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1. IntroductionUniversal healthcare (UHC), sometimes referred to as universal health coverage, universal coverage or universal care, usually refers to a healthcare system, which provides healthcare and financial protection to all citizens of a particular country. It is organised around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes [1]. The World Health Organization (WHO) defines a universal health system as one where ‘all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship’. In Ireland, the definition used in current policy for the introduction of UHC does not mention the issue of affordability but instead places the emphasis on access based on clinical need [2]. This is contrary to a key underlying tenet of UHC which is risk protection. Health payments are a heavy financial burden for millions around the world. Financial risk protection is concerned with safeguarding people against the financial hardship associated with paying for health services. The concept of financial risk protection, or conversely the absence of a risk of financial hardship, has been the focus of interest to economists and researchers for many years, and measuring the ability of a health system to protect people against the financial hardship associated with paying for health services has become an important issue for research and analysis across countries at all income levels [3]. It is unclear why health policy in Ireland has chosen to adopt a definition of UHC which is silent on the issue of affordability.The WHO has advocated UHC as the best means of improving global health. However, achieving UHC is not without challenges: from defining the goal of UHC to identifying the most appropriate methods to achieve it. The idea of UHC can be seen in the 1948 WHO Constitution [4] of which Ireland is a signatory. The concept of UHC was first introduced in Ireland through the 1948 Health Act [5]. UHC is also embedded in the 1978 Alma-Ata declaration that contains a number of important principles in relation to health. It specifies that all people regardless of race, religion, political belief, economic or social condition be entitled to enjoy the highest attainable standard of health as a fundamental right. In 2005 [6], 2011 [7] and 2013 [1] UHC has become the focus of various WHO campaigns as the importance and benefits of universal coverage become ever more apparent.Over recent years funding for the health service in Ireland has declined, amidst the most severe economic crisis since the 1930s, while the demands for care and patient expectations have increased [8], [9]. The health system managed ‘to do more with less’ from 2008 to 2012, achieved mostly by transferring the cost of care onto people and by significant resource cuts [10]. This is evident in reduced home care hours, increased wait-times, expensive agency staffing and accentuated inequities of access for patients within the health system. Alongside this there was a growing discourse in society to have a health system that is accountable, effective, efficient and capable of responding to the emerging and on-going needs of the public. This has been illustrated through debates on UHC internationally [11] and in Ireland [2].The structure of the Irish healthcare system has a number of unusual features [12] and is commonly referred to as a ‘two-tiered’ system. ‘Two-tier’ refers to the fact that people who can pay privately or have private health insurance (PHI) can get a diagnosis quicker and can secure faster hospital treatment, even in public hospitals, because they can afford the monthly premiums [13]. About 46% of the population have PHI [14]. Those who cannot afford PHI must often face long waiting lists for acute care [10], for example longer waiting times for minor operations and diagnostics such as CT scans [15]. About two fifths of the population have medical cards under the General Medical Services (GMS) scheme, which are means tested and mostly allocated on the basis of income. These cards enable people on low or no income to access general practice (GP) and hospital care without charge and medicines at a low cost. Healthcare financing relies predominantly on general taxation, which accounted for an estimated 69 per cent of total financing in 2015, with out-of –pocket payments by individuals and PHI contributing an estimated 13 per cent each [16]. Ireland is unusual amongst its European neighbours in not having universal access to primary care [17]. A recent analysis conducted by the European Observatory on Health Systems and Policies found that the highest formal payments in any primary care system exist in Ireland, where patients without a medical card (e.g. when income rises above a specified threshold) pay between €45 and €65 for each GP visit, with no reimbursement [17]. According to recent OECD data on 34 countries, Ireland is in the bottom third for both out-of-pocket expenditure and also unmet medical needs particularly in relation to medical examinations [18], whereby people indicated that they need medical treatment in the previous 12 months but did not receive it [18]. Cross sectional analysis of health seeking behaviour within primary care in Ireland revealed that those who had to pay out-of-pocket payments to see a GP were more likely to put off going to the doctor than those with a GMS card [19]. Similarly analysis on the impact of the introduction of copayments on prescriptions reported a reduction in medication adherence [20]. An antidote to this inequitable two-tiered system is UHC. Possible options for the implementation of UHC, including funding and restructuring as well as dealing with possible positive and negative outcomes are outlined in the Slaintecare report [2]. Details of the complicated nature of the Irish health system are explained in a recent analyses [21].In more recent years Ireland has recommitted its intention to introduce UHC by looking to change the underlying funding model to an insurance based system – universal health insurance (UHI). The 2011-16 Programme for Government states, “under this system there will be no discrimination between patients on the grounds of income or insurance status” [22]. In the final days of the previous Government, UHI became seriously delayed and abandoned in the run up to the 2016 General Election, with the Minister for Health indicating on foot of the publication of costings for UHI that the multi-payer model of private competing insurance companies is not viable stating it was ‘not acceptable, either now or any time in the future’[23]. More recently the Government has formed a cross-party committee, the primary role of which is to ‘establish a universal single tier service where patients are treated on the basis of health need rather than on ability to pay’ [24]. This committee, called the Oireachtas Committee on the Future of Healthcare, published its report entitled Slaintecare in May 2017 outlining a ten year plan for the introduction of UHC in Ireland [2].The issue around universalisation has therefore been an ongoing background debate for decades and periodically comes to the fore when the standing Government seeks to institute reforms. Despite these commitments by Ireland at international and national level, the two-tiered system still exists. This begs the question as to why?The legitimacy and sustainability of any major policy decision increasingly depends on how well it reflects the underlying values of the public. Experts and stakeholders provide essential technical input but their role is distinct from that of the citizen and cannot replace it. It is increasingly understood that citizens should be a stakeholder in framing health policy decisions [25] and it is recognised that citizens’ values should define the boundaries of action in healthcare in any democracy[26], [27], [28], [29]. This is particularly the case for UHC as patients and the public have been identified as key enablers for the implementation of any universal programme [30]. According to the OECD the general public bring new ideas and experiences to the decision-making process; encourage policy makers to think more carefully about the objectives of health services and to be more open and explicit about the choices being made [31].The call for public participation also suggests a shift in political philosophy about who has the democratic right to make healthcare decisions. The WHO have also used the language of rights when arguing that: ‘The people have the right and duty to participate individually and collectively in the planning and implementation of their health care’ [32]. Members of the general public want to be involved in decision-making at the national level [33] and they overwhelmingly want their preferences to inform