housing
De elopmen size
1,000
1,000
1,000
To al popula ion
2,580
2,564
2,554
Suppo ed en e %
30
80
10
P i a e en e %
20
10
40
Owne %
50
10
50
To al PN isi s
3,213
3,433
3,056
PN WTEs equi ed
0.49
0.52
0.46
Appendix Figu es A.1 and A.2 illus a e he dis ibu ion o GP and PN isi s ac oss
age o each benchma k de elopmen sepa a ely.
6.2.2 Uni e sal p ima y ca e
In ecen yea s, a numbe o ex ensions ha e been made o he GP isi ca d
scheme, including ee ca e o all hose unde six since 2015. In he p e ious
sec ion, ee GP and PN ca e is assumed o all hose unde 6 in acco dance wi h
his change, as well as o all hose aged 70+. A numbe o o he ex ensions ook
56 | Resul s: Heal hca e demand by de elopmen ype
place in 2023, including en i lemen o GP isi ca ds o all hose aged unde 8 and
all indi iduals ea ning less han he median annual income.
22
These ex ensions seek o mo e us close o he wide goal o uni e sal p ima y
ca e o he ull popula ion, as ou lined in Sláin eca e. Such expansion will inc ease
demand o GP and PN ca e in line wi h ecen e idence (O’Callaghan e al., 2018;
McDonnell e al., 2022). Recen esea ch a he ESRI has es ima ed he po en ial
expendi u e equi ed o he implemen a ion o uni e sal p ima y ca e (Connolly
e al., 2023).
As discussed in Chap e 4, he HHP model has been de eloped wi h he lexibili y
o examine speci ic policy changes i da a a e a ailable on such changes. In
Appendix A.3, we use he HHP model o es ima e he po en ial GP demand and
supply implica ions o uni e sal p ima y ca e. We es ima e ha in a 1,000-uni HFA
de elopmen , expansion o uni e sal p ima y ca e o all would inc ease demand
by 20 pe cen . This would equi e a commensu a e inc ease in GP WTEs o mee
his demand. These inc eases in demand would be p edominan ly d i en by adul s
aged 25–60 yea s who cu en ly ha e ela i ely low a es o medical ca d o GP
isi ca d co e age. Mo e discussion on he esul s can be ound in Appendix A.3.
This example highligh s he capabili ies o he HHP model o examine he po en ial
demand and supply implica ions o u u e heal hca e policy changes.
6.3 ACUTE PUBLIC HOSPITAL DEMAND AND SUPPLY
6.3.1 Eme gency depa men
Table 6.3 p o ide es ima es o he o al numbe o ED a endances o each o ou
h ee benchma k de elopmen s. In he 1,000-uni HFA de elopmen , he HHP
model es ima es ha an es ima ed 669 ED a endances would be expec ed o
occu . Unlike esul s shown in he p e ious sec ion o GP ca e, he e is ela i ely
li le a ia ion in a endances ac oss de elopmen ypes. Howe e , ED demand is
sligh ly highe (4.3 pe cen ) in he public housing de elopmen and sligh ly lowe
(-3.7 pe cen ) in he p i a e housing de elopmen .
As highligh ed in Appendix Figu e A.3, simila demand p o iles a e es ima ed ac oss
ages, and he HHP es ima es a e ela i ely insensi i e o enu e composi ion
changes. Fo example, in he HFA de elopmen , ED a endances a e highes among
young child en, and emain ela i ely s able ac oss age he ea e . In he public
housing de elopmen , a simila age p o ile is obse ed bu due o he enu e
composi ion suppo ed en e s a e d i ing demand.
22
See h ps://www.ci izensin o ma ion.ie/en/heal h/medical-ca ds-and-gp- isi -ca ds/gp- isi -ca ds/.
