Fine Gael's Healthcare reform-Your Opinions

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Fine Gael will introduce Universal Health Insurance
(2016–2020)
UHI – Changing the Role of the State in Healthcare Delivery: Under UHI every citizen will have health
insurance from one of a number of competing insurance companies, which will provide equal access to a
comprehensive range of hospital and medical services. The insurance companies will take over much of the
burden of administering the system. The State’s role will be to:
• Pay for children/students and those on medical cards (and their families). It will also subsidise those on
low income
• Require all insurance companies to offer a standard package of health insurance that will cover all
key service such as hospital care, GP care, maternity care, etc. A system of Community Rating will be
introduced which will ensure that no insurance company can discriminate on the basis of age, sex or
health status, and
• Be responsible for regulating the system, ensuring that safety and quality are maintained, and funding services
that are not covered through UHI such as long term care, mental health, disease prevention, etc. Public
hospitals will remain under public ownership but will be given much more freedom to run themselves
FairCare will split the HSE into two before the introduction of UHI:
• A Healthcare Commissioning Authority (HCA) for the acquisition of “cure services” – hospital care, GP
care, etc.
• A Care Services Authority (CSA) for the acquisition and provision of “care services” for the elderly,
disabled, children, etc.
Once UHI is introduced the HCA will cease to function and the majority of the people it employs will instead
be employed directly by the hospitals. Professionals whose work is not directly related to hospitals will
have their employment contracts switched to the CSA. Fairness and respect for employment conditions
will be central to this transition, and will be negotiated with trade unions.
Opening Up the Insurance Market: UHI will double the size of the health insurance market. This will
attract new entrants, increasing competition and choice for customers.
Reforming the VHI: Fine Gael believes that the VHI can provide a “public option” for customers once UHI
is introduced. However, we believe it should be slimmed down considerably so that it no longer has a
dominant market position.Fine Gael ManiFesto
l 49
Giving Local Hospitals More Control: Under FairCare individual or networks of hospitals will be managed
by hospital trusts, where patients, staff and members of the local community have a real say in the services
delivered and in the development of the hospital.
Gradually Introduce Free GP Care for All once UHI is established: Once UHI has been fully implemented
Free GP Care will be available to everyone and the two-tier system will end.
13.4 Fine Gael will make the Current Health System More Efficient
FairCare’s cost reduction programme will protect front line services as much as possible even as we see
reductions in the health budget as a result of the fiscal crisis.
Reducing Bureaucracy: Fine Gael will reduce HSE staff numbers by 8,000 by 2014 through a combination
of natural wastage and voluntary redundancies. Compulsory redundancy will therefore not be required.
Cutting Waste and Inefficiency: Significant savings will be found by reducing the cost of agency staff,
taxis, absenteeism and non-core pay such as overtime and allowances for example.
Cutting the Cost of Drugs: Fine Gael will introduce Reference Pricing and reduce the cost of generic
medicines in order to make savings to the State drugs bill. Private patients will benefit from cheaper
medicines in their local pharmacies.
Fine Gael will improve efficiency by 5-10% by introduce Money Follows the Patient.
Fine Gael will cut costs by transferring chronic disease management from hospitals to primary care.

http://www.rte.ie/news/2011/0215/finegaelmanifesto.pdf

The Health and Mental health section of the document is about 3/4's of the way down (the last piece before the irish part). I haven't copied all of it here.

I'm just wondering the opinion of people who currently work in the HSE think of Fine Gael's proposal?

Do you think it is feasible and can work?

They aim to cut the numbers by

8,000 by 2014

and to also

initiate a long-term manpower strategy to tackle the chronic front line
staff shortages we face in specialities such as general practice, mental health, physiotherapy, occupational
therapy and speech and language therapy to mention but a few.

It all looks good to me, however I'm not educated in this area at all, although I do hope to work within the health service in the Future.

Boethius

I agree that it all looks good in theory but then again it is an election manifesto and you wouldn't expect it otherwise :-) The big question that I have is where would the money come from to implement this.

A quick glance at the Dutch system shows that the average cost to the insured is 1200 euros per year which I imagine is well above the average of health insurance costs here. I may be mistaken on that point but I don't pay anything near that and this universal cover accounts for only 40% of medical procedures which I imagine would equate to a basic entry level insurance plan. This 1200 euros also relates to, in the Dutch system at least, only 45% of the premium with the government covering 5% and the individuals employer covers the other whopping 50%. Will this be offset against PRSI or will employers be faced with added taxation in the face of crippling small and medium sized business conditions.

The government then is required to cover the other 60% of procedures (which are more likely to be the less common but most expensive ones) as well as general insurance for medical card holders and youths.

So ya I'm just wondering that even if they could implement this reform, what would be the cost breakdowns and how would it be allocated and how would it compare to the cost of carrying on with Fine Fail's 30 year search for health care averageness. I personally think this is the main point to be considered which Fine Gael have apparently neglected to address.

Bit of a rant but ya sorry that's the angle I'm looking at it from.

maninasia

Good analysis, where I live I have universal health coverage, similar enough to the Dutch system, it works well but it's a fairly low cost economy. Taking averages is probably not a good measure, mean is a better measure.

Also we'd need to see what is the mean spend of an Irish working citizen now and compare to the proposed plan.

