The IMO in favour of universal health coverage

Jane5

http://www.irishhealth.com/article.html?id=17148

The above links to an article re: the IMO stance towards universal health coverage, and free at the point of access healthcare for all citizens and residents.

This needs to happen.

And I believe it would benefit the economy. Before anyone freaks out at the dreaded thought of paying a bit of tax, consider this:

No more keeping money in reserve in case you get sick, no more expensive drug bills and GP visits, no more 120euro A&E charges, nothing. That actually means more disposable income, a LOT more, which goes straight back into the economy.

Without realising it, the Irish have become like the Americans, frightened that illness will mean huge financial hits. Large amounts of disposable income are poured into insurance, GP visits, drug bills, consultant rooms fees, etc etc.

If we had actual universal insurance, which would be more affordable and unable to deny you cover, and free or very low cost prescription charges, this income would be used to pay off debts, saved in banks, paid off of mortgages, spent in the economy, and would actually be improving our financial situation.

Not to mention being vastly more moral and ethical and humane towards our own citizens and residents.

Welease

Just one problem.. it would be run by this government in conjunction with the HSE, which putting it mildly are some of the most morally and intellectually corrupt organisations in existance.

In short, it would cost a fortune and deliver even less than now.

Eliot Rosewater

But of course the IMO is in favor of universal health coverage. They, like every other trade union, know that working for the government is easier than being exposed to the meritocratic will of the market.

Public health care has proven to be a disaster. The HSE is constantly courting controversy while hemorrhaging billions of taxpayers' money. Clearly the system needs a shakeup. But all the IMO is suggesting is that this current system be expanded.

Under Fine Gael's new health plan hospitals would be privately run for profit. Health insurance would be mandatory for every citizen (with the State subsidizing those who cant afford it). The "money follows the patient" so that there is an onus on the hospitals to excel.

The IMO doesn't like this because suddenly there will be an entrepreneur - who has to run a profitable business - calling the shots. This entrepreneur will demand efficiency and cost effectiveness, two of the things most hated by trade unions.

Jane5

Eliot Rosewater wrote: »

But of course the IMO is in favor of universal health coverage. They, like every other trade union, know that working for the government is easier than being exposed to the meritocratic will of the market.

Public health care has proven to be a disaster. The HSE is constantly courting controversy while hemorrhaging billions of taxpayers' money. Clearly the system needs a shakeup. But all the IMO is suggesting is that this current system be expanded.

Under Fine Gael's new health plan hospitals would be privately run for profit. Health insurance would be mandatory for every citizen (with the State subsidizing those who cant afford it). The "money follows the patient" so that there is an onus on the hospitals to excel.

Eliot, if you read my post more carefully, you would read that I was talking about universal INSURANCE. While fully private, for profit healthcare is an unethical disastrous minefield, I don't think that universal insurance is a terrible idea at all. With Government subsidies for those who can't afford it, and insurance companies unable to refuse coverage and subject to stringent regulation, universal insurance is an excellent idea if it is implemented properly.

Far from being incredibly expensive, it would save the government money as it could be provided by any number of privately owned insurance companies, and private hospitals could also provide care. There would be no incentive to cherry pick "easy" patients with uncomplicated and profitable conditions.

It's not my first choice. I do think that citizens should be provided with free at the point of entry good quality healthcare and not be financially penalised for becoming ill. But this country just doesn't seem able to deal with providing decent services in this respect, no funding, gross mismanagement, and an immoral divide between private and public patients. Something needs to give.

Jane5

Eliot Rosewater wrote: »

The IMO doesn't like this because suddenly there will be an entrepreneur - who has to run a profitable business - calling the shots. This entrepreneur will demand efficiency and cost effectiveness, two of the things most hated by trade unions.

Eliot, you would do well to know what you are talking about before you mouth off here. The IMO represents over 4000 NCHDs, who are the most efficient and cost effective employees in the whole country, and have been for years.
They work for 24-36-48-60 hours straight-yes, they are rostered on for shifts that are longer than three days at times, with no sleep breaks. And they work them. Always have. Pregnant women too. And they don't strike over it or anything. True, quite a few crash their cars with fatigue and die or end up disabled, and suicide rate not insignificant, but they do it, and don't complain. You won't find that sort of "flexibility" anywhere, ANYWHERE in the private sector, or anywhere else in the public sector. Not that you should, as it's against the law.

Cost effectiveness? The hourly rate for NCHDs is very low. In January of this year, the IMO negotiated a new contract where NCHDs are not paid overtime anymore, rather, an average of the hours they work over a certain period. So they work many hours for free now. Pretty cost effective, IMO.

They pay 2-3k every year for their own training-in short-to be able to do their job. Kind of mental when you think about it. The "training" consists of working 40 hour shifts and being on call to A&E, and they pay to do it. This is so cost effective it's actually stupid.

During the weekends, and at nights, the reason the taxpayer doesn't have to pay for phlebotomists, more nurses, etc, is because NCHDs run around all night long taking bloods and resiting cannulas and doing ECGs-things that during "normal" working hours are done by more appropriate staff. Now the NCHDs are doing large amounts of this for free. If you can get more Dickensian and cost effective, I would like to hear it.

Pride Fighter

Eliot Rosewater wrote: »

But of course the IMO is in favor of universal health coverage. They, like every other trade union, know that working for the government is easier than being exposed to the meritocratic will of the market.

Public health care has proven to be a disaster. The HSE is constantly courting controversy while hemorrhaging billions of taxpayers' money. Clearly the system needs a shakeup. But all the IMO is suggesting is that this current system be expanded.

Under Fine Gael's new health plan hospitals would be privately run for profit. Health insurance would be mandatory for every citizen (with the State subsidizing those who cant afford it). The "money follows the patient" so that there is an onus on the hospitals to excel.

The IMO doesn't like this because suddenly there will be an entrepreneur - who has to run a profitable business - calling the shots. This entrepreneur will demand efficiency and cost effectiveness, two of the things most hated by trade unions.

Universal health care is a human right and any right-wing privatisation has proven to be a disaster. The state subsidises private health care, mainly as the current minister has a vested interest as she is married to a man who has interests in that sector. This corruption has led to funding both tiers of the health sector. If all the money of the boom was pumped into single tier, universal health Ireland would have one of the best healthcare systems in the world, not one of the worst in the developed world.