Residen ial de elopmen s and heal hca e | 57
TABLE 6.3 COMPARISON OF ED ATTENDANCES IN BENCHMARK DEVELOPMENT TYPES
Pa ame e s
(a) HFA
(b) Public
housing
(c) P i a e
housing
De elopmen size
1,000
1,000
1,000
To al popula ion
2,580
2,564
2,554
Suppo ed en e %
30
80
10
P i a e en e %
20
10
40
Owne %
50
10
50
To al ED a endances
669
698
644
6.3.2 Day pa ien
Table 6.4 p o ides es ima es o he o al numbe o day pa ien admissions, day
pa ien beds and day pa ien bed days o each o ou h ee benchma k
de elopmen s. In he 1,000-uni HFA de elopmen , he HHP model es ima es a
demand o 590 day pa ien admissions, which equa es o a bed equi emen o
0.75 day pa ien beds (assuming a 0.5 day a e age LOS). Simila o esul s o ED
a endances, he e is less a ia ion in demand and supply equi emen s ac oss
de elopmen ype compa ed o GP ca e. In gene al, demand is 3.7 pe cen and 5.9
pe cen lowe in he public housing and p i a e housing de elopmen s,
espec i ely.
Once mo e, as shown in Figu e A.4, he age dis ibu ion di e s li le ac oss
de elopmen ypes, while he enu e ype d i ing demand does a y.
TABLE 6.4 COMPARISON OF DAY PATIENT ADMISSIONS, BED DAYS AND REQUIRED BEDS IN
BENCHMARK DEVELOPMENT TYPES
Pa ame e s
(a) HFA
(b) Public
housing
(c) P i a e
housing
De elopmen size
1,000
1,000
1,000
To al popula ion
2,580
2,564
2,554
Suppo ed en e %
30
80
10
P i a e en e %
20
10
40
Owne %
50
10
50
To al admissions
590
568
555
Bed days
295
284
277
Beds
0.75
0.78
0.76
6.3.3 Elec i e inpa ien
Table 6.5 p o ide es ima es o he o al numbe o inpa ien admissions, bed days
and commensu a e inpa ien bed equi emen s o each o ou h ee benchma k
de elopmen s. In he 1,000-uni HFA de elopmen , he HHP model es ima es a
demand o 52 elec i e inpa ien admissions and 335 elec i e inpa ien bed days,
which equa es o a bed equi emen o 0.92 inpa ien pa ien beds.
58 | Resul s: Heal hca e demand by de elopmen ype
Compa ed o ED and day pa ien demand, we es ima e la ge a ia ions in demand
ac oss de elopmen ypes. Compa ed o he HFA de elopmen , elec i e inpa ien
demand, as measu ed in bed days, is app oxima ely 14 pe cen lowe in he public
housing de elopmen and 5.4 pe cen lowe in he p i a e housing de elopmen .
Appendix Figu e A.5 shows ha , compa ed o he HFA de elopmen , he public
housing de elopmen sees a peak in olde child en and again in olde wo king-age
adul s; demand is much lowe among olde people owing o hei lowe ela i e
popula ion wi hin he de elopmen as a whole. In he p i a e housing
de elopmen , he dis ibu ion o o al de elopmen is simila o ha o he HFA
one, hough he young adul popula ion is mo e ep esen ed in he o e all demand
p o ile.
TABLE 6.5 COMPARISON OF ELECTIVE INPATIENT ADMISSIONS, BED DAYS AND REQUIRED
BEDS IN BENCHMARK DEVELOPMENT TYPES
Pa ame e s
(a) HFA
(b) Public
housing
(c) P i a e
housing
De elopmen size
1,000
1,000
1,000
To al popula ion
2,580
2,564
2,554
Suppo ed en e %
30
80
10
P i a e en e %
20
10
40
Owne %
50
10
50
To al admissions
52
50
48
Bed days
335
288
317
Beds equi ed
0.92
0.79
0.87
6.3.4 Eme gency inpa ien
Table 6.6 p o ide es ima es o he o al numbe o eme gency inpa ien
admissions, bed days and commensu a e inpa ien bed equi emen s o each o
ou h ee benchma k de elopmen s. In he 1,000-uni HFA de elopmen , he HHP
model es ima es a demand o 244 eme gency inpa ien admissions and 1,448
eme gency inpa ien bed days, which equa es o a bed equi emen o jus unde
4 beds pe annum. This is much highe han obse ed o elec i e inpa ien ca e
and e lec s he ac ha up o 85 pe cen o all acu e public hospi al inpa ien
admissions a e admi ed as eme gencies (Walsh and B ick, 2023). Compa ed o he
HFA de elopmen , eme gency inpa ien bed days a e 13.6 pe cen lowe in he
public housing de elopmen and 5.4 pe cen lowe in he p i a e housing
de elopmen . As shown in Appendix Figu e A.6, hese di e ences a e d i en by
a ia ions in he age dis ibu ion o demand. In he HFA de elopmen , o al
admissions gene ally inc ease wi h age, wi h he g ea es demand a he uppe end
o he age dis ibu ion. In he public housing de elopmen , by con as , much o
he demand is ocused on he wo king-age adul popula ion, wi h ela i ely less
ound among he olde popula ion. The p i a e housing de elopmen is easonably
simila o he HFA de elopmen , al hough wi h a g ea e ep esen a ion o young
adul s in he o e all dis ibu ion d i en by an inc eased sha e o he de elopmen
being comp ised o p i a e en e s.