Universal health systems give incentives for hospitals to be effective and also introduce an element of competition for patients as fees are made per patient i.e. the patient becomes a valued customer. It also encourages large scale investment in private hospitals thus increasing numbers of beds and reducing waiting lists.

Finally it should be integrated with a universal health ID chip which would also improve the payment and health management and records management situation.

I'd see some businesses might be worried about adding another cost...that would worry me a bit.

<SNIP> mod edit: leave out the sniping and the pot-shots. no further warnings

opinion guy

Personally I think its a pipedream. It will cost too much to implement at the moment. 5 years ago it would have been feasable - but not now.

RobFowl

opinion guy wrote: »

Personally I think its a pipedream. It will cost too much to implement at the moment. 5 years ago it would have been feasable - but not now.

It's a phased plan to be implemented over the next 10 years (free GP care at the point of access being the final stage). The first few years is switching from block grant payments to hospitals to a funding per item of service system. It's not all going to come in at once and will be under constant review.
I think it hugely promising and would be a vast improvement on the mish mash of different systems we operate at present.

OMD

opinion guy wrote: »

Personally I think its a pipedream. It will cost too much to implement at the moment. 5 years ago it would have been feasable - but not now.

According to a Fianna Fail ad in the free newspapers today, to implement the Dutch System in full in Ireland will cost every family €5000 a year. If they are right that would be a massive saving to Irish families as the present system costs the average family €13,000 and on top of that we still have to pay for GP visits and a substantial proportion feel the system is so poor that they pay extra for private health insurance.

tallaght01

I know balls-all about the FG manifesto, but I've written a pretty comprehensive report on Dutch healthcare for work not so long ago. And I can't wotrk out

A) if the insurance companies in Ireland have been consulted about this, as they won't be allowed to alter premia based on risk factors.

where the investment for the private hospitals that we would need is going to come from? Are the banks going to star lending for this purpose?

of course there's the well trodden public health argument that increased choice does not equal better care, and often leads to worse care. but that's an issue for another day.

I don't see how Ireland is ready for a system that depends heavily on private investment/expenditure with very very high set-up costs and a malleable insurance system.

I'm a total believer in free healthcare for all at the point of access, but I don't see how our economy and our private sector is ready for this.

maninasia

It's not sniping, the thread hadn't been going anywhere yet this is probably the biggest proposed change for decades so it is legitimate to comment on the surprising lack of debate.

The investment can come from private hospital contractors the world over, not just from Ireland. All it needs is a level playing field and a return on their investment. Mixing private and public is the way to go as it stops one becoming dominant and evens out risk. Private contractors operate more efficiently and this puts the onus on public hospitals to up their game.

tallaght01

I don't think there's any compelling evidence that private hospitals offer a more efficient service, when comparing like with like.

The issue about the overseas contractors coming in is what I'm afraid of. I think if this sort of plan was implemented in a time when we have an economy to support it, then it would be good for business in Ireland. As it stands, I see a situation where the profit flows out of the country for the running of these hospitals.

Will overseas run private hospitals be accredited for the training of doctors? Or will it be a consultant led service?

Are the poor going to be left with the public hospitals getting treated by the SHO, while the rich are being dealt with in the private sector by the consultants? Are we just going to go full circle.

I think I'm gonna just have to suck it up and read that policy. Luckily I am very very bored today.

tallaght01

Just had a skim through their policy publication ("skim" being the operative word).

I think that it's disingenuous to compare it to the Netherlands system.

The FG plan will involve the government still running health and micromanaging waiting lists etc. The system in the Netherlands involves almost entirely private healthcare with minimal government intervention.

I'll be honest and say I'd traditionally be a Labour man, and I'm, frankly, embarrassed at the idea of Enda Kenny being elected to lead us in one of our worst crises ever. So, that's my conflict of interest here. Though I'm not stuck in my ways with regards to voting.

I love their idea of free GP care for every citizen. That, for me, would make them electable (from a health point of view) in itself. However, they give no real idea of the costs of this, and expect insurers to cover it. It's a good idea, but is it practical? presumably GPs won't be obliged to take part in this system? Has there been consultation with GPs?

They will be "reducing consultant costs by 60 million a year". No idea how they're going to do that I suspect the consultants are in for a mega pay cut again. Again, will they be obliged to work in the public sector? Unlikely.

They're hoping for 2000 voluntary redundancies in the HSE. is that not quite optimistic? These people will presumably go straight onto the dole, so their redundancy packages will have to be quite tempting. But they say later on that they will be disbanding the HSE, which goes against earlier claims that there will be no involuntary redundancies. I found that confusing.

My biggest concern is the issue of equity. They talk about hospitals being incentivised (is that a word?) to treat patients. They don't talk about the very important part of the Dutch model, which is the specific incentives given to hospitals which carry out important, yet unprofitable, functions. The concern with this kind of system, combined with a choice-based system (which is what they seem to be advocating) can be read about in any public health/health service text. Example:

Old lady with multiple comorbidities. She doesn't have transport and is reliant on her local hospital. Her hospital is a poor performer, and as a result less people attend, so it's budget is cut, so it performs even more poorly. But she's stuck with it. All her referrals are to her local hospital, as it's on the bus route (this is a surprisingly large portion of our most vulnerable patients) and that's it. No "choice" for her.