priority-setting decisions in healthcare [34].Public input into healthcare decision-making, at least in theory, is clearly advocated in Ireland. The importance of patient involvement has been acknowledged in numerous policy documents such as ‘A Vision for Change: Report of the expert group on mental health policy’ [35], ‘The National Health Strategy: Quality and fairness – a health system for you’[36], the Madden Report [37] and most recently in ‘Healthy Ireland – A Framework for Improved Health and Wellbeing 2013–2025 [38], as well as in numerous Health Service Executive (HSE) national service plans [39], [40], [41]. In Ireland researcher-administered questionnaires with 738 patients and family members attending outpatient services reported that 86.2% were supportive of greater patient participation in national level healthcare design, delivery and policy [42].The key prevailing issue relating to the Irish health system is how to end the inequitable two-tiered health system that exists. There has been one formal assessment of the general public’s views and opinions on universalisation in Ireland, however, this study included a convenience sample of patients attending for treatment in a primary care setting[43]. Beyond the media headlines little is actually known about the general public’s views on universal healthcare. We sought to identify what demographic factors and opinions influence the support of the general public for the introduction of universal healthcare (UHC) in Ireland.2. Materials and methods2.1. DesignA cross-sectional survey on the views and opinions of the general public on the introduction of UHC in Ireland.2.2. SamplingA sample of 972 participants were recruited. This provided a 3% margin of error with a 95% confidence level and total population of 4,757,976 based on the 2016 National Census [44].Random sampling was employed with random digit dialling of 85% mobile numbers and 15% landline numbers. This ensured listed and non-listed numbers have the same probability of being contacted. To ensure a representative sample soft quotas for age, gender, location, and social class were monitored. The data was weighted at analysis stage. Weightings were based on data from the 2011 Census and the Joint National Listenership Research (JNLR). The JNLR includes a sample of over 16,000 respondents aged over 15 conducted annually over 50 weeks of the year [45]. This was used alongside Census data to keep weightings as up to date as possible.2.3. ProceduresData collection took place over a two-week period in December 2016. A market research company who specialise in healthcare research were contracted to conduct questionnaires over the phone as part of an omnibus poll. The research team provided the data collectors with definitions for all key terms used in the questionnaire and meetings took place to ensure in depth understanding of the topic and questionnaire. All data collectors were provided with a full day of training, a briefing on the project and 10–15% of interviewer calls were monitored for quality control.The questionnaire was anonymous and researcher-administered over the phone. Consent was implied in completing the questionnaire.Ethical approval was provided by the School of Medicine Level 1 Research Ethics Committee in Trinity College Dublin (reference 20160208).2.4. MeasuresThe questionnaire was developed based on a literature review with standardised questions employed where possible. For example, Question 3b, ‘The government should prioritise spending on healthcare rather than reducing taxes’, was based on work by the Think-tank for Action on Social Change (TASC) which asked about investing in public services in general [46]. A definition of UHC based on the WHO definition was read out to participants after question one (‘I feel well informed about universal healthcare’) was answered. The definition provided was ‘“Universal Healthcare” is that all people have access to the health services they need (prevention, promotion, treatment, rehabilitation and palliative care) free at the point of access.’ (See Supplementary File A: Questionnaire). Further explanation was provided as required throughout the questionnaire after question one was answered. The questionnaire was piloted with 384 members of the general public in two locations in Dublin, Ireland with contrasting levels of deprivation in a face-to-face researcher-administered format. The pilot data was not included in the current paper as the data were collected through different mediums (telephone versus face-to-face) and also a convenience sample was utilised in the pilot.2.4.1. DemographicsParticipants were asked about their age, gender, where in the country they live (location) and level of education. Self reported health, level of healthcare cover, social class and knowledge of UHC were also recorded.Self-reported health (SRH)SRH was assessed by the answer to a single item ‘How is your health in general?’. There were five response categories: ‘very good, “good”, ‘fair’, ‘bad’, and ‘very bad’. This question has become a standard measure for SRH and due to its format can be compared with Irish and international data [47]. For analysis this variable was collapsed into ‘good self-rating of health’ including ‘very good’ and ‘good’ and ‘poor self-rating of health’ consisting of ‘fair’, ‘bad’ and ‘very bad’.2.4.2. Level of healthcare coverWhether the participant was eligible for the GMS scheme, had private health insurance or neither. Due to small numbers for analysis PHI and neither were collapsed together.2.4.3. Social classThe social grading classification system from The British National Readership Survey (NRS) has been well established and used since the 1960s and was employed in this study [48]. This was determined based on a series of questions about the chief income earner of the household in which the participant resides. This included questions on their employment status, type of employer, occupation, role and qualifications. Social class was divided into 5 categories; AB upper/middle class, C1 lower middle class, C2 skilled working class, DE other working class and F farmers.2.4.4. Knowledge of UHCParticipants were asked to indicate how much they agreed with the following statement on a 5-point scale from ‘strongly agree’ to ‘strongly disagree’. ‘I feel well informed about universal healthcare’. Participants were asked to answer this question before being provided with the definition of UHC. Categories were collapsed down to ‘agree’ (which included ‘strongly agree’ and ‘agree’) and ‘ disagree/neither’ (which included ‘neither’, ‘disagree’ and ‘strongly disagree’). The collapse of the answer categories was determined by those participants who indicated that they did not definitely ‘agree’ or ‘strongly agree’.2.4.5. Opinions and views on UHCParticipants were asked to indicate how much they agreed with the following statements on a 5-point scale from ‘strongly agree’ to ‘strongly disagree’. ‘Having the health service as a public system is important’, ‘The government should prioritise spending on healthcare rather than reducing taxes’, ‘I want healthcare free at the point of access’, ‘People who can pay for healthcare should pay’, ‘I am prepared to pay higher taxes for healthcare free at the point of access’. During analysis categories were collapsed down to ‘agree’ (which included ‘strongly agree’ and ‘agree’) and ‘ disagree/neither’ (which included ‘neither’, ‘disagree’ and ‘strongly disagree’). The collapse of the answer categories was determined by those participants who indicated that they did not definitely ‘agree’ or ‘strongly agree’.2.5. AnalysesA weighted logistic regression model was employed to assess the odds of participants who did not support the introduction of UHC in Ireland versus the odds of participants who did support the introduction of UHC in Ireland, taking demographic factors and opinions into account.Contingency tables were examined to ensure adequate sample size for each parameter. The final logistic regression model was selected based on the lowest Akaike’s information criterion (AIC). Interactions were checked for and none found. Tolerance and generalised variance inflation factors (GVIF) for independent variables were assessed to determine the presence of multicollinearity. All values were within acceptable limits with tolerance values lower than 1 [49] and GVIF values less than 2 [50].Results are displayed in terms of odds ratios (OR) and 95% confidence intervals (CI). ORs range from 0 to infinity with 1.0 meaning no difference in odds and ORs greater than 1.0 meaning that the ratio of those who support the introduction of UHC versus those who do not support the introduction of UHC in the selected group is greater than the reference group. If the 95% CI for OR crosses 1 this indicates that there is no evidence to suggest that there is any difference between the reference and selected group when comparing those who do and do not support the introduction of UHC in Ireland.Analysis was conducted using statistical software SPSS Version 22.3. Results3.1. Response rateA total of 1102 people were invited to complete the questionnaire on UHC after random digit dialling and eligibility checks. From this 972 participants completed the questionnaire providing a response rate of 88.2% as illustrated in Fig. 1: Flowchart of participants.Download high-res image (434KB)Download full-size imageFig. 