Residen ial de elopmen s and heal hca e | 59
TABLE 6.6 COMPARISON OF EMERGENCY INPATIENT ADMISSIONS, BED DAYS AND REQUIRED
BEDS IN BENCHMARK DEVELOPMENT TYPES
Pa ame e s
(a) HFA
(b) Public
housing
(c) P i a e
housing
De elopmen size
1,000
1,000
1,000
To al popula ion
2,580
2,564
2,554
Suppo ed en e %
30
80
10
P i a e en e %
20
10
40
Owne %
50
10
50
To al admissions
244
241
230
Bed days
1,448
1,251
1,370
Beds equi ed
3.97
3.43
3.75
In Appendix Table A.1 we combine elec i e inpa ien and eme gency inpa ien
esul s.
6.4 CONCLUSIONS
Compa ed o p ima y ca e, acu e public hospi al demand is much mo e highly
co ela ed wi h age. Fo all se ices included, olde people ypically equi e mo e
hospi al ca e han younge people. The e is also a lowe co ela ion be ween acu e
public hospi al demand and medical ca d s a us compa ed o p ima y ca e se ices.
Consequen ly, in mos new de elopmen s he magni ude o demand o hospi al
se ices is la gely de e mined by he age dis ibu ion o ha de elopmen . O no e,
de elopmen s comp ised p ima ily o homeowne s (who a e on a e age olde ) will
ypically ha e highe acu e heal hca e demand and hus g ea e supply is
necessa y.
66 | Summa y and conclusions
A dea h o housing supply in I eland means ha policies ou lined in he NDP and
he NPF aim o expand housing supply ex ensi ely in he coming yea s. The na ional
housing plan, Housing o All – A New Housing Plan o I eland (HFA), ou lines
pa hways o ac ions o be aken by na ional and local planne s and o he s a e
agencies o achie e 33,000 housing uni s pe annum. Howe e , be e in eg a ion
o hese housing plans and heal hca e planning is key. O he coun ies, no ably
England, New Zealand and he Ne he lands, ha e begun o be e in eg a e
planning o housing and heal hca e by ocusing on s a egic collabo a ion a a
na ional and local le el. Wi h he es ablishmen o HSE Heal h Regions, mo e o e
a emp s o unde ake such s a egic collabo a ion should be close o he op o
policymake s’ agendas. This will equi e de ined a ge s, communica ion and in-
dep h plans o ensu e ha inc eased housing in an a ea will be accompanied by
p opo iona e inc eases in key heal h and social ca e se ices.
New ools such as he Hippoc a es model and he HHP model p o ide a basis o
in o m heal hca e sys em needs a a na ional, egional and mo e localised le el. In
pa icula , he HHP model can p o ide guidance o planne s o make in o med
decisions abou he heal hca e supply equi emen s o new housing
de elopmen s. Such guidance may allow planning au ho i ies o ake a holis ic
app oach o modelling new de elopmen s. Adop ing a mo e in eg a ed app oach
o he p o ision o housing and heal h and social ca e se ices c ea es an
oppo uni y o ensu e he de elopmen and g ow h o heal hy, sus ainable
communi ies in I eland. Mo eo e , app op ia e planning o heal hca e se ices in
new esiden ial de elopmen s will allow planne s o mi iga e, a he han
exace ba e, p e iously obse ed dispa i ies in heal hca e accessibili y ac oss he
coun y. The HHP model, o he mac osimula ion app oach adop ed by he model,
could also be adop ed o model demand equi emen s a ising om esiden ial
de elopmen s o o he key se ices such as educa ion and ec ea ional ameni ies.