Compare to her to the retired judge, who needs secondary care treatment. She has choice. She can choose the big hospital in Dublin. Her relatives can bring her up, and they can afford to stay in a hotel close by if she needs an elective admission.

Health isn't equitable at the moment, but I'm not sure this system will improve it. I've never known health system where lots of choice has done anything for the vulnerable patients.

I'm also concerned that they've based their cliams about costs savings in chronic disease on the findings of one study (the SPHERE study, which I believe only involved looking at cardiovascular disease, with nice easy-to-measure outcomes).

The GPs amongst you will be glad to hear that part of the mental health strategy is to educate you all properly

It's an interetsing read, though a bit short on detail at points.

It can be found at http://www.finegael2011.com/pdf/FairCareDocument.pdf

OMD

tallaght01 wrote: »

I know balls-all about the FG manifesto, but I've written a pretty comprehensive report on Dutch healthcare for work not so long ago. And I can't wotrk out

A) if the insurance companies in Ireland have been consulted about this, as they won't be allowed to alter premia based on risk factors.

where the investment for the private hospitals that we would need is going to come from? Are the banks going to star lending for this purpose?

of course there's the well trodden public health argument that increased choice does not equal better care, and often leads to worse care. but that's an issue for another day.

I don't see how Ireland is ready for a system that depends heavily on private investment/expenditure with very very high set-up costs and a malleable insurance system.

I'm a total believer in free healthcare for all at the point of access, but I don't see how our economy and our private sector is ready for this.

There is no need for extra hospitals or extra funding, we have enough hospitals already. Whether you call them private or public is not really the point. Ideally we would have a major cut down on poorly performing, inefficient hospitals. Health insurance (what we now call tax) would be used to fund treatments. They could be funded in what we call public hospitals (in which case the money goes back to the government) or in private hospitals. As the amount of money each gets would be the same for the amount of work done, in theory there is no reason why one should be better than the other. A hospital that can do the work more efficiently would be more profitable. The system is not to improve choice but to improve hospitals. I think you are looking at it as been an extension of the current private systemwhereas in actual fact it is closer to an abandondment of the current private system and an improvement to the public system. It means doctors will be answerable for decisions they make. They will have to stand up to external audits from doctors in other countries as well as from Ireland. They will have to justify tests and investigations that are ordered etc

opinion guy

Tallaght what do you think of labours plan ?

It looks alot more sensible and achievable to me!

tallaght01

OMD wrote: »

There is no need for extra hospitals or extra funding, we have enough hospitals already. Whether you call them private or public is not really the point. Ideally we would have a major cut down on poorly performing, inefficient hospitals.

I personally think poorly performing hospitals should be helped, and not punished. It works very successfully here in oz where I do A+E. We have targets for seeing patients within a time frame. If we don't meet them...we get EXTRA resources, believe it or not. This is the total reverse of the FG policy, and is where I'm uneasy about their plans.

OMD wrote: »

Health insurance (what we now call tax) would be used to fund treatments. They could be funded in what we call public hospitals (in which case the money goes back to the government) or in private hospitals. As the amount of money each gets would be the same for the amount of work done, in theory there is no reason why one should be better than the other. A hospital that can do the work more efficiently would be more profitable.

I think the issue here is that the public hospitals, under the FG plan, will still be micromanaged by government, whereas the private ones won't, which gives them a distinct advantage. The worry is also about private hospitals cherry picking the profitable stuff, which is what we saw in the UK when they tried a system like this (I use the word "like" in a very loose sense).

OMD wrote: »

The system is not to improve choice but to improve hospitals. I think you are looking at it as been an extension of the current private systemwhereas in actual fact it is closer to an abandondment of the current private system and an improvement to the public system. It means doctors will be answerable for decisions they make. They will have to stand up to external audits from doctors in other countries as well as from Ireland. They will have to justify tests and investigations that are ordered etc

There's no abandonment of the private system proppsed from what I can see, and I'm not sure how they intend improving public hospitals magically. I don't see anything in their policy about docs being more answerable, except from a financial point of view. I think the net result will actually be over ionvestigation and over treatmentm, if there's going to be payment for it.

opinion guy wrote: »

Tallaght what do you think of labours plan ?

It looks alot more sensible and achievable to me!

I think labour's plan is a lot closer to the Netherlands' system than FGs is, as they both have similar plans, but Labour would make our current public hospitals into independent hospitals, which I would prefer to see.

I alo think the labour plan is basically "FG Lite", but their plans are a little sketchy too. And the consultants will be in for a big paycut under a labour govt, which I think will push the best ones into the private sector, and the inequity issue raises its head again.

But I would have to say that its labour's social policies which would make me vote for them. I don't think any of the parties have got health sussed out.

drzhivago

tallaght01 wrote: »

I don't think there's any compelling evidence that private hospitals offer a more efficient service, when comparing like with like.

The issue about the overseas contractors coming in is what I'm afraid of. I think if this sort of plan was implemented in a time when we have an economy to support it, then it would be good for business in Ireland. As it stands, I see a situation where the profit flows out of the country for the running of these hospitals.

Will overseas run private hospitals be accredited for the training of doctors? Or will it be a consultant led service?

