Dr. Maev-Ann Wren:

We are very explicit about that. We adopted that approach initially because when one is building a model, one has to start from the status quo. Although we can now apply the model to an examination of the effects of changes, that requires having evidence about substitution. If we are modelling an increase in primary care, we need to apply evidence of how that might affect acute care. The capacity review that was published by the Department of Health recently acknowledges that there is a paucity of quantifiable evidence in this area. We are working very closely on this issue. Another ESRI study, which is funded by the Health Research Board, is looking at the effects of non-acute supply on the use of acute hospitals by region throughout Ireland.

It is our hope and plan to apply the findings, within the model, to looking at the substitution effects and changes in models of care.