Fine Gael's health system propsals

ccosgrave

I apologise if there's a thread on this already, but I had a bit of a look around and didn't see anything.

I'm just wondering what this board thing of Fine Gael's proposal to model the Irish health system after what's going on in the Dutch system. From what I gather, the system entails the mandatory purchase of private health insurance by every person in the country,subsidised for low-income earners by the State. In this system, there are no more public hospitals or facilities, which effectively removes the State from the healthcare 'business'. The benefits, I suppose, is that it ensures less wasteful use of resources, increased competition and shorter waiting lists.

So are there any drawbacks to such a system? I wouldn't be a supporter of FG, but one of the things that this country has been crying out for has been universal health insurance. To me, it's one of the single most important issues we could face, I am strongly considering voting FG in the next election as a result of this sole initiative. I was just wondering what the general opinion on this concept is, whether or not it would work in Ireland, what possible drawbacks there could be. I don't know much about this sort of thing, so I'd like to generate a discussion on the matter.

Here is the Wiki article on the Dutch system which might explain things a little better: http://en.wikipedia.org/wiki/Health_care_in_the_Netherlands

oscarBravo

It looks like a pretty good model. Any feedback from the Dutch people on how it's been working out for them?

My philosophy for some time has been: if what you're doing isn't working, do something different. It's hard to escape the conclusion that the HSE is irreversibly broken - maybe a proposal like this is exactly what's required.

Sully

It was discussed last night on "The Week in Politics" where FF defended the HSE and FG discussed their proposals.

See: http://www.rte.ie/player/#v=1046562

Alun

I lived in the Netherlands for 13 years before moving here, and have experienced the system first hand, and can say that, for me, at least it ticks all the boxes.

There are, as you say, no 'public' or 'private' hospitals, just hospitals, most if not all of them run, as far as I can tell, as non-profit making organisations, or what the Dutch call a 'stichting'. That's not to say that you couldn't have hospitals or other medical service providers that were run as profit-making businesses, it's just that it would make zero difference to what they received from the insurance companies for any particular procedure.

The insurance thing is decided on a salary cut-off point. Above a certain cut-off point you are obliged to take out 'private' health insurance, and below that you're obliged to take out a subsidised insurance, called the 'ziekenfonds'. Things were changing a bit when I left, so I'm not sure of the exact position now, but it used to be the case that the ziekenfonds was a purely government run thing, but I think now that many of the other insurance companies now provide a ziekenfonds type insurance as well.

Note that the type of insurance you have has no impact whatsoever on the type of hospital you go to, the quality of treatment you get, which doctor you get or your position on the waiting list (such as it is), so there are no separate public vs. private waiting lists. Neither does it affect what the hospital charge the insurance company for their services. About the only difference between them, and between various packages of private insurance, are to do with ancillary stuff like being in a single private room with your own telly, as opposed to being in a larger room (rarely more than 6) with other patients, stuff like that.

Most importantly it gets the government out of the business of providing health care and puts it into the hands of people who know what they're doing.

Sully

Just came across this via BreakingNews.ie;
http://www.faircare.ie/

Interesting game on the side!

jank

Yea, sounds like a good plan. Although it would take years to impliment here as the Unions would drag their feet!

Flamed Diving

And now I take another step towards voting for FG.

grahamo

Sounds like a good plan. One thing that I can see wrong. Everyone in the country is obliged to take out Health insurance. Fair enough! Will this mean we then pay a lower PRSI rate and we won't need to pay the health levies anymore?
That should be the case but I doubt it will be.

Flamed Diving

grahamo wrote: »

Sounds like a good plan. One thing that I can see wrong. Everyone in the country is obliged to take out Health insurance. Fair enough! Will this mean we then pay a lower PRSI rate and we won't need to pay the health levies anymore?
That should be the case but I doubt it will be.

There should be significantly lower PRSI, that's true.

Robxxx7

I'd be interested in hearing more about the non-profit side of things .. aslong as the money is ploughed back into facilities rather than pay ..then it is a system that could work. You will still need the bean counters to ensure the money is being spent wisely and not over budget (or it will cause insurance premiums to rise)

So still not 100% convinced until i understand more about the logistics

Akrasia

Its a good idea if the main insurance companies are run not for profit, There would have to be very very strong safeguards to protect people who have long term medical conditions that private insurance companies would refuse to cover.

Flamed Diving

Akrasia wrote: »

Its a good idea if the main insurance companies are run not for profit, There would have to be very very strong safeguards to protect people who have long term medical conditions that private insurance companies would refuse to cover.