Right-wing health systems like the US are appalling. They turn down patients who cannot pay. This is anathema to the whole idea of healthcare. The Hippocratic oath says 'do no wrong'. Turning down dying patients is wrong. And for healthcare systems to believe that profit is the key is anathema to what healthcare is about, saving lives.

Socialised medicine, like that in the Nordic countries and Canada is the best model anyone can follow. I believe that if someone is sick or dying they have the right to life. Its a thing called morals, one of the cornerstones of being a human being. The right-wing, capitalist, attitudes of some is appalling. Survival of the fittest, greed is good is not what humans should be. We are all equal, we should all get equal treatment in our schools and hospitals.

Amhran Nua

Pride Fighter wrote: »

Universal health care is a human right and any right-wing privatisation has proven to be a disaster.

Actually the system FG (and AN) are pushing, mentioned by Eliot Rosewater, is based directly on the Dutch model, rated best quality of care and second best value for money in the OECD. The last time I ran the numbers it was around a third cheaper per citizen, and far superior in service.

Pride Fighter

Amhran Nua wrote: »

Actually the system FG (and AN) are pushing, mentioned by Eliot Rosewater, is based directly on the Dutch model, rated best quality of care and second best value for money in the OECD. The last time I ran the numbers it was around a third cheaper per citizen, and far superior in service.

It is nothing but a right wing disaster. There are no patients at all in the Dutch model, they are customers. The system is designed so that for profit companies and hospitals make money at the expense of patients. It is a neo-liberal disaster waiting to happen. The Dutch pumped massive amounts of money into their world class, state run health service. It is world class, only cause of the amount of money pumped into state hospitals until the early 2000's when the healthcare system was privatised.

With the pressures of having to get new 'customers' several Dutch hospitals are on the verge of closing down. Soon enough the Dutch model will be a laughing stock. It'll only be a matter of a few years before the state will have to re-nationalise their healthcare or risk their own citizens travelling abroad to get their healthcare needs.

Amhran Nua

Pride Fighter wrote: »

It is nothing but a right wing disaster. There are no patients at all in the Dutch model, they are customers. The system is designed so that for profit companies and hospitals make money at the expense of patients. It is a neo-liberal disaster waiting to happen. The Dutch pumped massive amounts of money into their world class, state run health service. It is world class, only cause of the amount of money pumped into state hospitals until the early 2000's when the healthcare system was privatised.

With the pressures of having to get new 'customers' several Dutch hospitals are on the verge of closing down. Soon enough the Dutch model will be a laughing stock. It'll only be a matter of a few years before the state will have to re-nationalise their healthcare or risk their own citizens travelling abroad to get their healthcare needs.

Okay, can you support any of this with links or facts, in particular that the Dutch government didn't receive value for money in terms of its investments in hospitals when they were privatised? I'm genuinely interested to hear opposing views. Keep in mind that the Dutch government still subisidises the payments of the disadvantaged, nobody is left sitting by the roadside as they might be in the US. They even have a leaderboard where you can select the best hospital for your healthcare needs.

Eliot Rosewater

Jane5 wrote: »

Eliot, if you read my post more carefully, you would read that I was talking about universal INSURANCE....

The article you linked wasn't. It suggested a fully socialized system which "would be funded through higher taxes or through a new social insurance system." Given that your title was "The IMO in favour of universal health coverage" I decided to base my reply on the definition the IMO have of universal health coverage, which doesn't appear to be compatible with yours.

Jane5 wrote: »

But this country just doesn't seem able to deal with providing decent services in this respect, no funding, gross mismanagement, and an immoral divide between private and public patients.

Which is why I would support Fine Gael's (and AN's) plan. By privatizing hospitals and transferring services to private insurance companies, it will reduce the lack of funding and the "gross mismanagement".

Jane5 wrote: »

Eliot, you would do well to know what you are talking about before you mouth off here...

I'm working off of a generalization - that working for the Government is easier than working for a private business - a generalization that's effectively accepted by public sector trade unions, representatives of the workers themselves.

If the NCHD's are as hard working as you claim they are then surely privatization of services will not hurt them?

Jane5 wrote: »

If you can get more Dickensian and cost effective, I would like to hear it.

This begs the question: have you ever read any of Charles Dickens' books? Because nothing in the country comes anywhere near to "Dickensian".

Eliot Rosewater

Pride Fighter wrote: »

There are no patients at all in the Dutch model, they are customers.

I'll assume with that kind of rhetoric that your qualms with the Dutch system lie not in how effective it actually is, but just with the idea itself; that for profit companies would operate health-care. As AH said, the system is very highly ranked in terms of care and cost effectiveness.

Pride Fighter

Amhran Nua wrote: »

Okay, can you support any of this with links or facts, in particular that the Dutch government didn't receive value for money in terms of its investments in hospitals when they were privatised? I'm genuinely interested to hear opposing views. Keep in mind that the Dutch government still subisidises the payments of the disadvantaged, nobody is left sitting by the roadside as they might be in the US. They even have a leaderboard where you can select the best hospital for your healthcare needs.

It was explained on the week in politics a couple of months ago. It should be somewhere on the RTE website.

The last thing you said the leaderboard is why a load of hospitals are on the verge of closing. These hospitals are running out of money as people can just visit the 'best' hospital quite easily as the Netherlands is a small country. The so called 'bad' hospitals are not bad. Its just that the ones on top of the leaderboard have more experienced doctors and surgeons. These so called 'bad' hospitals are on the verge of closing, which will leave doctors and nurses on the dole queues and a poorer delivery of health care on a regional level, with more hospitals being based in central locations.

Amhran Nua

Pride Fighter wrote: »

It was explained on the week in politics a couple of months ago. It should be somewhere on the RTE website.

Sorry the question is too vague to be easily searched, you've seen these articles, can you link to them please? I'd like to take a look.

Pride Fighter wrote: »

These so called 'bad' hospitals are on the verge of closing, which will leave doctors and nurses on the dole queues and a poorer delivery of health care on a regional level, with more hospitals being based in central locations.