1. Flowchart of Participants.3.2. Descriptive analysesA demographic description of the sample is provided in Table 1 (non-weighted) and Table 2 (weighted). These are broken down by support for the introduction of UHC in Ireland. An overview of opinions relating to UHC in Ireland are also illustrated.Table 1. Non-weighted demographic description broken down by agreement with UHC.CovariateAgreeDisagreeNeitherTotal84687.0%656.7%616.3%972100.0%Age18–249110.823.1711.510010.325–4428033.12030.82744.332733.645–6430636.22436.92134.435136.165+16920.01929.269.819420.0Missing––––––––GenderMale45954.34467.73659.053955.5Female38745.72132.32541.043344.5Missing––––––––ProvinceDublin24328.71624.61219.727127.9Rest of Leinster22927.11929.21931.126727.5Munster23327.51726.21829.526827.6Connaght/Ulster14116.71320.01219.716617.1Missing––––––––EducationSecondary level or lowera39246.83250.01626.244044.7Third levelb44553.23250.04573.852254.3Missing––––––101.0GMS StatuscGMSd21225.11116.9711.523023.7Private health insurance46655.14467.74472.155457.0Neither16819.91015.41016.418819.3Missing––––––––Social ClassUpper middle class13816.31015.42032.816817.3Lower middle class23227.42132.31829.527127.9Skilled working class13816.3710.8813.115315.7Other working class29635.02436.91016.433034.0Farmers425.034.658.2505.1Missing––––––––Having the health service as a public system is importantAgree80595.24975.45386.990793.3Disagree/Neither414.81624.6813.1656.7Missing––––––––The government should prioritise spending on healthcare rather than reduce taxesAgree73186.42944.63760.779782.0Disagree/Neither11513.63655.42439.317518.0Missing––––––––I want healthcare free at the point of accessAgree73086.33146.22947.578981.2Disagree/Neither11613.73553.83252.518318.8Missing––––––––People who can pay for healthcare should payAgree56767.01523.14268.965967.8Disagree/Neither27933.05076.91931.131332.2Missing––––––––I am prepared to pay higher taxes for healthcare free at the point of accessAgree56666.91929.22642.661162.9Disagree/Neither28033.14670.83557.436137.1Missing––––––––I feel well informed about UHCAgree42149.82335.41118.045546.8Disagree/neither42550.24264.65082.051753.2Missing––––––––Self-reported healthPoor16920.01624.669.819119.7Good67780.04975.45590.278180.3Missing––––––––– = Not applicable.aSecondary level education includes primary school education (up to the age of 12) and secondary school education (up to the age of 18) and is equivalent to A Levels.bThird level education is any qualification above school e.g. undergraduate degree, postgraduate diploma.cParticipants could select more than one method of health cover. A total of 74 (7.6%) participants indicated having private health insurance as well as some form of a GMS card. These participants were included within the GMS category.dThe state provides a general medical services (GMS) card primarily based on income but also for other criteria such as age and other government schemes (HSE, 2015). This provides free at the point of contact access to healthcare services.Table 2. Weighted demographic description broken down by agreement with UHC.CovariateAgreeDisagreeNeitherTotal84887.5%616.3%606.2%969100.0%Age969100.018–249711.423.3711.710610.925–4432938.82236.13050.038139.345–6427232.12032.81830.031032.065+15017.71727.858.317217.8Missing––––––––Gender969100.0Male40647.93861.33355.047749.2Female44152.12438.72745.049250.8Missing––––––––Province969100.0Dublin25129.61727.41322.028129.0Rest of Leinster22726.81625.81728.826026.9Munster22927.11625.81627.226127.0Connaght/Ulster14016.51321.01322.016617.0Missing10.1Education969100.0Secondary level or lowera38646.03151.71626.743344.6Third levelb45354.02948.34473.352654.2Missing101.2GMS Statusc969100.0GMSd22426.41219.7811.924425.1Private health insurance44452.33963.94067.852354.0Neither18021.31016.41220.320220.9MissingSocial Class969100.0Upper middle class10212.0711.51525.912412.8Lower middle class23227.42032.81931.727128.0Skilled working class17720.9914.81016.719620.3Other working class28633.82236.11016.731832.8Farmers505.934.9610.0596.0Missing10.1Having the health service as a public system is important970100.0Agree80795.34775.85488.590893.6Disagree/Neither404.71524.2711.5626.4Missing––––––––The government should prioritise spending on healthcare rather than reduce taxes969100.0Agree73086.22947.53660.079582.0Disagree/Neither11713.83252.52440.017317.9Missing10.1I want healthcare free at the point of access969100.0Agree73887.13150.82948.379882.4Disagree/Neither10912.93049.23151.717017.5Missing10.1People who can pay for healthcare should pay970100.0Agree55965.94674.24066.764566.5Disagree/Neither28934.11625.82033.332533.5Missing––––––––I am prepared to pay higher taxes for healthcare free at the point of access970100.0Agree56066.12032.32744.360762.6Disagree/Neither28733.94267.73455.736337.4Missing––––––––I fell well informed about UHC969100Agree40748.12134.41118.043945.3Disagree/Neither44051.94065.65082.053054.7Missing––––––––Self-reported health970100.0Poor16919.91524.2610.019019.6Good67980.14775.85490.078080.4Missing––––––––– = Not applicable.aSecondary level education includes primary school education (up to the age of 12) and secondary school education (up to the age of 18) and is equivalent to A Levels.bThird level education is any qualification above school e.g. undergraduate degree, postgraduate diploma.cParticipants could select more than one method of health cover. A total of 65 (6.7%) participants indicated having private health insurance as well as some form of a GMS card. These participants were included within the GMS category.dThe state provides a general medical services (GMS) card primarily based on income but also for other criteria such as age and other government schemes (HSE, 2015). This provides free at the point of contact access to healthcare services.Examination of Table 1 (non-weighted) shows that females account for 44.5% (n = 433) of the sample, 33.6% (n = 327) were aged between 25 and 44, 54.3% (n = 522) had a third level qualification and 57.0% (n = 554) of participants had PHI.The introduction of UHC in Ireland was supported by 87.0% (n = 846) of participants. The majority of participants also supported the Government prioritising spending on healthcare rather than reducing taxes (82.0%; n = 797), healthcare free at the point of access (81.2%; n = 789) and that having the health system as a public service is important (93.3%; n = 907).3.3. Regression analysesThe final logistic regression model as determined by the AIC is presented in Table 3 with crude and adjusted ORs for participants who support the introduction of UHC in Ireland compared with those who do not support the introduction of UHC in Ireland (‘disagree’ or ‘neither’). The model was statistically significant and fit the data well [x2[20] = 159.712, p < 0.001; Hosmer and Lemeshow, p > 0.05]. This was the most parsimonious model with the lowest AIC.Table 3. Factors Associated With Agreeing With the Introduction of UHC in Ireland (n = 962; 99.0%).Independent variablesCrude OR95% CIAdjusted ORa95% CIAge18–24BaseBase25–440.69(0.31,1.54)0.64(0.24, 1.67)45–641.10(0.64, 1.89)0.88(0.41, 1.87)65+0.98(0.55, 1.72)0.84(0.31, 1.74)GenderMaleBaseBaseFemale1.52(1.03, 2.24)e1.10(0.70, 1.74)ProvinceDublin1.32(0.76, 2.31)2.16(1.13, 4.11)eRest of Leinster0.84(0.49, 1.43)0.78(0.42, 1.46)Munster1.05(0.62, 1.76)1.14(0.62, 2.10)Connaght/UlsterBaseBaseEducationSecondary level or lowerbBaseBaseThird levelc0.73(0.49, 1.08)0.90(0.54, 1.48)GMS StatusGMSdBaseBasePrivate health insurance/Neither0.54(0.32, 0.89)0.53(0.28, 0.99)*Social ClassUpper middle classBaseBaseLower middle class1.16(0.50, 2.72)1.57(0.59, 4.20)Skilled working class0.91(0.41, 2.01)1.52(0.62, 3.74)Other working class0.61(0.26, 1.43)1.09(0.41, 2.84)Farmers0.61(0.27, 1.35)1.18(0.46, 3.01)Having the health service as a public system is importantAgree4.31(2.45, 7.57)e1.65(0.81, 3.34)Disagree/NeitherBaseBaseThe government should prioritise spending on healthcare rather than reduce taxesAgree5.35(3.56, 8.04)e3.43(2.12, 5.57)eDisagree/NeitherBaseBaseI want healthcare free at the point of accessAgree6.80(4.52,10.23)e4.72(2.95, 7.54)eDisagree/NeitherBaseBasePeople who can pay for healthcare