Are the poor going to be left with the public hospitals getting treated by the SHO, while the rich are being dealt with in the private sector by the consultants? Are we just going to go full circle.

I think I'm gonna just have to suck it up and read that policy. Luckily I am very very bored today.

Have to disagree here Tallaght, considerable experience of private and public system

Much fewer staff in private hospitals, often see consultant pushing patients in and out of theatre on trolley to get the next patient in, woudlnt happen in public

Much fewer administrators who are focussed on targets which are meaningful to them again unlike public side

Everything is costed for a patient episode, unlike waste in Public side


IN SAYING all that it is an elective cold service in the main, I hate the term cherry picking but that is what is used in the media to describe the service however they do offer a very good service with realistic timetable when patient can expect to have their operation on day it is booked unlike publci where may be cancelled multiple times.

To my horror I cost a man his job many years ago in public system as I had to cancel his case one too many times fro his employer, 3 weeks in a row, having takn time off work each time in advance with employer, early 90's when jobs werent easy to coem about either

the private service should really be looked upon as the functioning elective system of our health service which doesnt compete with A&E for beds, that is why it is efficient as well

drzhivago

OMD wrote: »

There is no need for extra hospitals or extra funding, we have enough hospitals already. Whether you call them private or public is not really the point. Ideally we would have a major cut down on poorly performing, inefficient hospitals. Health insurance (what we now call tax) would be used to fund treatments. They could be funded in what we call public hospitals (in which case the money goes back to the government) or in private hospitals. As the amount of money each gets would be the same for the amount of work done, in theory there is no reason why one should be better than the other. A hospital that can do the work more efficiently would be more profitable. The system is not to improve choice but to improve hospitals. I think you are looking at it as been an extension of the current private systemwhereas in actual fact it is closer to an abandondment of the current private system and an improvement to the public system. It means doctors will be answerable for decisions they make. They will have to stand up to external audits from doctors in other countries as well as from Ireland. They will have to justify tests and investigations that are ordered etc

Ama hospital doctor but dont stand to gain from doing laods of procedures but have to say multiple reports have identified our dearth of hospital beds (public or private) which is why the Acute Hospital Bed Capacity report laid out scenarios of efficiency and even with maximum efficiency how we could need 2,800 beds

Thsi got watered down to the co-located 100 bed only plan but the fact is we need them now and will need them more in future

The wider access to GP care in future will lend to a lead time bias (like that one Tallaght) in diagnosing many conditions and leading to an explosion in need for diagnostic and operative services in early years of this plan


Agree will have to audit test use/outcomes, doctors use of drugs resources etc

But system is more like private than public however should lead to improvements in public but not without major restructuring of admin staff who may be re-deployed locally as on site staff for some of the new insurers

tallaght01

drzhivago wrote: »

Have to disagree here Tallaght, considerable experience of private and public system

Much fewer staff in private hospitals, often see consultant pushing patients in and out of theatre on trolley to get the next patient in, woudlnt happen in public

Much fewer administrators who are focussed on targets which are meaningful to them again unlike public side

Everything is costed for a patient episode, unlike waste in Public side


IN SAYING all that it is an elective cold service in the main, I hate the term cherry picking but that is what is used in the media to describe the service however they do offer a very good service with realistic timetable when patient can expect to have their operation on day it is booked unlike publci where may be cancelled multiple times.

To my horror I cost a man his job many years ago in public system as I had to cancel his case one too many times fro his employer, 3 weeks in a row, having takn time off work each time in advance with employer, early 90's when jobs werent easy to coem about either

the private service should really be looked upon as the functioning elective system of our health service which doesnt compete with A&E for beds, that is why it is efficient as well

This is why I talked about efficiency when like is compared with like.

There's no comparison in the efficiency of an elective-centred private hospital with a consultant-led service. But that is very very different to what we're talking about.

As I can work it out, the FG plan keeps the public hospitals under govt control, who will deal with everything, and the private hospitals still get to provide the services they want, which, to me, is not significant progress.

I don't see how this won't simply lead to money being diverted from the public hospitals to the private hospitals. Fair enough if you have a genuine choice of provider, but if you don't then it's not good.

RobFowl

tallaght01 wrote: »

As I can work it out, the FG plan keeps the public hospitals under govt control

Technically they are going to make them independent entities or trusts.
I can see a lot of positives in the plan and it is a work in progress.
Personally would like if there was a state run insurance plan as well as private operators but the states history of doing this efficiently isn't good...

drzhivago

tallaght01 wrote: »

This is why I talked about efficiency when like is compared with like.

There's no comparison in the efficiency of an elective-centred private hospital with a consultant-led service. But that is very very different to what we're talking about.

As I can work it out, the FG plan keeps the public hospitals under govt control, who will deal with everything, and the private hospitals still get to provide the services they want, which, to me, is not significant progress.