The Irish geographical and demographic situation is substantially different to that of the Netherlands, so we couldn't copy it over directly, a minimum standard of care would need to be subsidised by insurance companies in the form of small regional clinics to deal with the most common complaints.

Have you got facts to support that Dutch healthcare would suffer due to the closure of less effective hospitals, it being such a small country the effects would surely be absorbed by the larger ones, statistics etc? The healthcare system doesn't exist for its own sake, it exists to serve the populace - perhaps those hospitals you claim will close aren't really needed?

I'm really going to need some substantiation here.

opinion guy

Eliot Rosewater wrote: »

But of course the IMO is in favor of universal health coverage. They, like every other trade union, know that working for the government is easier than being exposed to the meritocratic will of the market.

Wait wait wait. The IMO also represents the consultants. This group have gained ALOT, possibly more than anyone else from the public private policy. And here they are saying that policy is bad.

Jane5 wrote: »

The IMO represents over 4000 NCHDs

Hmmm ok wait this needs clairfication. The IMO has several branches. One of which represents NCHDs. The also have a branch that represents consultants, another for gps and another for public health docs. These groups all have different and sometimes conflicting interests. Which begs the question how can one organisation effectively represent them all.....but thats a discussion for another time. But then when all these groups agree on a statement like this - then people should listen.

Eliot Rosewater wrote: »

I'm working off of a generalization - that working for the Government is easier than working for a private business - a generalization that's effectively accepted by public sector trade unions, representatives of the workers themselves.

Has it occurred to you your generalisaiton is inappropriate to the current discussion ? There is clearly a difference between working 9-5 as a civil servant in an overstaffed office, and working in an underresourced, understaffed, crowded A&E.

If the NCHD's are as hard working as you claim they are then surely privatization of services will not hurt them?

They are that hardworking. But I'm not sure what your point is. Here is my point. Privatisation would be good for them. BUT THEY STILL SAY ITS A BAD IDEA CAUSE ITS BAD FOR PATIENTS.


Quite apart from any of this. For profit health insurance is morally reprehensible. I don't have a problem with drug companies and medical supply companies for example making profit - its rewards them for their risk and incentivises reinvestment. But for profit health insurance is essentially speculating on people suffering, and incentivises the restriction of insurance (and as a consequence healthcare) to those who are either low risk, or high bank balance. Its disgusting.

In January of this year, the IMO negotiated a new contract where NCHDs are not paid overtime anymore, rather, an average of the hours they work over a certain period.

Really ? Have a reference for that ?

Permabear

This post has been deleted.

opinion guy

donegalfella wrote: »

This post has been deleted.

NOO. THats not what it said. Go to 1:20. It says "payment for private medical services" is not allowed. This is fundamentally different to what you claimed above. Its also different to a universal insurance healthcare system

tallaght01

Eliot Rosewater wrote: »

But of course the IMO is in favor of universal health coverage. They, like every other trade union, know that working for the government is easier than being exposed to the meritocratic will of the market.

.

Is this joker for real.

It's piss easy to make shed loads of cash in Ireland i private medicine, considering the paucity of consultants. Universal private care would be a total cash cow for Irish docs. But despite what the mental oul lads here think, the vast majority of docs care more about their patients then money, or we'd all be doing exclusively private work.

The Dutch health system is OK, nothing more It used to be the French system that all the nutcases wanted to emulate, but as of late, the Dutch system can be googled for tables about one dimensional economic outcomes, and the various economic think-tanks have latched onto this.

Irish healthcare is ****. And a lot of Irish docs get pissed off with the IMO. BUt they're spot on with this.

Eliot Rosewater

Pride Fighter wrote: »

These hospitals are running out of money as people can just visit the 'best' hospital

Damn the people, wanting to get the best services possible! Lets force them into substandard health-care, because that is what's right!

opinion guy wrote: »

Quite apart from any of this. For profit health insurance is morally reprehensible.

Socialized medicine isn't as effective as the Dutch system yet you are supporting it; "what redeems it is the idea only." I think it's pretty depressing when an effective method of delivery of a core service of this country is resisted by idealogical purism.

opinion guy wrote: »

incentivises the restriction of insurance (and as a consequence healthcare) to those who are either low risk, or high bank balance. Its disgusting.

I think it has been made pretty clear here that a system like the Dutch one subsidizes insurance premiums for those unable to pay. I know you'd literally love the idea of the "right wingers" casting staving children out on the street, but unfortunately for your position that simply isn't going to happen.

Permabear

This post has been deleted.

opinion guy

Eliot Rosewater wrote: »

Socialized medicine isn't as effective as the Dutch system yet you are supporting it; "what redeems it is the idea only." I think it's pretty depressing when an effective method of delivery of a core service of this country is resisted by idealogical purism.

Don't put words in my mouth. I didn't say what I support. I merely said what I thought was wrong. Profit taken by insurance companies represents sicks peoples money removed from the healthcare system - money they pay to get better that goes to pay for those nice buildings you see the insurance companies have. THAT is wrong.

I think it has been made pretty clear here that a system like the Dutch one subsidizes insurance premiums for those unable to pay. I know you'd literally love the idea of the "right wingers" casting staving children out on the street, but unfortunately for your position that simply isn't going to happen.

Errr. What ? And STOP telling me what my position is.

donegalfella wrote: »

No, you're wrong, I'm afraid. Look into the history of Canadian socialized health care, especially leading up to the Canadian Supreme Court's decision in Chaoulli. v. Quebec.

I'm not wrong. I directly quoted your video. now "payment for private medical services" does effectively outlaw private health insurance cause well they would not be able to provide any services to anyone. But whilst I think private health insurance is morally reprehensible, I am not saying "payment for private medical services" is wrong. In fact I think we need it.

Pride Fighter

The neo-con brigade out in force. Its no use reasoning with them opinion guy and tallaght01. They will never change.

Thankfully the far right does not have much traction in Ireland. To quote a great man I'll say this.

'The era of Thatcher and Reagan and Bush must join the PD's in the dustbin of history'- Eamon Gilmore

Eliot Rosewater

Pride Fighter wrote: »

They will never change.

Irony.