That's a good point. We would need to get Bupa back in here, once we get those corrupt swine out of the Dail.

EDIT: This is what the Dutch do to counteract this:

The Netherlands has a dual-level system. All primary and curative care (i.e. the family doctor service and hospitals and clinics) is financed from private compulsory insurance. Long term care for the elderly, the dying, the long term mentally ill etc. is covered by social insurance funded from taxation.

The_Minister

It's a good idea (personally I supported the Dutch model for quite a while - although somehow I doubt Enda stole the idea from me:D)

However, it is important to note that it probably would be very difficult to introduce in Ireland, given the ossification of the public service, the high wages that they are paid, and the lack of flexability in the health service in general.
I would imagine that this would be fought tooth and nail, as a certain level of efficiency would have to be reached, and many admin jobs would have to go.

It would be a tough thing to implement (but easier then Singapore's;))

SeanW

It sounds like a great idea, but I can't help but fear that the government of the day that tries to implement it would bottle it when the public "service" trade union mafia declares war on them.

Pride Fighter

Saw this on the week in politics. Absolutely disgusting. For profit companies providing health care, nothing but PD type neo liberal nonsense. The PD's FG are incorporating are getting to work quickly.

Dr Galen

Pride Fighter wrote: »

Saw this on the week in politics. Absolutely disgusting. For profit companies providing health care, nothing but PD type neo liberal nonsense. The PD's FG are incorporating are getting to work quickly.

Why exactly does this cause you so many problems or create such disgust in your mind?

I was no fan of the PD's in their day, and the co-location plan is a sham of epic proportions, but shouldn't I/we have a choice? Surely if a private facility can provide good quality care and do so profitably then it's not a bad thing?

turgon

Akrasia wrote: »

Its a good idea if the main insurance companies are run not for profit, There would have to be very very strong safeguards to protect people who have long term medical conditions that private insurance companies would refuse to cover.

Yeah well isn't it up to the individual people to make sure that they get good insurance? Why should the government have to hold their hand?

And why should we be forced to buy insurance? Its a given that this proposal is many times better than public health. But if I don't want health insurance that should be respected. It might be a foolish decision, and if I break something Im a gonor for sure, financially at least. But thats my own fault. Once again, why should the government have to hold my hand?

turgon

Pride Fighter wrote: »

Saw this on the week in politics. Absolutely disgusting. For profit companies providing health care, nothing but PD type neo liberal nonsense. The PD's FG are incorporating are getting to work quickly.

Why? Wont the money motivate the hospitals to provide a good service?

Edit: I am actually very glad that this is being proposed. I will have to look into it in greater depth.

Vorsprung

Sully wrote: »

Interesting game on the side!

A pity that the headline grabbing topics are named, but some of the actual problems aren't mentioned e.g. lack of provision of long-term care beds, lack of uptake of childhood vaccinations, lack of single rooms.

John_C

Is it the main difference between this and the American system that the government helps out the poor with insurance payments?

oscarBravo

turgon wrote: »

And why should we be forced to buy insurance?

Probably for similar reasons to why you're forced to buy car insurance: if you're not insured, someone else is going to have to pick up the tab.

Face it - if you choose not to purchase health insurance, and you are (let's say) in a serious accident, you're not realistically going to be left on the side of the road, which means that there will have to be some form of acute care of last resort for the uninsured - which removes the incentive to be insured.

oscarBravo

John_C wrote: »

Is it the main difference between this and the American system that the government helps out the poor with insurance payments?

That, and risk equalisation and strong regulation of the insurers.

Flamed Diving

turgon wrote: »

Once again, why should the government have to hold my hand?

So if you take a nasty fall and split your head in a life-threatening way, the hospital should turn you away, in this case?

Flamed Diving

John_C wrote: »

Is it the main difference between this and the American system that the government helps out the poor with insurance payments?

No. The insurers are heavily regulated. They cannot turn down an insurer and they cant wriggle their way out of paying valid claims.

The wikipedia article above tells ya all this.

YFlyer

I don't see anywhere for prevention orientated healthcare system.

nesf

Mystik Monkey wrote: »

I was no fan of the PD's in their day, and the co-location plan is a sham of epic proportions, but shouldn't I/we have a choice? Surely if a private facility can provide good quality care and do so profitably then it's not a bad thing?

More importantly when that hospital provides the same care to those who have their insurance paid for them as those who pay their own insurance you have a private hospital system with all the benefits of a government owned one.