I don't see how this won't simply lead to money being diverted from the public hospitals to the private hospitals. Fair enough if you have a genuine choice of provider, but if you don't then it's not good.

most public hospitals not government control, they have independency
They get their funding form government that is all
I think for a lot of peoples needs the private can provide it and they will if they see that it is profitable (for the for profit hospitals) and not loss making (for the not for profit privates)

consider primary care, we have private GPs and public GPs will a free for all system have any effect on what services each offers or not, we already have this with vaccination and service is provided by public and private

tallaght01

drzhivago wrote: »

most public hospitals not government control, they have independency
They get their funding form government that is all

Well, public hospitals are under control of the HSE, which is essentially an arm of the dept of health. The HSE can control salaries that the hospitals can pay, can set recruitment moratoria and can set priorities. They can't do this for the private sector. I know individual hospitals have boards, but they are administered by the HSE.

drzhivago wrote: »

I think for a lot of peoples needs the private can provide it and they will if they see that it is profitable (for the for profit hospitals) and not loss making (for the not for profit privates)

consider primary care, we have private GPs and public GPs will a free for all system have any effect on what services each offers or not, we already have this with vaccination and service is provided by public and private

I'm not disputing this is how it will work. That's exactly how I'm saying it will work.
What I'm wondering is how is this different to what we have already? If it's simply the presence of universal coverage, then A) it's not based on the netherlands system and It's no different to the labour policy.

The policy seems to be all about choice and rewarding the high performing hospitals. Of course I think that's OK when everyone has legitimate choice about seeking health care. But that's obviously not the case in reality.

I also think it's disingenuous to sell us a health policy on the basis that the netherlands is "ranked 4th overall in europe for health and 1st for quality" and then introduce a system that's only very very loosely based on that system. That's before we get into the criteria on which these rankings were compiled (though I am a fan of the netherlands system).

Traumadoc

tallaght01 wrote: »

Well, public hospitals are under control of the HSE, which is essentially an arm of the dept of health. The HSE can control salaries that the hospitals can pay, can set recruitment moratoria and can set priorities. They can't do this for the private sector. I know individual hospitals have boards, .

The independence of the voluntary hospitals, allows them to acquire equipment that the HSE hospitals cannot. That is why many voluntary hospitals have had PAC systems for the last 14 years while they are still held up by the national implementation body in the HSE hospitals.

I think that a funding following the patient would be great. But if the dept of health are implementing it - I would expect 2025 as the commencement date for a staged implementation.:rolleyes:

Breezer

I can't see this happening now, unfortunately. Fine Gael are going to try keep Labour out of Finance, which will probably mean a Labour Minister for Health.

We'll see anyway.

tallaght01

Traumadoc wrote: »

The independence of the voluntary hospitals, allows them to acquire equipment that the HSE hospitals cannot. That is why many voluntary hospitals have had PAC systems for the last 14 years while they are still held up by the national implementation body in the HSE hospitals.

I think that a funding following the patient would be great. But if the dept of health are implementing it - I would expect 2025 as the commencement date for a staged implementation.:rolleyes:

I don't disagree with this at all. The problem with the theory is that the issue is much bigger than equipment acquisition. FG have, for example, decided on the implementation of a national patient record system, and a determined minister of health could bring in PACS nationally.

The issue is that the independent hospital will be like, as robfowl said above, "trusts" like we see in the UK. Under the "trust model", the govt still set the targets, and the hospital has the independence in how to achieve them. So, the independence is limited.Trusts invariably become target-hitting machines, which is good for no one. Targets lead to disproportionate focus on outcomes which are easy to measure, and public health, geriatrics, chronic care and mental health will almost always suffer under a system like that.

nesf

tallaght01 wrote: »

The GPs amongst you will be glad to hear that part of the mental health strategy is to educate you all properly

GPs in general need more training on mental health issues. They are not an effective screening tool for mental health right now in general. There are exceptions to this, I chose my own GP based on how good she was on mental health issues, but from personal experience the majority of GPs I've seen know very little but the basics when it comes to mental health.

How to actually fix this, I've no idea. Mental health diagnosis is just so much more complicated and prone to error than most other areas of medicine.

Mucco

tallaght01 wrote: »

I've written a pretty comprehensive report on Dutch healthcare for work not so long ago.

Hi Tallaght01,

Maybe you can help me out with some info on the Dutch system. I can't understand how they expect the insurers to compete when they all have to offer the same basic package, and cannot compete in terms of risk. Also, as smaller insurers, they each have to contract with the hospitals and therefore lose monopoly power, and there will be administrative waste. Is a single payer not more efficient?

I think the FG policy is largely based on the ESRI/DoH report from last year. I posted on it here:
http://boards.ie/vbulletin/showpost.php?p=70648154&postcount=56

nesf

Mucco wrote: »

Hi Tallaght01,

Maybe you can help me out with some info on the Dutch system. I can't understand how they expect the insurers to compete when they all have to offer the same basic package, and cannot compete in terms of risk. Also, as smaller insurers, they each have to contract with the hospitals and therefore lose monopoly power, and there will be administrative waste. Is a single payer not more efficient?

I think the FG policy is largely based on the ESRI/DoH report from last year. I posted on it here:
http://boards.ie/vbulletin/showpost.php?p=70648154&postcount=56

They can compete through price by undercutting under the maximum set by the Government. They can compete by adding extras to the basic package (they are not, to my knowledge, required only to offer a basic package but to offer at least a basic package). They can also compete through advertising and brand awareness.

Think of it in terms of Coca Cola and Pepsi. They effectively offer the same product with minor differences, around the same price point and in the same locations etc. They still have a lot to compete with!