At least myself, donegalfella and Amhrán Nua support the systems we do because we see the benefits such systems hold. Private companies benefiting from health care may be "morally reprehensible" to you but, unfortunately for your position, it works better in terms of cost effectiveness and level of care. Because your position is based on high ideology instead of practicality, you refuse to debate the ins, the outs and the specifics of what we propose, instead falling back on lame clíches such "neo-cons".

I think this whole dogma can be summarized by your short sighted rejection of meritocracy in medicine. You are outraged that patients would want to go to the best hospitals in the country: "These hospitals are running out of money as people can just visit the 'best' hospital quite easily as the Netherlands is a small country". And just because you put the word best in inverted commas doesn't make your position any more tenable. All I can gather from that post is that you are against patient choice, as it causes the worst hospitals to close down.

Count Dooku

Pride Fighter wrote: »

The neo-con brigade out in force. Its no use reasoning with them opinion guy and tallaght01. They will never change.

Thankfully the far right does not have much traction in Ireland. To quote a great man I'll say this.

'The era of Thatcher and Reagan and Bush must join the PD's in the dustbin of history'- Eamon Gilmore

And fact that Labour Party didn’t gain anything from falling popularity of Fianna Fail is best proof for that

Jane5

Opinion Guy,
A link for the NCHDs new contract?

I AM an NCHD! I could scan in my new contract-once they actually give it to me! Do your own homework. Visit the IMO website. Google it. There is, and has been, a new NCHD contract in force since January 2010. We had to vote on it in December. It was supposed to include compliance with the EWTD, but this has not happened. All that has happened is the parts about not getting paid for hours worked, and getting an "average" of the hours you work over any one month. But people are still working the hours. Oh boy, are they. Working more than ever as management won't/can't get locums, and NCHDs are leaving the country in droves, increasing the pressure on the ones left behind.

Frankly, privatisation would work much better for NCHDs. But it's wrong. Civilised countries have a responsibility to provide good quality healthcare to their citizens and ensure that no-one is financially penalised for becoming ill.

Amhran Nua

tallaght01 wrote: »

It's piss easy to make shed loads of cash in Ireland i private medicine, considering the paucity of consultants.

We've got access to consultants from across the EU due to free movement of labour laws, what are you talking about here.

tallaght01 wrote: »

Universal private care would be a total cash cow for Irish docs.

If every Irish doctor decided to be a consultant or a GP, there would be a glut of them, so some would cut their prices to stay in business, and so the cost of healthcare would fall, basic supply and demand. Also, Ireland is far from the only country in the world that produces qualified doctors, we already have a large representation of South/Southeast Asian doctors and nurses in the system.

tallaght01 wrote: »

It used to be the French system that all the nutcases wanted to emulate, but as of late, the Dutch system can be googled for tables about one dimensional economic outcomes, and the various economic think-tanks have latched onto this.

Have they indeed. So tell us what economic think tank full of nutcases you think the EHCI represents? Previously it was the WHO who were advocating the French system, also apparently an economic think tank full of nutcases, but they haven't released a ranking table since 2000.

The Netherlands' healthcare system was this week rated the best in Europe by the annual Euro Health Consumer Index (EHCI). Experts believe it could serve as a model for US healthcare reform.

The EHCI, the 2008 version of which was published on 13 November, is compiled annually. It is based on publicly-available statistics and data from a private Swedish company, Health Consumer Powerhouse (HCP). From 34 indicators of quality, the overall ranking was divided into six categories: e-Health, patient rights, patient information, waiting time for treatment, waiting time for pharmaceuticals, and the speed at which new drugs are deployed.

The EHCI praised the Dutch effort, describing the winning margin as "the biggest since this 31-country ranking started in 2005". The Netherlands was also paraded as "the truly stable top performer" in the EU, primarily due to its successful patient empowerment track record.

This has nothing to do with right or left. Its demonstrably the best working and available system that is out there, and so should be something we should look at learning a few lessons from. You wouldn't use a wrench to hammer in a nail, would you? You'd use the best tool for the job.

Traumadoc

Amhran Nua wrote: »

We've got access to consultants from across the EU due to free movement of labour laws, what are you talking about here.


If every Irish doctor decided to be a consultant or a GP, there would be a glut of them, so some would cut their prices to stay in business, and so the cost of healthcare would fall, basic supply and demand. Also, Ireland is far from the only country in the world that produces qualified doctors, we already have a large representation of South/Southeast Asian doctors and nurses in the system.

We already train more consultants than we employ. Consultants would not cut their prices, they would leave for better pay and conditions elsewhere.

Junior docs are already leaving because the conditions , training, prospects and pay is better abroad.
Hospitals may have to curtail services because we cannot attract doctors to work here.

Pivatisation could lead to a US style system, where 16% of GDP goes on healthcare, leading to a lot of rich doctors and drug compaines

opinion guy

Jane5 wrote: »

Opinion Guy,
A link for the NCHDs new contract?

I AM an NCHD! I could scan in my new contract-once they actually give it to me! Do your own homework. Visit the IMO website. Google it. There is, and has been, a new NCHD contract in force since January 2010. We had to vote on it in December. It was supposed to include compliance with the EWTD, but this has not happened. All that has happened is the parts about not getting paid for hours worked, and getting an "average" of the hours you work over any one month. But people are still working the hours. Oh boy, are they. Working more than ever as management won't/can't get locums, and NCHDs are leaving the country in droves, increasing the pressure on the ones left behind.

I know u are an NCHD. jeesh relax. I wasn't doubting you I just want to see how its put officially. IMO don't have any info on their website on it.

Amhran Nua wrote: »

We've got access to consultants from across the EU due to free movement of labour laws, what are you talking about here.

What are you talking about ? They can't just come work here without meeting IMC requirements.

If every Irish doctor decided to be a consultant or a GP, there would be a glut of them, so some would cut their prices to stay in business, and so the cost of healthcare would fall, basic supply and demand. Also, Ireland is far from the only country in the world that produces qualified doctors, we already have a large representation of South/Southeast Asian doctors and nurses in the system.

You have no idea how this works. You can't just decide to be a consultant or a gp because you've been to medical school. You have to go thru a training scheme for many years then hope that you get given a consultant job or in the case of a gp have the money and balls to set up your business.
[/QUOTE]

tallaght01

Amhran Nua wrote: »

We've got access to consultants from across the EU due to free movement of labour laws, what are you talking about here.