A p ima y con ibu ion o his epo is o highligh how new esiden ial
de elopmen s o a ying composi ions will con ibu e o he demand o
heal hca e se ices in a local a ea. We ha e shown ha a ia ions in he enu e
ype o a new de elopmen will induce a ia ions in he o e all demand o
heal hca e, and consequen ly, he heal hca e supply ha will be equi ed. O
pa icula no e, de elopmen s comp ising indi iduals who a e, on a e age, olde
will equi e mo e heal hca e se ices, as will hose wi h a la ge numbe o people
wi h public heal hca e co e age (medical ca ds and GP isi ca ds).
While exac es ima es o heal hca e demand and supply equi emen s a e no
possible due o he complexi y o modelling he I ish heal hca e sys em, he HHP
model o e s planning au ho i ies a obus es ima e o he po en ial heal hca e
se ice implica ions o building new esiden ial de elopmen s. By in eg a ing
enu e-le el demog aphic in o ma ion wi h g anula da a on heal hca e u ilisa ion
Residen ial de elopmen s and heal hca e | 67
p o iles, we can cons uc de ailed es ima es o agg ega e heal hca e demand as
well as demand a ising om speci ic subg oups.
The s uc u e o he HHP model allows o u he de elopmen and g ea e
p ecision as new da a become a ailable. No ably, u u e i e a ions will endea ou
o include a b oade ange o heal h and social ca e se ices, o p ojec heal hca e
demand and supply as a esiden ial de elopmen e ol es o e ime, and o o e
insigh s in o he in as uc u al equi emen s and capi al in es men needed o
accommoda e heal hca e se ices. Fu he mo e, wi h he a ailabili y o mo e
de ailed socio-demog aphic da a, he p ecision o ou es ima es will be enhanced.
68 | Re e ences
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74 | Appendices
APPENDIX
A.1 PRIMARY CARE DEMAND PROFILES ACROSS BENCHMARK DEVELOPMENTS
FIGURE A.1 GP VISITS BY AGE IN BENCHMARK DEVELOPMENT TYPES
(a) HFA de elopmen
(b) Public housing de elopmen
(c) P i a e housing de elopmen
Residen ial de elopmen s and heal hca e | 75
FIGURE A.2 PN VISITS BY AGE IN BENCHMARK DEVELOPMENT TYPES
(a) HFA de elopmen
(b) Public housing de elopmen
(c) P i a e housing de elopmen
82 | Appendices
gi en ha hey a e al eady en i led o ee GP ca e. The g ea es inc eases in
demand would a ise among wo king age adul s, pa icula ly hose in he 25–60 age
b acke .
Thus, when planning o new esiden ial de elopmen s, i is e iden ha planning
au ho i ies mus also conside he impac o changing policy amewo ks in he
heal hca e sphe e. The in oduc ion o uni e sal p ima y ca e, conside ed a
p io i y unde he cu en P og amme o Go e nmen , is likely o pa icula ly al e
he p o ile o heal hca e demand in any gi en new esiden ial de elopmen . As a
esul , planning o inc eased supply o p ima y ca e and he associa ed
in as uc u e mus also o m pa o he planning p ocess o a new esiden ial
de elopmen .
TABLE A.3 COMPARISON OF THE IMPLICATIONS FOR GP DEMAND AND SUPPLY IN A 1,000-UNIT
HFA DEVELOPMENT WITH AND WITHOUT UNIVERSAL PRIMARY CARE
Pa ame e s
Cu en policy
Uni e sal p ima y ca e
De elopmen size
1,000
1,000
To al popula ion
2,580
2,580
Suppo ed en e %
30
30
P i a e en e %
20
20
Owne %
50
50
To al GP isi s
10,979
13,254
GP WTEs equi ed
1.50
1.80
FIGURE A.7 COMPARISON OF GP VISITS IN 1,000-UNIT HFA DEVELOPMENT WITH AND WITHOUT UNIVERSAL
PRIMARY CARE
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