should payAgree0.82(0.54, 1.24)0.72(0.44, 1.19)Disagree/NeitherBaseBaseI am prepared to pay higher taxes for healthcare free at the point of accessAgree3.15(2.13, 4.67)e1.91(1.21, 3.03)eDisagree/NeitherBaseBaseI feel well informed about UHCAgree2.62(1.71, 4.02)e2.13(1.32, 3.44)eDisagree/NeitherBaseBaseSelf-reported healthPoorBaseBaseGood0.85(0.51, 1.40)1.21(0.68, 2.17)aLogistic regression- adjusting for other factors included in the model.bSecondary level education includes primary school education (up to the age of 12) and secondary school education (up to the age of 18) and is equivalent to A Levels.cThird level education is any qualification above school e.g. undergraduate degree, postgraduate diploma.dThe state provides a general medical services (GMS) card to households on low income. This provides free at the point of contact access to healthcare services.eStatistically significant.Statistically significant factors associated with support for UHC included location, GMS status and attitudinal related factors (e.g., ‘The government should prioritise spending on healthcare rather than reduce taxes’, ‘I want healthcare free at the point of access’, ‘I am prepared to pay higher taxes for healthcare free at the point of access’ and ‘I feel well informed about UHC’).Adjusting for the effects of other factors, the odds of participants living in Dublin agreeing with the introduction of UHC were greater than those living in Connacht or Ulster (OR 2.16, 95% CI (1.13, 4.11)). The odds for those who do not have a GMS card agreeing with the introduction of UHC were lower than the odds of those who have a GMS card (OR 0.53, 95% CI (0.29, 0.99)). The odds for those who agreed that the Government should prioritise spending on healthcare rather than reducing taxes were greater than the odds of those who indicated ‘disagree’ or ‘neither’ (OR 3.43, 95% CI (2.12, 5.57)). The odds of participants who agreed that they wanted healthcare free at the point of access were greater than the odds of those who did not want healthcare free at the point of access (OR 4.72, 95% CI (2.95, 7.54)). The odds of those prepared to pay higher taxes for healthcare free at the point of access were greater than the odds of those who were not prepared to pay higher taxes for healthcare free at the point of access (OR 1.91, 95% CI (1.21, 3.03)). The odds of those who felt well informed about UHC agreeing with the introduction of UHC were greater than the odds of those who did not feel well informed about UHC (OR 2.13, 95% CI (1.32, 3.44)).4. DiscussionGeneral public support for the introduction of UHC is influenced by demographic factors and related attitudinal factors. The introduction of UHC in Ireland was supported by 87.0% (n = 846) of participants. Of those that supported the introduction of UHC, this was influenced by factors including location, GMS status, opinions on the government prioritising spending on healthcare, healthcare being free at the point of access, taxes being increased to provide care free at the point of access and feeling informed about UHC.Differences in context and reform proposals generate differences in the interests of stakeholders and their positioning on reform making it difficult to make cross-national comparisons [30]. However, in the absence of general population information on this topic it would appear that the high level of support for UHC reported in this study is reflective of support for UHC demonstrated internationally. Web-based surveys with 2241 medical students revealed that 86.8% were supportive of UHC in Ontario and 51.1% in California [51]. A similar sentiment was reported from postal surveys with 1675 physicians in the United States with 89% agreeing that all Americans should receive needed medical care regardless of ability to pay [52].When asked if Government should prioritise spending on healthcare rather than reducing income taxes 82.0% (n = 797) of participants agreed with this statement. The 2015 Behaviour and Attitudes Survey asked a similar question but focused on public services in general rather than just health services. A total of 69% of participants agreed with focusing on spending on public services [46]. This is lower than the support for prioritising spending on healthcare perhaps illustrating the importance placed on healthcare and the support for improving services in this area. This is of importance for health policy leaders and makers, particularly in Ireland, as recent examples of protest and demonstrations from the public have been proven to be effective. For example, public outcry against the removal of the GMS card for those over the age of 70, and the attempted removal of GMS cards to very sick children resulted in a rolling back of these policies during the economic recession.Higher socioeconomic status was the principal determining factor for the willingness of members of the general public to support participating in national health insurance in a cross sectional study in St Vincent and the Grenadines [53]. An examination of individual level dynamics in healthcare attitudes toward UHC between 2008 and 2010 in the United States revealed that respondents did not take a position towards UHC reflective of their income [54]. Similarly in the current study social class was not a significant factor influencing support for the introduction of UHC.The current two-tier system has been shown to be ineffective for all groups, GMS and private, with GMS patients facing long waiting times and private patients high insurance premiums and out of pocket payments for both groups [55]. Despite the system not working for any group GMS status influenced participants’ opinions on the introduction of UHC with those with GMS cards slightly more likely to support the introduction of UHC. This is to be expected as those who have PHI nor neither PHI nor a GMS card could be the ones who experience the most change from the introduction of UHC, and may anticipate that not all change will be positive. For example, the creation of a single tier service may mean that those currently with PHI could experience longer waiting times for hospital treatment under UHC than they currently do, but lower out of pocket payments for primary care services.The current research had a number of strengths and limitations. This is a nationally representative sample with 972 participants (response rate of 88%) providing the views and opinions of the general public on UHC at a time when one of the question marks over the implementation of a plan for healthcare in Ireland centres around public opinion. The questionnaire included questions that have been previously used and extensive piloting was conducted. Data collectors were trained and the data collection process was monitored for quality. However, the sample was not weighted in terms of GMS status with the proportion of GMS holders accounting for 23.7% (n = 230) of the sample versus 36% of the general population. Focusing on level of education 54.3% (n = 522) of the sample had a third level education or higher. This is comparison to 34% of the general population aged between 15 and 64 [56]. Additionally, caution must be taken when interpreting results as the number of respondents who selected the ‘disagree’ or ‘neither’ category for the introduction of UHC was substantially lower that the number of respondents whom agreed with the introduction of UHC.5. ConclusionThis paper is relevant and timely for policy leaders both in Ireland and internationally. In Ireland the Slaintecare Report [2] has been published outlining a ten year plan for the introduction of UHC in Ireland and implementation remaining the key question now. Internationally, these findings are of interest as countries with UHC, such as the United Kingdom, are facing difficulties maintaining health services in the public realm with ongoing debate on the privatisation of the NHS [57] and other countries, such as the United States, are debating universal elements for their healthcare system. The current study provides a template that can be used to explore public opinions of UHC in other countries. There is a high level of support for the introduction of UHC in Ireland, which is influenced by demographic, and related attitudinal factors. Patients and the general public have been acknowledged as having a key role to play in all areas of healthcare. This research provides timely information from a representative sample for the ongoing debate on the future of healthcare in Ireland. Future research should explore what people want to obtain from the introduction of UHC and what they are willing to contribute to ensure that the voice of patients and the public is heard at all stages of developments. It would be interesting for this to be explored from a number of different stakeholder groups such as clinicians.