If every Irish doctor decided to be a consultant or a GP, there would be a glut of them, so some would cut their prices to stay in business, and so the cost of healthcare would fall, basic supply and demand. Also, Ireland is far from the only country in the world that produces qualified doctors, we already have a large representation of South/Southeast Asian doctors and nurses in the system.


Have they indeed. So tell us what economic think tank full of nutcases you think the EHCI represents? Previously it was the WHO who were advocating the French system, also apparently an economic think tank full of nutcases, but they haven't released a ranking table since 2000.

This has nothing to do with right or left. Its demonstrably the best working and available system that is out there, and so should be something we should look at learning a few lessons from. You wouldn't use a wrench to hammer in a nail, would you? You'd use the best tool for the job.

LOL

A glut of consultants :P Not really as simple as that. Are you proposing your party will run the health service? In the kind of service you woud like, hospitals and consutants don't take on complex patients. They take low risk patients, so their survival and recovery figures look good, and the public get suckered into thinking they're the best. When I worked in the UK, I was in a unit where we took the sickest of the sick. A newspaper fond out we had higher death rates than other units, and suddenly we were accused of being a poorly run unit, when we had the best docs in the country.

I'd make 3 times my salary at least in the private sector, in the job I was offered when I was in Dublin a while back. BUt patient care wouldn't be much better, as things stand.

The EHCI look at simple economics Their report has no decent internationally recognised measurement of quality treatment. It's a politically attractive report, which is why you've adopted it. But You won't see the peer reviewed health systems journals printing high quality research that backs it up. People like "reports". But most of them aren't peer revieed and are, essentially balls. The main reason for the netherlands wiping the floor in this report was because they added an "ehealth" section to their assessment criteria. This separated countries, which were very closely grouped in previous reports. E-health is important but no-one has shown it's impact on health outcomes yet, so I'm not sure why it's given such importance in this report.

I had to laugh when I read about Canada and the misunderstanding of their syetm, expressed through the medium of a daily mail style rant.I've just finished writing a report on health economics in British Columbia, but I've included actual health inices in the analysis, and they actually do it quite equitably, in comparison with international standards.And they publish their results in proper jouirnals.
Private healthcare doesn't offer better care than the public system. It just provides quicker treatment.

Jane5 will know the private way of doing it, which is inefficient. You get a random swollen cervical gland and you go to your private hospital and you get told to come back for a 1)fine needle aspirate (several hundred snots) then that's inconclusive so you come back for 2) a core biospy, which we all know will be inconclusive. Then finally you've to come back for your excision biopsy, which is the only reliable way to ensure you don't ave lymphoma.

In my public clinic, we might do a FNA at your first presentation, and send you straight fr an excision. That won't make much sense to anyone but the medics reading this, who see this kind of thing happening all the time with private patients, who believe they're getting the best care because they get lots of tests.

Anyway, I know how this works. I;ve talked to enough old men about health in my time, and they always have opinions on everything. I know it's a never ending circle of anecdotal argument and random reports. The Irish govt has no clue how to run a health service. So who knows what they'll do. What I know is that we need to give people better access to healthcare, because that has real health impacts. Most of the posts here don't address that. But I won't be holding my breath.

tallaght01

Amhran Nua wrote: »

Previously it was the WHO who were advocating the French system, also apparently an economic think tank full of nutcases, but they haven't released a ranking table since 2000.

.

This actually warrants special mention.

Do you know why WHO stopped producing ranking tables?

Yea, coz they don't reflect any reality. they're highly complex, and a simple table is no way to represent that kind of data.

If you want to set up a political party (which this country does need) you need to do more reading. You need to know your area. No-one working in healthcare would take your party seriously after reading what you've just written.

Good luck with it.

opinion guy

tallaght01 wrote: »

LOL
Jane5 will know the private way of doing it, which is inefficient. You get a random swollen cervical gland and you go to your private hospital and you get told to come back for a 1)fine needle aspirate (several hundred snots) then that's inconclusive so you come back for 2) a core biospy, which we all know will be inconclusive. Then finally you've to come back for your excision biopsy, which is the only reliable way to ensure you don't ave lymphoma.

In my public clinic, we might do a FNA at your first presentation, and send you straight fr an excision. That won't make much sense to anyone but the medics reading this, who see this kind of thing happening all the time with private patients, who believe they're getting the best care because they get lots of tests.

Of course the other factor in this is that the private sector in Ireland leeches off the public sector by making use of public sector staff and resources when these private patients are admitted to hospital for their test. Which both downgrades the public service, and makes the private sector look better than it is

Amhran Nua

Traumadoc wrote: »

Junior docs are already leaving because the conditions , training, prospects and pay is better abroad.

Well then they should be delighted with the privatisation of the health services.

opinion guy wrote: »

What are you talking about ? They can't just come work here without meeting IMC requirements.

You have no idea how this works. You can't just decide to be a consultant or a gp because you've been to medical school. You have to go thru a training scheme for many years then hope that you get given a consultant job or in the case of a gp have the money and balls to set up your business.

Hold on a minute, why should this be any harder for doctors from abroad than Irish doctors? If the bottleneck is training course positions, that should be relatively simple to rectify.

tallaght01 wrote: »

In the kind of service you woud like, hospitals and consutants don't take on complex patients. They take low risk patients, so their survival and recovery figures look good, and the public get suckered into thinking they're the best.

Before making comments about what we would or would not like, do yourself a favour and look up the actual policy, which deals with everything you've just mentioned, in which risk is irrelevant. Or perhaps you think the Dutch routinely drop the very ill off at the airport?

tallaght01 wrote: »

I'd make 3 times my salary at least in the private sector, in the job I was offered when I was in Dublin a while back. BUt patient care wouldn't be much better, as things stand.

Sure, so if you think privatisation would help you financially so much, why are you opposed to it? Do you think patient care would suffer? If you do, why is the Netherlands, upon which this policy is based, rated as the best in Europe?

tallaght01 wrote: »

But You won't see the peer reviewed health systems journals printing high quality research that backs it up. People like "reports". But most of them aren't peer revieed and are, essentially balls. The main reason for the netherlands wiping the floor in this report was because they added an "ehealth" section to their assessment criteria. This separated countries, which were very closely grouped in previous reports. E-health is important but no-one has shown it's impact on health outcomes yet, so I'm not sure why it's given such importance in this report.