Universal access through universal insurance is what makes this kind of system work. Private medical care doesn't have to end up with the mess they have in the States.

Breezer

Pride Fighter wrote: »

Saw this on the week in politics. Absolutely disgusting. For profit companies providing health care, nothing but PD type neo liberal nonsense. The PD's FG are incorporating are getting to work quickly.

What difference does it make who pays for the healthcare if the care is delivered? I'd be quite happy knowing people were profiting from the fact that I was admitted to hospital on time, tested with equipment that's working properly, correctly diagnosed, treated and discharged MRSA-free. If, on the other hand, I waited months for a scan, eventually got the wrong result due to broken equipment (not that it would matter because my cancer would now be terminal due to the delay), and was left to die on a trolley in a corridor while every superbug in the hospital had a party in my body, I doubt I'd be taking comfort from that fact that the fat cats had a few quid less.

Pride Fighter, I normally agree with you here, and respect your well thought-out opinions, but in this case I think you're being completely blinded by ideology. Surely a system where everyone is treated equally and has access to excellent healthcare is far better than the current two tier BS? If you want to see the result of a real disgusting system, pop into the Mater A & E ward sometime. Careful you don't trip over a patient though.

Flamed Diving

Breezer wrote: »

What difference does it make who pays for the healthcare if the care is delivered? I'd be quite happy knowing people were profiting from the fact that I was admitted to hospital on time, tested with equipment that's working properly, correctly diagnosed, treated and discharged MRSA-free. If, on the other hand, I waited months for a scan, eventually got the wrong result due to broken equipment (not that it would matter because my cancer would now be terminal due to the delay), and was left to die on a trolley in a corridor while every superbug in the hospital had a party in my body, I doubt I'd be taking comfort from that fact that the fat cats had a few quid less.

Pride Fighter, I normally agree with you here, and respect your well thought-out opinions, but in this case I think you're being completely blinded by ideology. Surely a system where everyone is treated equally and has access to excellent healthcare is far better than the current two tier BS? If you want to see the result of a real disgusting system, pop into the Mater A & E ward sometime. Careful you don't trip over a patient though.

Yup. Ideology tends to do that to people. I find its better to think first, then make your mind up.

eoinbn

One big difference betweeen here and holland is hollands extremely high popualtion density. I image that is much easier to "shop" around for the best hospital when their is 3-4 within 15-20km, where as in many parts of ireland there is little to no choice.

Breezer

bigjimthefirst wrote: »

A pity that the headline grabbing topics are named, but some of the actual problems aren't mentioned e.g. lack of provision of long-term care beds, lack of uptake of childhood vaccinations, lack of single rooms.

Have another look bigjim:

Faircare.ie, Fine Gael Plan page wrote:

Fine Gael recognises that significant bed capacity in hospitals could also be freed-up if patients facing delayed discharge or requiring rehabilitation could be treated in the Community. We will publish specific proposals on this issue over the next few months to address the current deficits in long-term care and rehabilitation.

And listed under "New Costs," which are later balanced against "Additional revenues":

Faircare.ie, Q & A page wrote:

Expansion of primary care and upgrading of hospital infrastructure (private rooms, etc.)

Nothing in there about vaccinations though, although the idea is that a slimmed-down HSE would remain and be allowed to focus on Public Health.

eoinbn wrote:

One big difference betweeen here and holland is hollands extremely high popualtion density. I image that is much easier to "shop" around for the best hospital when their is 3-4 within 15-20km, where as in many parts of ireland there is little to no choice.

True enough, but a big part of the plan is to improve primary care in the community (and have it covered by the health insurance), thereby getting people out of hospitals altogether, allowing them to be more efficient. Therefore, we wouldn't need as many hospitals.

oscarBravo

Breezer wrote: »

I'd be quite happy knowing people were profiting from the fact that I was admitted to hospital on time, tested with equipment that's working properly, correctly diagnosed, treated and discharged MRSA-free.

An excellent point.

turgon

Flamed Diving wrote: »

So if you take a nasty fall and split your head in a life-threatening way, the hospital should turn you away, in this case?

Ok, I see where I erred. Never let it be said that man cannot change his outlook!

The_Minister

Breezer wrote: »

True enough, but a big part of the plan is to improve primary care in the community (and have it covered by the health insurance), thereby getting people out of hospitals altogether, allowing them to be more efficient. Therefore, we wouldn't need as many hospitals.

Except that the number of GPs is about to plummet over the next 4-8 years, meaning that we probably will not be able to sustain even the levels of primary care that we do now.