There are a handful of serious legal and cultural issues that men face,1 which MRAs are fighting, that some powerful feminist organisations directly oppose. The most prominent ones arei) Protection against female-on-male domestic violence: It was second wave feminists who lobbied for the Violence Against Women Act and constructed the Duluth Model. The latter applies an outdated gendered lens to largely gender-neutral dynamics of Intimate Partner Violence,2 while the former is benevolent sexism that leads some men to be convicted upon their abusive partner’s false accusations.3ii) Child custody and visitation rights. The National Organisation for Women’s stance opposing shared parenting.4 This is bizarrely traditionalist, and contradicts the public stance of most feminists that ‘men get child custody less because of Patriarchy (women are assumed to be primary caregivers.)’ It is justified by NOW and the policy’s sympathisers via the assumptions (in my experience, not remotely fact, but I am biased) that-men are c. 90% successful in achieving custody if they are pro-active about it (i.e. most men don’t try hard enough)-therefore, most father’s rights groups and activists are insincere causes abundant with abusive ex-husbands who are using child custody as leverage to maintain contact with their victim ex-wives. Therefore, it is not in the interests of the children for there to be mandatory shared parenting rights. This ties into the ‘dead beat dad’ narrative of thousands of men trying to dodge child support.iii) False rape accusations: This is in direct opposition to feminist aims of spreading awareness of a ‘rape culture’and ‘systemic gendered violence disproportionately against women’, including the proposed solution of affirmative consent. It’s considered victim-blaming of a rape victim to assume innocence until guilt is proven-even the ‘trust but verify’ standard-on many college campuses. The ‘Dear Colleague’ letter reinforced the erosion of due process.iv) ‘Financial abortion’ rights: While not as controversial as the Religious Right’s opposition to abortion rights, the concept of financial abortion i.e. expecting fathers waiving child support to an unwanted child (in the eyes of a militant feminist) plays into the idea of men viewing women mainly as fuckable objects they’re entitled to and that they have no interest in empathising with, hence why they’d refuse to take responsibility for fatherhood. In reality this is a straw man argument, of course.There are some issues-such as the education gap, deviance from hetero-normativity and male circumcision, which for the most part mainstream feminists are compassionate towards-though they disagree with the causes how to resolve these. Historically feminists such as Mary Koss were ambivalent about defining male rape victims as victims of the same crime as female rape victims; however, but if you ask most feminists these days, they’d be shocked about the WHO conceptualisation of IPV study and Mary Koss defining male rape victims as only victims if ‘made to penetrate.’ For this reason, I did not include it.However, the 4 issues above are fiercely polarising, and play right into each side’s core values. The same occurs to a lesser extent with generalised sexist terms against men and women, e.g. ‘Nice Guys’, ‘creeps,’ ‘man-children,’ ‘sluts,’ and so on.5Any activist or advocate who spends any length of time supporting or involved in a cause, and faces a movement or group that poses barriers to achieving the cause’s goals and seems hostile to it, is going to struggle with radicalisation and tribalism. This honestly makes sense; if you were surrounded by women who had been raped, abused, harassed, denied access to abortion, ridiculed in their careers and treated like pretty toys in a marriage, you would probably not be very sympathetic to the cries of #watabouttehmenz. Equally, if you have encountered friends who have sank into depression because their ex wife was a totally abusive bitch who neglected the children while they the fathers spent a lot of free time with them, and yet the courts gave her child custody and limited or banned your visitation rights, then you’re going to be extremely pissed off when someone complains about ‘male privilege’ and ‘misogyny.’It is my experience that there are just as many feminists who have a gender bias towards women due to this process, as there are MRAs with a bias towards men.For example, if a radicalised feminist6 were to be told by a woman that she (the woman) was getting abused, then they (the radicalised feminist) would instinctively and involuntarily tell her that she needs to get out now, call the police on him, provide links to domestic violence shelters and so on. On the other hand, were a man to share a case with the exact same details, or thereabouts, then they’d have some cognitive dissonance between treating everyone equally, and taking pot-shots at the out-group (men, chauvinists, misogynists). So, they may end up defending the ostensibly abusive woman or accusing the man of being the abuser.I have seen the reverse situation from the extreme MRAs, the ‘anger phase’ Red Pillers and the embittered MGTOWs and Incels. In any given situation, the radicals seem to jump to the worst case scenario which confirms prejudices about the out-group while victimising the in-group.7 So it is that some feminists see everything as ‘male privilege’ and ‘male entitlement,’ while some MRAs see everything as ‘misandry’, ‘gynocentrism’ and ‘hypergamy.’ This is absolutely not true of all feminists or MRAs, obviously; however, it is something to be wary of. I am myself conscious of my bias and sometimes have to refrain from posting when I think that my frustrations at gender double standards veer into irrational sexism or misogyny.I’m fortunate that the worst I have personally experienced IRL is my parents’ marriage becoming a bit abusive and very dysfunctional before they split up, and honestly that pales in comparison to the shit I hear the most hardened advocates speak of seeing. I have contacts who have worked with clients who committed suicide before they could be helped. Many a person falsely prosecuted for DV by an abusive ex, or alienated from their child by state mandate. It is very much a civil war zone.It is my observation that there are a lot (again #NotAll) of activists and advocates on each side who police and shame Allies through whatever means necessary. However, interestingly it is much easier for male feminists to be policed by other feminists than female Men’s Rights Activists/Advocates.It is my experience that this is due to numerous consequences of the old cultural hegemony not being entirely eroded, and likely never being so.i) Patriarchy historically resulted in women being on average, more socially skilled, and requiring manipulation to survive on some occasions.ii) The classical patriarchy held (gender-performing) women to be more morally virtuous and closer to ‘God’ than both the patriarch and the disposable male. The price of being honourable men of action and status was to risk falling into sin through committing wicked deeds for the ‘greater good’, in its numerous forms throughout the religions.Prior to having rights to access to education, this ‘soft power’ was just objectifying women; however, with the collapse of the Old World in the wake of the two world wars, alongside the steady decline of organised religion (particularly Christianity) for the past 2 centuries, the inherent assumption that ‘she is a woman, so she is more morally just/empathetic/emotionally intelligent/kinder and more compassionate than a man’ is outdated and gives women a ‘soft power’ to compliment and exploit the institutional powers that men have held. I call this phenomenon ‘feminine-primary morality.’ The conservative MRA argument is that Feminism redefines morality away from a religious, collectivist, hetero-normative framework, into one which is determined by the standard of individual women (and feminists) on a case by case basis. There is an odd tension between individualism and collectivism in both feminism and the MRM, but I think that’s for another post.I’d like to stress that I don’t think most women are even conscious of this soft power, bar narcissists and Dark Triad women, and as a collective it’s not always successful. Thus this is a form of ‘unconscious sexism’ which goes under the radar a lot, and ironically it’s mostly feminists who actually notice.iii) Moreover, there is no benevolent sexism towards men, who Alison Tieman points out have never been a class protected by victim status, but rather were disposable. Of course this played into evolutionary imperatives, where women werea) child bearers the tribe needed for survivalandb) too weak to fight in battleTherefore, it was perceived that men could be either heroes or villains, but not victims; they have agency, and therefore deserve more respect for their actions and success to women, but also less sympathy for their hardships, responsibilities, insecurities, failures and inaction to avoid these stressors, than women and children who lack this agency and have intrinsic reproductive value. (Incidentally, a major complaint of the MRM is that, outside of academia, corporate feminism as expressed in the mainstream i.e. ‘Girl Power’ reinforces the Women are Wonderful effect, through promoting the ways women are successful and respectable, often superficially and gratuitously, but does little to acknowledge the hardships men face, unless it can relate to sexism against women somehow.)What I am trying to get at is that, since it’s pretty much indisputable that a minority of men had institutional power historically, male feminists have an easier time branding a challenging Ally, fence-sitter or non/anti-feminist as a ‘misogynist.’ But-and this is where the hypocrisy lies-some of these use awful beatdown tactics which reinforce hegemonic masculinity i.e. traditional gender roles, particularly male hyper-agency and stoicism. This is most evident in the male feminists who constantly remind MRAs and men discussing sexism against men that-it is not feminist’s responsibility to solve men’s issues (yet, it is the MRM’s responsibility to solve men’s issues within a feminist-friendly framework)-feminists are not in any way responsible for sexism against men-all men’s issues can and SHOULD be solved by solving women’s issues first; until then discussion of men’s issues is whining (hint: trickle-down economics doesn’t work, this is a silencing tactic)-if you as an individual man suffer in this world, then it’s probably your own fault, not that of women or feminists, so suck it up and be better/improve yourself-since you are a privileged [white] male, it is egregiously entitled to expect people to ake your life EASIER for you already-if a woman manipulates you or takes advantage of you, it’s not because you’re a victim but because you’re a weak-willed, spineless sap who thinks with his dick…and then there are some who simply resort to the ad hominem attacks. “It’s clear from the way you don’t respect women why you’re a lonely virgin now.” “Boys like you are pathetic excuses for men.” etc.8Remember the agency theory I mention earlier? Well there we go. A common theme of all of these is basically to “man up, shut up and protect women at your own expense.” This is the same traditionalist gynocentrism which created a male-only draft and restricted women from dangerous labour. Men have to earn their right to be viewed as ‘good,’ while women have to actively work to lose it.I am not sure why this is except that it’s a form of benevolent sexism in action, most often expressed by older male feminists who may have witnessed and participated in the second wave. It ought to be understood that ‘Patriarchy Hurts Men Too’ is a fairly recent phenomenon, that arose out of conclusions drawn from Judith Butler’s theory of gender performaitvity as means of dissolving the gender binary. So yes, to answer your question, much praise to Ms. Butler for that foundational thesis on gender roles.Since these men act as benevolent sexists endorsing the old traditionalist conservative order which reinforcing male disposability and female soft privilege, we call these ‘white knights.’You also get some psuedo-feminist, and a lot of traditionalist, women who will revert to traditionalist soft powers of female victimhood (hypo-agency, gynosympathy) when a man is failing to ‘man up.’ Again it is a gross irony of the MRM that feminists are theoretically their best friends, in terms of their goals for dissolving the gender binary.9As mentioned, many intersectional feminists and progressives do the same distribution of empathy and hostility with white people v. non-white people, healthy people v. the disabled, Christians, v. non-Christians (particularly Muslims) and so on.Conclusion: Some MRAs feel their platform is threatened because it is-by some, militant feminists, and some feminist organisations which intentionally or obliviously reinforce the cultural hegemony that ‘true feminism’ would seek to eradicate. Ditto feminism feeling threatened by the MRM. The result is cognitive bias, in-group out-group bias, and default sympathy to the in-group and hostility to the out-group respectively, from both movements and their advocates/activists.I hope that was at least an attempt by me at an impartial answer for you, OP.______1 I’m specifically going to speak about issues men face to not be derailed by Lydia’s partially truthful, yet hostile comment above. The legal issues men face are mostly bi-products of the residue of patriarchy, which are getting ignored by many feminists because they contradict the ‘male privilege’ narrative.Also please note that I am primarily speaking about gender politics in the English-speaking first world here, where human rights laws are institutionalised, as are Discrimination Acts. I am not qualified to determine the need for men’s rights advocacy in the likes of India and Saudi Arabia, nor in mainstream Europe and Asia for that matter, although I can point you to activists and advocates who are.2 https://pubpages.unh.edu/~mas2/V71-Straus_Thirty-Years-Denying-Evidence-PV_10.pdfErin Pizzey criticises the duluth model 3 In defence of modern intersectional feminists, once of the biggest motivations for obscuring rates of DV was not just ‘misandry’-of which an activist hosting a safe house for battered wives was bound to struggle with, somewhat understandably-but homophobia. It was considered problematic that IPV in same-sex relationships was of a higher frequency than heterosexual relationships, which might mean letting gay men and lesbian women into the already crowded shelters; the second wave radical feminists were not all so open to LGBT as the Intersectionalists are. Remember that Duluth activists formed the model prior to the AIDs outbreak, and long before transgender rights were in the picture.4 NOW-New York State Oppose LegislationOpposing Shared Parenting: The Feminist Track RecordMen's Issues: Interview with Warren Farrell5 Do note however that, while a genuine and justified criticism of factions of the Manosphere, it is a common feminist straw man criticism/smear campaign of the MRM to make out it’s primarily a reactionary movement for rape apologists to future out how to get laid more easily. On the other had, since so much of gender politics is liked to gendered socialisation, of which one part is the tension of sexual and romantic relations between men and women in particular, it’s near impossible to critique the likes of rape culture and affirmative consent without also mentioning the ways men are socialised to attract women, and critiquing ‘creep-shaming’ culture. See for examplehttps://www.quora.com/Why-cant-men-read-the-signals-women-give-off-when-theyre-interestedTom Ramsay's answer to Why can't men read the signals women give off when they're interested?6 Please don’t confuse this with ‘radical feminist,’ which is a technical school of feminism that re-defined Patriarchy to be[sic] ‘a historical cultural system which gives men more institutional power and authority than women, through valuing masculinity and manhood while devaluing femininity and womanhood.’7 Intersectionalists have an even stronger bias towards oppressed groups as per the progressive stack, which is a fascinating exercise in cognitive bias because it effectively distributes empathy relative to one’s position in the stack based upon largely in-born traits, like sex, race, sexuality, and so on.8 Once again, let’s remember that the radical MRAs/MGTOWs/Redpillers/Incels spend a lot of time bashing Tumblr-style feminists about being “fat sluts who can’t get a good man since they hit the Wall, and need to bitch about patriarchy to feel like victims while they live alone with 10 cats.” The most infamous Internet psuedo-advocates on either side are obviously the most extreme, counter-productive, and childishly obnoxious.[N.B. ‘the Wall’ is the Red Pill concept that when women lose the conventional beauty of their youth, their ‘sexual market value’ drastically decreases and they lose a lot of the special treatment and attention they received from men/society when younger and/or more attractive. I am not endorsing it as a universal constant or a moral standard, and where it occurs it’s blatant sexism/objectification, so don’t shoot the messenger.]9 I haven’t yet mentioned but I’ve observed a dispute between conservative and liberal MRAs, who vastly disagree on whether this dissolution of the gender binary is desirable or not. Trad-con MRAs tend to feel threatened by how feminism is eroding gender roles and in their opinion, ‘devaluing masculinity’ and ‘feminising men.’ They are often referred to as Masculinists. They represent a great number of, but by no means the majority, of MRAs. Where feminist groups suggest that the MRM is homophobic and transphobic, it is usually due to the presence of the (extreme) masculinists. It has to be said that some of the Alt Right use MRA and r/MensRights as their platform for forwarding a white supremacy agenda. In this instance, one should separate extremists exploiting a movement from the movement itself.