Okay, so which peer reviewed health system would you prefer to use as the basis for ranking?

tallaght01 wrote: »

I had to laugh when I read about Canada and the misunderstanding of their syetm, expressed through the medium of a daily mail style rant.

I didn't say anything about the Canadian system, its not terribly bad overall.

tallaght01 wrote: »

Private healthcare doesn't offer better care than the public system. It just provides quicker treatment.

Would you say that speed of treatment might perhaps be a factor in dealing with injuries or sicknesses?

tallaght01 wrote: »

The Irish govt has no clue how to run a health service.

Not to pull a taxi driver conversation on it, but what would you recommend?

tallaght01 wrote: »

Do you know why WHO stopped producing ranking tables?

Yea, coz they don't reflect any reality. they're highly complex, and a simple table is no way to represent that kind of data.

I was aware of that. I was also aware of the immense political pressure being put on the WHO to advocate one system or another. You certainly can rank healthcare systems on various criteria, and measure results. The Dutch do it for individual hospitals as a matter of course.

tallaght01 wrote: »

If you want to set up a political party (which this country does need) you need to do more reading. You need to know your area. No-one working in healthcare would take your party seriously after reading what you've just written.

Again, I'm hearing nothing but negatives here. Lets have it - do you think the Irish system is as good as it gets, and if not what would you change?

opinion guy

Amhran Nua wrote: »

Hold on a minute, why should this be any harder for doctors from abroad than Irish doctors? If the bottleneck is training course positions, that should be relatively simple to rectify.

Sigh. For someone who is speaking with such authority you are demonstrating a huge amount of ignorance of the system which you profess to know how to fix when all else have failed. Let me make it simple. There are not enough doctors in total. Furthermore the bottleneck is in appointing consultant posts. Plenty are qualified and chomping at the bit to practice but the government won't create the jobs for them to fill. So they are forced to sty in registrar posts, or move abroad. Junior doctors know this and are leaving in their droves to go places like America where they know from the outset they will reach consultancy in 4-7 years depending on specialty. Its for this reason (and the medieval working conditions) that the HSE are having trouble filling the training posts that are there.

And finally there are no private hospital based training posts yet. So far as I know none of the private hospitals are accredited for that. (Why train people when you can set about making money instead?)

Traumadoc

Amhran Nua wrote: »

W


If every Irish doctor decided to be a consultant or a GP, there would be a glut of them, so some would cut their prices to stay in business, and so the cost of healthcare would fall, basic supply and demand.

This is so simplistic on so many levels, why are US doctors paid so much?

http://assets.opencrs.com/rpts/RL34175_20070917.pdf

opinion guy

Traumadoc wrote: »

This is so simplistic on so many levels, why are US doctors paid so much?

Its freaking scary simple from someone supposedly trying to promote a political party

Jane5

Amhran Nua wrote: »

Hold on a minute, why should this be any harder for doctors from abroad than Irish doctors? If the bottleneck is training course positions, that should be relatively simple to rectify.

Training COURSE positions? No. Post graduate training is done in the form of being a junior doctor. A ....drum roll....Public Service Employee! Often joined to a union and everything. While overtime has been slashed, the government still has to pay them salaries and annual leave and all the other stuff for years while they are staffing the hospitals until they become consultants or GPs. So not only is it far from easy-as those coming from overseas as well as those from Ireland have to be Garda vetted, have their qualifications recognised, have the right amount of experience, be registered with the Medical Council on the appropriate register, and then the Dept of Health has to find the money to pay them. Scheme positions, especially Specialist registrar conditions- which is the training scheme that leads to consultancy, usually require that in addition to all of the above, one has their membership exams (which can only be obtained at a post grad level, while working in a hospital).
So, no, not at all easy to rectify.

Amhran Nua wrote: »

Sure, if you think privatisation would help you financially so much, why are you opposed to it? Do you think patient care would suffer? If you do, why is the Netherlands, upon which this policy is based, rated as the best in Europe?

Oh my goodness.
Well, this is a shocker, but not all people value financial gain ahead of everything, literally, everything else, people's lives, human suffering, morality etc.
Yes. I might stand to gain financially from working in a private hospital as opposed to a public one. However, we'll all be ice skating in hell before I work in one, as long as we have a two tier system. The exception would be if we all had universal health insurance, and all hospitals in the country were equal, and took all patients.
My position is: as long as I can make a living from medical care, enough so that I and my family do not suffer hardship, then that is the job I will do. More money at the expense of my moral beliefs holds no attraction for me. It never will. Most right wingers cannot understand that.

Opinion guy, sorry for the OTT reply. I just get tired of the accusations over on P.ie that all junior doctors are on 100k, and they don't seem to have heard of the new (****e) contract either, so I tend to bristle when it's mentioned.

Permabear

This post has been deleted.

Amhran Nua

opinion guy wrote: »

Sigh. For someone who is speaking with such authority you are demonstrating a huge amount of ignorance of the system which you profess to know how to fix when all else have failed.

Eh I never claimed an in depth understanding of the minutae of the consultancy programmes available, merely the broad strokes of how a health system should optimally work, based on a working and acclaimed model. This discussion is interesting though, albeit not really making any strong arguments against the Dutch system.

opinion guy wrote: »

Its for this reason (and the medieval working conditions) that the HSE are having trouble filling the training posts that are there.

Er so surely a privatised system would allow the market to create these posts as and where needed? I don't see this as an argument for top down centralised control.

opinion guy wrote: »

And finally there are no private hospital based training posts yet. So far as I know none of the private hospitals are accredited for that. (Why train people when you can set about making money instead?)

How quickly would that change if the whole lot was privatised however?

Traumadoc wrote: »

This is so simplistic on so many levels, why are US doctors paid so much?

Whats even more simplistic is equating every mention of the privatisation of healthcare with the US healthcare system. If you could point out for us where I advocated moving to a US style healthcare system, that'd be great.

opinion guy wrote: »

Its freaking scary simple from someone supposedly trying to promote a political party

Oh I forgot, this is Ireland, where the rules of supply and demand are different to other places.