Breezer

Breezer wrote: »

I can't see this happening now, unfortunately. Fine Gael are going to try keep Labour out of Finance, which will probably mean a Labour Minister for Health.

We'll see anyway.

It appears I was wrong. The PfG's Health section seems to mirror Fine Gael's policy pretty closely. Strong emphasis on primary care too. Delighted.

Mucco

nesf wrote: »

They can compete through price by undercutting under the maximum set by the Government. They can compete by adding extras to the basic package (they are not, to my knowledge, required only to offer a basic package but to offer at least a basic package). They can also compete through advertising and brand awareness.

Think of it in terms of Coca Cola and Pepsi. They effectively offer the same product with minor differences, around the same price point and in the same locations etc. They still have a lot to compete with!

Thanks for the reply. I'm still not sure it works. The basic package will also have to be an adequate package. Anything extra can therefore be seen as unnecessary, eg private room, newspaper in the morning (this does happen!) etc... In effect insurers will compete for the 'hotel' factors of health care. This will not make a health service more efficient.

Regarding your Coke/Pepsi analogy. Both companies reap the rewards of innovation for cheaper manufacture, insurers won't. Both Coke and Pepsi cost nothing to make, they spend a lot on marketing, leading to a high price - again, if insurers do this, it adds to cost while doing nothing for efficiency.

tallaght01

Mucco wrote: »

Thanks for the reply. I'm still not sure it works. The basic package will also have to be an adequate package. Anything extra can therefore be seen as unnecessary, eg private room, newspaper in the morning (this does happen!) etc... In effect insurers will compete for the 'hotel' factors of health care. This will not make a health service more efficient.

Regarding your Coke/Pepsi analogy. Both companies reap the rewards of innovation for cheaper manufacture, insurers won't. Both Coke and Pepsi cost nothing to make, they spend a lot on marketing, leading to a high price - again, if insurers do this, it adds to cost while doing nothing for efficiency.

god knows how its gonna work. In Holland, your employer pays a bit, so you go with whoever your boss has negotiated the best deal with. That won't happen in Ireland. Well, it won't be compulsory.

If you're poor in Holland, the state pays for it, depending on who gives them the best deal for basic packages.

For the better packages, some of them cover homeopathy and acupuncture, which some people want. others cover a certain amount of physio sessions, denatl, OT etc. People tailor the extras to their needs.

The system being proposed by FG is only very very loosely based on the Dutch system. I regard it as being very disingenuous, as they're selling it by quoting the Dutch stats, which is just wrong.

No one knows the full details, as they're not in the manifesto or the health documents. there are more questions than answers, for me.

The worry is also that the basic package won't cover physio and OT, which are covered by the state at the moment, or dentistry. So some people could end up with less coverage.

A general rule in health is that competition and choice almost never equals equity. I can't think of an example where it's worked. We need proper, high quality, co-ordinated care for all, in all our hospitals. The UK govt have just realised this, and are trying to stamp out exactly the kind of thing we're trying to introduce.

Dutch system is good, but this is about 20%c of the Dutch system. But the free GP plan will be huge for irish health.

aside from free GP care, I think this will improve healthcare for a lot of us, but the most vulnerable will see little, if any, change, and possibly worsening of their healthcare. But I await more details.

maninasia

Just as an aside, who are the most vulnerable? Is it not the case that social welfare recipients and pensioners in Ireland get a medical card, whereas working age adults and students have the worst deal, as in they cannot afford to seek medical care a lot of the time. There is something seriously wrong with a system like that, a sort of anti working/middle class socialism.

Also I can't abide the argument of no choice. Choice of which GP or which hospital to attend is important for the patient. It also puts up for everybody to see which place/system is performing better and allows the patient to choose, not forced to accept a given situation. Monopolies just end up solidifying and stultifying over time. Each hospital/GP is given a budget according to patient and let's see what they can do with it (yes with adjustments for community care etc..but an element of competition and the ability to compare different models is important). Let's bring in private hospitals, if they compete within the rules they will prosper, if not they will die. You need to create an environment where success is rewarded but there is often no way to accurately predict which model will be successful until they are exposed to the real world.

Mucco

maninasia wrote: »

Just as an aside, who are the most vulnerable? Is it not the case that social welfare recipients and pensioners in Ireland get a medical card, whereas working age adults and students have the worst deal, as in they cannot afford to seek medical care a lot of the time.

Also I can't abide the argument of no choice. Choice of which GP or which hospital to attend is important for the patient. It also puts up for everybody to see which place/system is performing better and allows the patient to choose, not forced to accept a given situation. Monopolies just end up solidifying and stultifying over time.

Stats show that Ireland is pretty good for access to a GP (good as in progressive). But access to a specialist is mostly for the rich. So poor people cannot access specialist healthcare. Plus there is the portion just outside the medical card limit who could still be on relvatively low incomes (don't know about GP card).