Studies of OBEsEarly collections of OBE cases had been made by Ernesto Bozzano (Italy) and Robert Crookall (UK). Crookall approached the subject from a spiritualistic position, and collected his cases predominantly from spiritualist newspapers such as the Psychic News, which appears to have biased his results in various ways. For example, the majority of his subjects reported seeing a cord connecting the physical body and its observing counterpart; whereas Green found that less than 4% of her subjects noticed anything of this sort, and some 80% reported feeling they were a "disembodied consciousness", with no external body at all.The first extensive scientific study of OBEs was made by Celia Green (1968).She collected written, first-hand accounts from a total of 400 subjects, recruited by means of appeals in the mainstream media, and followed up by questionnaires. Her purpose was to provide a taxonomy of the different types of OBE, viewed simply as an anomalous perceptual experience or hallucination, while leaving open the question of whether some of the cases might incorporate information derived by extrasensory perception.In 1999, at the 1st International Forum of Consciousness Research in Barcelona, International Academy of Consciousness research-practitioners Wagner Alegretti and Nanci Trivellato presented preliminary findings of an online survey on the out-of-body experience answered by internet users interested in the subject; therefore, not a sample representative of the general population.1,007 (85%) of the first 1,185 respondents reported having had an OBE. 37% claimed to have had between two and ten OBEs. 5.5% claimed more than 100 such experiences. 45% of those who reported an OBE said they successfully induced at least one OBE by using a specific technique. 62% of participants claiming to have had an OBE also reported having enjoyed nonphysical flight; 40% reported experiencing the phenomenon of self-bilocation (i.e. seeing one's own physical body whilst outside the body); and 38% claimed having experienced self-permeability (passing through physical objects such as walls). The most commonly reported sensations experienced in connection with the OBE were falling, floating, repercussions e.g. myoclonia (the jerking of limbs, jerking awake), sinking, torpidity (numbness), intracranial sounds, tingling, clairvoyance, oscillation and serenity.Another reported common sensation related to OBE was temporary or projective catalepsy, a more common feature of sleep paralysis. The sleep paralysis and OBE correlation was later corroborated by the Out-of-Body Experience and Arousal study published in Neurology by Kevin Nelson and his colleagues from the University of Kentucky in 2007.The study discovered that people who have out-of-body experiences are more likely to suffer from sleep paralysis.Also noteworthy, is the Waterloo Unusual Sleep Experiences Questionnaire that further illustrates the correlation. William Buhlman, an author on the subject, has conducted an informal but informative online survey.In surveys, as many as 85% of respondents tell of hearing loud noises, known as "exploding head syndrome" (EHS), during the onset of OBEs.Miss Z studyIn 1968, Charles Tart conducted an OBE experiment with a subject known as Miss Z for four nights in his sleep laboratory. The subject was attached to an EEG machine and a five-digit code was placed on a shelf above her bed. She did not claim to see the number on the first three nights but on fourth gave the number correctly.The psychologist James Alcock criticized the experiment for inadequate controls and questioned why the subject was not visually monitored by a video camera.Martin Gardner has written the experiment was not evidence for an OBE and suggested that whilst Tart was "snoring behind the window, Miss Z simply stood up in bed, without detaching the electrodes, and peeked."Susan Blackmore wrote "If Miss Z had tried to climb up, the brain-wave record would have showed a pattern of interference. And that was exactly what it did show."Neurology and OBE-like experiences EditThere are several possible physiological explanations for parts of the OBE. OBE-like experiences have been induced by stimulation of the brain. OBE-like experience has also been induced through stimulation of the posterior part of the right superior temporal gyrus in a patient.Positron-emission tomography was also used in this study to identify brain regions affected by this stimulation. The term OBE-like is used above because the experiences described in these experiments either lacked some of the clarity or details of normal OBEs, or were described by subjects who had never experienced an OBE before. Such subjects were therefore not qualified to make claims about the authenticity of the experimentally-induced OBE.English psychologist Susan Blackmore and others suggest that an OBE begins when a person loses contact with sensory input from the body while remaining conscious. The person retains the illusion of having a body, but that perception is no longer derived from the senses. The perceived world may resemble the world he or she generally inhabits while awake, but this perception does not come from the senses either. The vivid body and world is made by our brain's ability to create fully convincing realms, even in the absence of sensory information. This process is witnessed by each of us every night in our dreams, though OBEs are claimed to be far more vivid than even a lucid dream.Irwin pointed out that OBEs appear to occur under conditions of either very high or very low arousal. For example, Green found that three quarters of a group of 176 subjects reporting a single OBE were lying down at the time of the experience, and of these 12% considered they had been asleep when it started. By contrast, a substantial minority of her cases occurred under conditions of maximum arousal, such as a rock-climbing fall, a traffic accident, or childbirth. McCreery has suggested that this paradox may be explained by reference to the fact that sleep can supervene as a reaction to extreme stress or hyper-arousal.He proposes that OBEs under both conditions, relaxation and hyper-arousal, represent a form of "waking dream", or the intrusion of Stage 1 sleep processes into waking consciousness.Olaf Blanke studiesResearch by Olaf Blanke in Switzerland found that it is possible to reliably elicit experiences somewhat similar to the OBE by stimulating regions of the brain called the right temporal-parietal junction (TPJ; a region where the temporal lobe and parietal lobe of the brain come together). Blanke and his collaborators in Switzerland have explored the neural basis of OBEs by showing that they are reliably associated with lesions in the right TPJ region and that they can be reliably elicited with electrical stimulation of this region in a patient with epilepsy.These elicited experiences may include perceptions of transformations of the patient's arms and legs (complex somatosensory responses) and whole-body displacements (vestibular responses).In neurologically normal subjects, Blanke and colleagues then showed that the conscious experience of the self and body being in the same location depends on multisensory integration in the TPJ. Using event-related potentials, Blanke and colleagues showed the selective activation of the TPJ 330–400 ms after stimulus onset when healthy volunteers imagined themselves in the position and visual perspective that generally are reported by people experiencing spontaneous OBEs. Transcranial magnetic stimulation in the same subjects impaired mental transformation of the participant's own body. No such effects were found with stimulation of another site or for imagined spatial transformations of external objects, suggesting the selective implication of the TPJ in mental imagery of one's own body.In a follow up study, Arzy et al. showed that the location and timing of brain activation depended on whether mental imagery is performed with mentally embodied or disembodied self location. When subjects performed mental imagery with an embodied location, there was increased activation of a region called