Jane5 wrote: »

Training COURSE positions? No. Post graduate training is done in the form of being a junior doctor. A ....drum roll....Public Service Employee!

Yes, the mention of "course" was in response to the previous comment, lets not be pedantic here.

Jane5 wrote: »

So not only is it far from easy-as those coming from overseas as well as those from Ireland have to be Garda vetted, have their qualifications recognised, have the right amount of experience, be registered with the Medical Council on the appropriate register, and then the Dept of Health has to find the money to pay them.

I'm not seeing the problem, since the department of health wouldn't be paying them. Ireland has a paltry population of medical professionals compared to for example the Indian subcontinent - there is nothing magical about Irish doctors that make them uniquely capable of being consultants.

Jane5 wrote: »

Scheme positions, especially Specialist registrar conditions- which is the training scheme that leads to consultancy, usually require that in addition to all of the above, one has their membership exams (which can only be obtained at a post grad level, while working in a hospital).
So, no, not at all easy to rectify.

If the political will was there, it would be. The problem isn't so much with front line staff but more with the amount of beaurocracy and inbuilt inertia in administration within the Irish healthcare system - even something like Singapore's electronic patient database would reduce admin costs immensely, but its very difficult to get that into action here.

Jane5 wrote: »

Oh my goodness.
Well, this is a shocker, but not all people value financial gain ahead of everything, literally, everything else, people's lives, human suffering, morality etc.

Do not bother playing the morality card strawman, that wasn't the point, as I said that patient care should not suffer in the process.

Permabear

This post has been deleted.

opinion guy

Amhran Nua wrote: »

Er so surely a privatised system would allow the market to create these posts as and where needed? I don't see this as an argument for top down centralised control.


How quickly would that change if the whole lot was privatised however?

OMG you don't even know how much you don't get it. You can't just create training posts. It takes years of planning and investment. The hospitals have to meet certain standards and pass reviews etc etc etc. Its takes considerable time, resources and investment to get up to scratch.


You want to know what the real problem is? Politians like you trying to fix a system from a reductionist standpoint without bothering to understand it first.

Now you can continue to display your ignorance and arrogance and earn bad PR for your party and lose votes, or you could actually listen to Jane, traumudoc and tallaght who are all docs workign in the system and actually know what the problems are. For christ sake tallaght is not only a doctor, he just told you he is finishing up a peer reviewed article on the subject. You do realise this makes him an expert ? Both from his experience, and from his studies/report. AND YOU, THE POLITICAL TYPE, STILL AREN'T LISTENING TO HIM.
THIS IS THE PROBLEM!!!

NUIG_FiannaFail

Universal Health Insurance is a terrible idea. It will just pass the costs of health care even further onto PAYE workers. People should have the choice whether they want to give money to private insurance corporations.

Traumadoc

Amhran Nua wrote: »

E



I'm not seeing the problem, since the department of health wouldn't be paying them. Ireland has a paltry population of medical professionals compared to for example the Indian subcontinent - there is nothing magical about Irish doctors that make them uniquely capable of being consultants.

What will the pull be?
Come to Ireland and set up in private practice.( to hell with what the Indian subcontinent population healthcare needs are) .

If enough of you come the amount you earn will drop.:rolleyes:

As I said we already train more consultants than we employ, every year trained specialists leave, many never to return.

Amhran Nua

opinion guy wrote: »

OMG you don't even know how much you don't get it. You can't just create training posts. It takes years of planning and investment. The hospitals have to meet certain standards and pass reviews etc etc etc. Its takes considerable time, resources and investment to get up to scratch.

And we're not talking about full free market rules either. I've already mentioned a minimum standard of care in rural locations, why do you think that demand would not create a need for consultants?

opinion guy wrote: »

You want to know what the real problem is? Politians like you trying to fix a system from a reductionist standpoint without bothering to understand it first.

Now you can continue to display your ignorance and arrogance and earn bad PR for your party and lose votes, or you could actually listen to Jane, traumudoc and tallaght who are all docs workign in the system and actually know what the problems are. For christ sake tallaght is not only a doctor, he just told you he is finishing up a peer reviewed article on the subject. You do realise this makes him an expert ? Both from his experience, and from his studies/report. AND YOU, THE POLITICAL TYPE, STILL AREN'T LISTENING TO HIM.
THIS IS THE PROBLEM!!!

Yes, large red underlined fonts make your argument more persuasive. Settle down, I don't think anyone is trying to make things worse here, and don't project your understandable issues with politicians onto me. Its very easy to handwave away new ideas with terms like "reductionist" without looking into the details of those ideas first, which I am almost certain you have not. The Irish healthcare system, of which consultants form a small part, is not anywhere near optimal, so we're talking about ideas to address that.

If you think the Dutch healthcare system wouldn't work in Ireland, please elaborate on why that might be the case. Or perhaps you think that the Dutch don't have any consultants, or they are of a lesser standard than Irish ones?

Amhran Nua

Traumadoc wrote: »

( to hell with what the Indian subcontinent population healthcare needs are) .

Your alternative would be to lock them out because they tried to improve themselves and reach a standard of excellence that would be difficult even in a first world country? Doesn't seem very fair.

Traumadoc wrote: »

As I said we already train more consultants than we employ, every year trained specialists leave, many never to return.

Exactly, in a privatised environment the government wouldn't get to dictate how many roles there would be, the amount of people that need those roles would. Or to put it another way, what good would keeping the system the same do? Have you suggestions for alternative ideas?

Traumadoc

Some of us do go into private practice- you can be a private only consultant.
But most of us want to treat all patients not just those who can afford to "jump the queue".

Amhran Nua

Traumadoc wrote: »

Some of us do go into private practice- you can be a private only consultant.
But most of us want to treat all patients not just those who can afford to "jump the queue".

Under the proposed system patients cannot be refused insurance on the basis of previous illness, and by risk equalisation won't pay much more. And if they can't afford it, they get subsidised. I see no moral difficulties here, patient care shouldn't suffer (quite the opposite with the Dutch system, it apparently gets better). Besides which, is jumping the queue not a problem already?