I'm not convinced about choice - how do you, as a non-medic, know what's best?

maninasia

Sure I don't have a clue, I've just been a patient in the Irish medical system and other systems that are far better. Blinkered attitude.
I fail to see how a system of GP care that costs approx 60 euro a visit not including meds and discretionary follow up payments with no clear guidelines is 'good'. 60 euro is approx 8 euro (minimum wage) x 8 hours, so one full day's pay for a minimum wage worker. Seems like they are not going to avail of privilege much.

http://www.irishtimes.com/blogs/pricewatch/2010/02/24/doctor-doctor-give-me-the-news/

I'm not derailing this thread, but that's some ignorant comment. In fact it worries me that you actually think like this and don't understand that medicine is a two way street.

tallaght01

Mucco wrote: »

Stats show that Ireland is pretty good for access to a GP (good as in progressive). But access to a specialist is mostly for the rich. So poor people cannot access specialist healthcare. Plus there is the portion just outside the medical card limit who could still be on relvatively low incomes (don't know about GP card).

I'm not convinced about choice - how do you, as a non-medic, know what's best?

You're entirely right. Access to GPs is good in a theoretical sense. But I, like many others growing up, remember not being able to access medical care, as my family couldn't afford it. Or if we were really sick, my parents went without. My folks never went to the GP in the 80s, as they could never afford it.

Nowadays it's different for many. But for a lot of people they still simply can't afford primary healthcare, which is the gatekeeper to most secondary healthcare. Hence the poor and vulnerable suffer most. There's hordes of people with low incomes who simply cannot access healthcare in Ireland, except through A+E. Choice is not the issue for them, access is. Access to GPs is purely theoretical for many. It's fantastic that this might change.

Same with secondary care. Choice has only ever made it worse, when combined with financial rewards. The poor, the immobile, the mentally ill etc depend on their local hospital entirely. When it performs badly, it loses patients, and resources under the proposed new model. So, it goes downhill, and fails the vulnerable patients in the locality even more. The well-off will just go to Dublin, to the big fancy hospital, and the BFH will just eat up more money and Bogsville general loses even more money. Choice, combined with a "money follows the patient" model has never worked in the way it's being proposed for Ireland.

Businessmen and the young and the naive will say it works. But anyone who works with vulnerable patients will see this is a potential disaster. It won't work for my patients in the refugee clinic that I do. They rely 100% on their local hospital

In fact, it's mostly vulnerable people who will rely completely on their local hospital if it fails, which is the cruel paradox of a system designed to bring equity to healthcare.

maninasia

Your comments about access prior to choice are spot-on. No access means no healthcare, which is the point I was making but seems to some to be irrelevant in a 'progressive' system, what does that mean anyway?

As for the model of 'money follows the patient' and 'choice', since when did Ireland have such a model...never. There is nothing to compare it to.

tallaght01

maninasia wrote: »

Your comments about access prior to choice are spot-on. No access means no healthcare, which is the point I was making but seems to some to be irrelevant in a 'progressive' system, what does that mean anyway?

As for the model of 'money follows the patient' and 'choice', since when did Ireland have such a model...never. There is nothing to compare it to.

yea but lots of countries do have that system, and it's never worked.

The dutch system works because of the safety nets.

The tories in the UK were mad for this model, as it appeals to the right wing politicians, but are now slowly moving away from it because it just makes inequity more entrenched.

maninasia

It has worked in Asia and worked very well, we've had a good debate about it but you ignore what I write even though you have no experience of it. Still don't let that stop you :rolleyes: .
To be clear I wouldn't advocate private insurers getting involved as that is an unneccessary middle-man. I advocate government budget on a pay per patient basis, employer contribution, social welfare contribution and employee contribution under a universal scheme, it is not clear to me where the need is for private insurance companies in this scheme. You want private medical insurance, that can be acheived but outside the universal system, not inside it.

tallaght01

maninasia wrote: »

It has worked in Asia and worked very well, we've had a good debate about it but you ignore what I write even though you have no experience of it. Still don't let that stop you :rolleyes: .
To be clear I wouldn't advocate private insurers getting involved as that is an unneccessary middle-man. I advocate government budget on a pay per patient basis, employer contribution, social welfare contribution and employee contribution under a universal scheme, it is not clear to me where the need is for private insurance companies in this scheme. You want private medical insurance, that can be acheived but outside the universal system, not inside it.

As a businessman, the Taiwan system makes sense to you. As a doctor and patient advocate, it's not a good deal for patients. Being a patient in Taiwan as a middle class male doesn't make you an expert in it's responsiveness as a health system.

Regardless, you don't advocate private insurers...well that's the proposal here, and that's the model I'm talking about.

Pay per-patient simply doesn't work. it becomes about treating the young, affluent, simple patients, as they make the most profit. I've outlined the arguments against diverting resources from poor hospitals to good hospitals above. It's not complex. it works well for patients like you and me, but not for the vulnerable. It never has worked.

Also, I don't want private health insurance to play any part in this. that's the point I was making.

Mucco

maninasia wrote: »

Sure I don't have a clue, I've just been a patient in the Irish medical system and other systems that are far better. Blinkered attitude.
I fail to see how a system of GP care that costs approx 60 euro a visit not including meds and discretionary follow up payments with no clear guidelines is 'good'. 60 euro is approx 8 euro (minimum wage) x 8 hours, so one full day's pay for a minimum wage worker. Seems like they are not going to avail of privilege much.

http://www.irishtimes.com/blogs/pricewatch/2010/02/24/doctor-doctor-give-me-the-news/

I'm not derailing this thread, but that's some ignorant comment. In fact it worries me that you actually think like this and don't understand that medicine is a two way street.