The_Minister

turgon wrote: »

Ok, I see where I erred. Never let it be said that man cannot change his outlook!

I'm glad to hear that, you big, dirty free rider, you:)

Breezer

The_Minister wrote: »

Except that the number of GPs is about to plummet over the next 4-8 years, meaning that we probably will not be able to sustain even the levels of primary care that we do now.

That's why such a focus is being placed on developing the sector. Primary care is about more than just GPs, although I agree they're pretty essential. Don't get me started on the "number of medical graduates looking to be GPs vs number of GP training places vs number of GPs needed" situation...

I'd like to see more info on exactly what's going to be done for primary care too. Don't forget that this is a roadmap though, and more detailed documents are to follow. *Waits for someone to complain that policies take time to develop*

irish_bob

Pride Fighter wrote: »

Saw this on the week in politics. Absolutely disgusting. For profit companies providing health care, nothing but PD type neo liberal nonsense. The PD's FG are incorporating are getting to work quickly.

your the kind of left wing idealogue who would be happier with a public health service hamstringed by obtuse unions and leaking millions while all the while failing to deliver care to the patient - citizen than (a perish the thought )private orientated health care system being a vast improovement

personally i trust the for profit business model every time

Vorsprung

The_Minister wrote: »

Except that the number of GPs is about to plummet over the next 4-8 years, meaning that we probably will not be able to sustain even the levels of primary care that we do now.

Add to that the fact that GP training places are being cut.

@ Breezer - My point was in relation to that game FG have on the front page of its site.

The_Minister

bigjimthefirst wrote: »

Add to that the fact that GP training places are being cut.

Thats odd.
Harney was trying to get them to train more doctors about a year ago, and was negotiating with the representatives of the Doctor's Guilds unions, and was getting education to increase the number of medical places in colleges.

Was this a cost cutting measure, or a policy change?

jank

Pride Fighter wrote: »

Saw this on the week in politics. Absolutely disgusting. For profit companies providing health care, nothing but PD type neo liberal nonsense. The PD's FG are incorporating are getting to work quickly.

You mean neo-conservative nonesense?:rolleyes:

By the way, whats the singapore model?

Breezer

The_Minister wrote: »

Harney was trying to get them to train more doctors about a year ago, and was negotiating with the representatives of the Doctor's Guilds unions, and was getting education to increase the number of medical places in colleges.?

Was that not undergraduate places? GP training is postgrad.

bigjimthefirst wrote:

@ Breezer - My point was in relation to that game FG have on the front page of its site.

Note to self: don't take everything so seriously

turgon

I may be wrong here, but it seems that FG want to force all the insurance companies to offer the same price and same terms. Surely this is distortion of competition?

Vorsprung

Breezer wrote: »

Was that not undergraduate places? GP training is postgrad.

Bingo.

Breezer wrote: »

Note to self: don't take everything so seriously

I just have a problem with MRSA being thrown around as a problem when a lot of people don't actually know much about it.

Breezer

turgon wrote: »

I may be wrong here, but it seems that FG want to force all the insurance companies to offer the same price and same terms. Surely this is distortion of competition?

No, not quite. They would all have to offer the same basic package covering essential services, and each individual company would have to charge all its customers the same price for this. But companies would be free to offer the package at a lower price than other companies if that's part of their business model. They could also offer supplemental cover for non-essential services, such as cosmetic treatments, and charge what they liked for that. The companies would also negotiate their own deals with the healthcare providers. So there's plenty of room there for competition.

bigjimthefirst wrote:

I just have a problem with MRSA being thrown around as a problem when a lot of people don't actually know much about it.

It's an incurable virus that causes flesh-eating bacteria. Everyone knows that

Amnesiac_ie

A universal health insurance system, where "money follows the patient" is always a system I've been interested in and it does look like Fine Gael have put real effort into looking abroad for new ideas and coming up with the beginnings of a plan to implement such a solution in Ireland. But is now really a good time to sell a market driven approach to health care to the Irish voting public? Has the Labour party made any formal response to this? Could Eamon Gilmore form a government that had this plan as the cornerstone of its legislative agenda.

As someone who works at the frontline in the mess that is the HSE (and a formal Labour party member and usual Labour voter) I hope the answer to the above questions is "Yes." I'm totally frustrated with both the top level autocrats in the HSE and the protectionist health sector unions.

And does this mean I could vote for Enda Kenny? Hmm, maybe I AM running a fever...

ccosgrave

To be quite honest, this is probably the one issue that could possibly cause me to vote FG.