Count Dooku

opinion guy wrote: »

OMG you don't even know how much you don't get it. You can't just create training posts. It takes years of planning and investment. The hospitals have to meet certain standards and pass reviews etc etc etc. Its takes considerable time, resources and investment to get up to scratch.


You want to know what the real problem is? Politians like you trying to fix a system from a reductionist standpoint without bothering to understand it first.

Now you can continue to display your ignorance and arrogance and earn bad PR for your party and lose votes, or you could actually listen to Jane, traumudoc and tallaght who are all docs workign in the system and actually know what the problems are. For christ sake tallaght is not only a doctor, he just told you he is finishing up a peer reviewed article on the subject. You do realise this makes him an expert ? Both from his experience, and from his studies/report. AND YOU, THE POLITICAL TYPE, STILL AREN'T LISTENING TO HIM.
THIS IS THE PROBLEM!!!

This is why Ireland always will be ruled by populists, which will give false promises and never will be responsible for anything
10 years ago we heard that Irish nurses were the most hard working nurses in EU we need more of them instead of investments into hospital beds and doctors
Now we have more nurses per capita then any other EU country, but nothing improved.
Why people should trust to statements that free healthcare will fix everything?

tallaght01

Amhran Nua wrote: »

Under the proposed system patients cannot be refused insurance on the basis of previous illness, and by risk equalisation won't pay much more. And if they can't afford it, they get subsidised. I see no moral difficulties here, patient care shouldn't suffer (quite the opposite with the Dutch system, it apparently gets better). Besides which, is jumping the queue not a problem already?

Jesus. I'm done here. But I just want to say you need to get someone involved with your party who understands health.

You can't just "allow more consultants". There are HUGE gulfs in standards and training internationally, so you cant just import as many as you like.

Private hospitals deal in profitable things. They will happily plough money into cataracts, adenoids and mole removal, as they provide lots of cash for straightforward procedures. But globally about 30% of healthcare resources need to be expended on the sickest 5% of the population. This subgroup are mostly unprofitable chronic disease patients, drug abusers and alcoholics. Private enterprise have zero interest in these patients. Zero. They will, as is the case in Holland, do the bare minimum for these people. But the old lady's arthritis pain doesn't register on their health stats. The fact that she's been prescribed some steroids will be though.

With universal health coverage, we wil still have the same amount of patients vying for treatment. The private sector don't provide better care then the public sector now, when they can cherry pick their patients, and they're going to find it difficult of they have to see the same patients as the public sector.

But making health the responsibility of the private sector means the end (or significantly reduced standards) of care for the elderly with chronic illness, abusers of alcohol and drugs, those with psychiatric illness.

We need free GP services, while giving the GPs an income that won't send them to the UK or Oz. But most of all we need to look at health A) in the long term and in all it's facets (primary, secondary, tertiary care). It needs more resources. We need staff to come back from overseas. I've worked in Ozzie hospitals exclusively staffed by Irish and UK docs. There are enough Irish docs overseas to make huge dents in waiting times.

Harney needs to go, too. And really soon.

BUt the fact that you are king for "an evidence based country" to base our healthcare on means that I would never vote for you. Ireland has particular problems and a particular burden of disease that requires a solution tailored to Ireland. Pick and choose the good from other countries, but you don't just superimpose a Dutch model into an Irish situation.

The answer is highly complex, and is beyond the scope of a forum like this. BUt you need to wake up to the fact that the private sector doesn't provide better healthcare. It just cherrypicks and over-investigates. You also need to stop looking at simple tables as indicators of health performance, and look at detailed health indices.

This is highly complex. I know everyone on here has an opinion. BUt if you want to win the confidence of healthcare staff, hire senior healthcare staff to advise you on health.

tallaght01

Count Dooku wrote: »

10 years ago we heard that Irish nurses were the most hard working nurses in EU we need more of them instead of investments into hospital beds and doctors

Anyone who said that is a nutcase, and knows nothing about health. You shoudl never have listened to people like that in the first place, and you wouldn't if you knew about health.

tallaght01

Jane5 wrote: »

I just get tired of the accusations over on P.ie that all junior doctors are on 100k, .

Can you send me a link for that. I joined p.ie there to see if their forum is any more sensible than here. Would be nice to actually discuss politics online again.

Amhran Nua

tallaght01 wrote: »

They will, as is the case in Holland, do the bare minimum for these people. But the old lady's arthritis pain doesn't register on their health stats. The fact that she's been prescribed some steroids will be though.

Hold on there - have you any evidence at all for your statement that Holland has worse healthcare for marginal patients than Ireland? Your argument seems to hinge entirely on this concept - I'm not saying you are wrong, I'd just like to know why you think that, and a general perception of private hospitals isn't sufficient.

tallaght01 wrote: »

Ireland has particular problems and a particular burden of disease that requires a solution tailored to Ireland. Pick and choose the good from other countries, but you don't just superimpose a Dutch model into an Irish situation.

Indeed, I've already said as much in this thread.

We're spending approximately €14 billion a year on the Department of Health and Children, with a population of 4 million, and another billion for the market in health insurance. This gives a spend to population ratio of 3.75, zeroes excluded.

The Dutch model, which is what we are aiming for, since it was rated best quality of service and second best value for money in the world, by comparison are spending approximately €46 billion a year on health with a population of 16 million. This gives a spend to population ratio of 2.875, thus they spend about 75% as much on health as we do, and have far better healthcare. They have insurance premiums of around €30 a week to pay at a minimum (actually €22, but they have a few other charges on top of that).

To maintain current levels of healthcare and all the inefficiency that entails, we'd need to subsidise the insurance premiums (assuming everyone paid bare minimum) by about €8 billion, still a hefty saving, and with streamlining and efficiency measures to bring health to Dutch standards (0.75 cost) we're looking at a total cost to the exchequer of around €5 billion per annum.

Also by going down the privatisation route, we can put the income from the sale of the health systems, very conservatively estimating €12 billion on the basis of profit versus business sales, into upgrading hospital and clinical equipment and processes to provide top quality systems and services, and handling any industrial disputes arising from the transition.

This is back of the envelope stuff here, but I hope it gets across the idea.

NUIG_FiannaFail

How much will Fine Gael's buddies in the private insurance companies make in profits from their plan? Billions every year no doubt