My comment is informed from van Doorslaer et al in the Canadian Medical Association Journal, they're the ignorant ones.

maninasia

tallaght01 wrote: »

As a businessman, the Taiwan system makes sense to you. As a doctor and patient advocate, it's not a good deal for patients. Being a patient in Taiwan as a middle class male doesn't make you an expert in it's responsiveness as a health system.

Regardless, you don't advocate private insurers...well that's the proposal here, and that's the model I'm talking about.

Pay per-patient simply doesn't work. it becomes about treating the young, affluent, simple patients, as they make the most profit. I've outlined the arguments against diverting resources from poor hospitals to good hospitals above. It's not complex. it works well for patients like you and me, but not for the vulnerable. It never has worked.

Also, I don't want private health insurance to play any part in this. that's the point I was making.

All the points you make are invalidated if you actually visit a country with a functioning system, but you refuse to listen to me! You think you know better but you have no direct experience, that's very strange don't you think, a blindspot the size of the channel tunnel? I have been a student, worker, family man and most important a PATIENT long-term in a functioning universal health system. How many people can say that in Ireland, including medical personnel, eh? I have experience all my family and friends here from poor to rich, I see that the only people it does not adequately cover are the most destitute in society (whose contribution is covered by charitable organisations). FFS I see realms of your poor vulnerable people in every hospital I visit. It's nothing to do with my profession.

What has 'being a businessman' got to do with moral character anyway, that's twisted stuff. Newsflash, people need to work to make money. Do you work for free, let me know how that's going for you lately?

As for the chart, pro-poor, pro-rich, not very illustrative is it? What is rich in one country and poor in another. There are people on social welfare in Ireland that have substantial incomes. Then there are the working poor who are growing in number and students. Plus it only shows a few Western countries, the world has how many countries at last count?

I totally fail to see Tallaght's point why it will become focused on young, affluent, rich? Why? The payment is per treatment, if anything poor old people will be their favourite customers.

tallaght01

maninasia wrote: »

All the points you make are invalidated if you actually visit a country with a functioning system, but you refuse to listen to me! You think you know better but you have no direct experience, that's very strange don't you think, a blindspot the size of the channel tunnel? I have been a student, worker, family man and most important a PATIENT long-term in a functioning universal health system. How many people can say that in Ireland, including medical personnel, eh? I have experience all my family and friends here from poor to rich, I see that the only people it does not adequately cover are the most destitute in society (whose contribution is covered by charitable organisations). FFS I see realms of your poor vulnerable people in every hospital I visit. It's nothing to do with my profession.

As for the chart, pro-poor, pro-rich, not very illustrative is it? Plus it only shows a few Western countries, the world has how many countries at last count?

I totally fail to see Tallaght's point why it will become focused on young, affluent, rich? Why? The payment is per treatment, if anything poor old people will be their favourite customers.

Honestly, restart the old thread if you want to publicly reignite your love affair with the taiwanese health system.

It's not the same as is being proposed in ireland, so it's a pointless argument (on so many levels, frankly)

maninasia

The debate is relevant in this case, very relevant, but it's not my intention either to go into this, I just don't like being characterised as 'not a medic' and a 'businessman' as if that will discount my opinion, probably one of the only people here who has long-term experience of a universal health system!
It's a bit like telling a guy who has played rugby for 20 years he doesn't know anything because we learned all about rugby in class and now we have the qualification to prove it even though we've only ever played soccer.

tallaght01

maninasia wrote: »

The debate is relevant in this case, very relevant, but it's not my intention either to go into this, I just don't like being characterised as 'not a medic' and a 'businessman' as if that will discount my opinion, probably one of the only people here who has long-term experience of a universal health system!
It's a bit like telling a guy who has played football for 20 years he doesn't know anything because we learned all about football in class.

I have significant experience in 2 countries (as a health worker and a patient) with universal health coverage. That alone don't make me an expert in jack all except anecdote. Same goes for you.
I've worked in 5 countries, with differing models of health. Same goes for that. It all means feck all until you dig a bit deeper.

I read a jazz-mag last night, but it doesn't mean I know much about threesomes.

Mucco

Can we please ignore trolls and get back to discussing the FG health plan.

The Irish spending on Healthcare is similar to the OECD average, so we should expect a reasonably good system. Obviously that is not what we have. How does the FG plan attempt to get to a good system from here. Current spending is probably adequate, so efficiency is the key. The OECD agrees. The question is, does the dutch system lead to efficiencies - I can't see how.

tallaght01

Mucco wrote: »

Can we please ignore trolls and get back to discussing the FG health plan.

The Irish spending on Healthcare is similar to the OECD average, so we should expect a reasonably good system. Obviously that is not what we have. How does the FG plan attempt to get to a good system from here. Current spending is probably adequate, so efficiency is the key. The OECD agrees. The question is, does the dutch system lead to efficiencies - I can't see how.

The Dutch system is pretty efficient, but the proposed system isn't, in reality, much like the Dutch system.

maninasia

Ignore is a good word .

p1akuw47h5r3it

This is all interesting reading. I wish i had put in a poll tho!