the "extrastriate body area" (EBA), but when subjects performed mental imagery with a disembodied location, as reported in OBEs, there was increased activation in the region of the TPJ. This leads Arzy et al. to argue that "these data show that distributed brain activity at the EBA and TPJ as well as their timing are crucial for the coding of the self as embodied and as spatially situated within the human body."Blanke and colleagues thus propose that the right temporal-parietal junction is important for the sense of spatial location of the self, and that when these normal processes go awry, an OBE arises.In August 2007 Blanke's lab published research in Science demonstrating that conflicting visual-somatosensory input in virtual reality could disrupt the spatial unity between the self and the body. During multisensory conflict, participants felt as if a virtual body seen in front of them was their own body and mislocalized themselves toward the virtual body, to a position outside their bodily borders. This indicates that spatial unity and bodily self-consciousness can be studied experimentally and is based on multisensory and cognitive processing of bodily information.Ehrsson studyIn August 2007, Henrik Ehrsson, then at the Institute of Neurology at University College of London (now at the Karolinska Institute in Sweden), published research in Science demonstrating the first experimental method that, according to the scientist's claims in the publication, induced an out-of-body experience in healthy participants.The experiment was conducted in the following way:The study participant sits in a chair wearing a pair of head-mounted video displays. These have two small screens over each eye, which show a live film recorded by two video cameras placed beside each other two metres behind the participant's head. The image from the left video camera is presented on the left-eye display and the image from the right camera on the right-eye display. The participant sees these as one "stereoscopic" (3D) image, so they see their own back displayed from the perspective of someone sitting behind them.The researcher then stands just beside the participant (in their view) and uses two plastic rods to simultaneously touch the participant's actual chest out-of-view and the chest of the illusory body, moving this second rod towards where the illusory chest would be located, just below the camera's view.The participants confirmed that they had experienced sitting behind their physical body and looking at it from that location.Both critics and the experimenter himself note that the study fell short of replicating "full-blown" OBEs. As with previous experiments which induced sensations of floating outside of the body, Ehrsson's work does not explain how a brain malfunction might cause an OBE. Essentially, Ehrsson created an illusion that fits a definition of an OBE in which "a person who is awake sees his or her body from a location outside the physical body."AWARE studyIn 2001, Sam Parnia and colleagues investigated out of body claims by placing figures on suspended boards facing the ceiling, not visible from the floor. Parnia wrote "anybody who claimed to have left their body and be near the ceiling during resuscitation attempts would be expected to identify those targets. If, however, such perceptions are psychological, then one would obviously not expect the targets to be identified."The philosopher Keith Augustine, who examined Parnia's study, has written that all target identification experiments have produced negative results.Psychologist Chris French wrote regarding the study "unfortunately, and somewhat atypically, none of the survivors in this sample experienced an OBE."In the autumn of 2008, 25 UK and US hospitals began participation in a study, coordinated by Sam Parnia and Southampton University known as the AWARE study (AWAreness during REsuscitation). Following on from the work of Pim van Lommel in the Netherlands, the study aims to examine near-death experiences in 1,500 cardiac arrest survivors and so determine whether people without a heartbeat or brain activity can have documentable out-of-body experiences.As part of the study Parnia and colleagues have investigated out of body claims by using hidden targets placed on shelves that could only be seen from above.Purnia has written "if no one sees the pictures, it shows these experiences are illusions or false memories".In 2014 Parnia issued a statement indicating that the first phase of the project has been completed and the results are undergoing peer review for publication in a medical journal.No subjects saw the images mounted out of sight according to Parnia's early report of the results of the study at an American Heart Association meeting in November 2013. Only two out of the 152 patients reported any visual experiences, and one of them described events that could be verified.On October 6, 2014 the results of the study were published in the journal Resuscitation. Among those who reported a perception of awareness and completed further interviews, 46 per cent experienced a broad range of mental recollections in relation to death that were not compatible with the commonly used term of NDEs. These included fearful and persecutory experiences. Only 9 per cent had experiences compatible with NDEs and 2 per cent exhibited full awareness compatible with OBEs with explicit recall of 'seeing' and 'hearing' events. One case was validated and timed using auditory stimuli during cardiac arrest. According to Caroline Watt "The one ‘verifiable period of conscious awareness’ that Parnia was able to report did not relate to this objective test. Rather, it was a patient giving a supposedly accurate report of events during his resuscitation. He didn’t identify the pictures, he described the defibrillator machine noise. But that’s not very impressive since many people know what goes on in an emergency room setting from seeing recreations on television."AWARE Study IIThis observational multi centre study is a continuation or enhancement of the previous AWARE Study. The AWARE Study II will collect data from about 1500 patients who experienced cardiac arrest. The patient recruitment will close in May 2017. Once a patient experiencing a cardiac arrest meeting the study inclusion criteria is identified, researchers will attend with portable brain oxygen monitoring devices and a tablet which will display visual images upwards above the patient as resuscitation is taking place. Measurements will be obtained during cardiac arrest and survivors will then be followed up and with their consent will have in-depth, audio recorded interviews. Researchers think that the recollection of memories of what happened during cardiac arrest in certain patients might be related to a better cerebral oxygenation during cardiac arrest in those patients. Images displayed in the tablet above the patient tries to identify whether the "autoscopy" phenomenon observed in some patients is just an illusion or not.Smith & MessierA recent functional imaging study reported the case of a woman who could experience out of body experience at will. She reported developing the ability as a child and associated it with difficulties in falling sleep. Her OBEs continued into adulthood but became less frequent. She was able to see herself rotating in the air above her body, lying flat, and rolling in the horizontal plane. She reported sometimes watching herself move from above but remained aware of her unmoving “real” body. The participant reported no particular emotions linked to the experience. "[T]he brain functional changes associated with the reported extra-corporeal experience (ECE) were different than those observed in motor imagery. Activations were mainly left-sided and involved the left supplementary motor area and supramarginal and posterior superior temporal gyri, the last two overlapping with the temporal parietal junction that has been associated with out-of-body experiences. The cerebellum also showed activation that is consistent with the participant’s report of the impression of movement during the ECE. There was also left middle and superior orbital frontal gyri activity, regions often associated with action monitoring."OBE training and research facilities EditThe Monroe Institute's Nancy Penn Center is a facility specializing in out-of-body experience induction. The Center for Higher Studies of the Consciousness in Brazil is another large OBE training facility. The International Academy of Consciousness in southern Portugal features the Projectarium, a spherical structure dedicated exclusively for practice and research on out-of-body experience.Olaf Blanke's Laboratory of Cognitive Neuroscience has become a well-known laboratory for OBE research.Source: Wikipedia