What one thing would you change about the Healthcare system in this Country?

MLH1

Free Primary Care, or a minimal fee of €5-10.


With all the Docs and healthcare workers on this site, I though this would be an interesting topic.

opinion guy

Replace the current two tier system with a one tier one

Delancey

Make the system one that is truly patient centred .

Having worked in the HSE I can say that at present staff needs come first and foremost.

opinion guy

Delancey wrote: »

Make the system one that is truly patient centred .

Having worked in the HSE I can say that at present staff needs come first and foremost.

I don't believe that patient needs and staff needs are mutually exclusive.

However union needs and management needs have an awful habit of getting in the way of the first two.

Bella mamma

http://www.boards.ie/vbulletin/showthread.php?t=2056176231

Bella mamma

Delancey wrote: »

Make the system one that is truly patient centred .

Having worked in the HSE I can say that at present staff needs come first and foremost.

"Hello, my name is Betty and I'd like to apply for a position doing as little as possible........preferably nothing.......in The HSE. Yes, that's correct "Full time", however I'll need every weekend off; bank holidays and birthdays naturally; 2 weeks at Christmas and 2 weeks at Easter, the last 2 weeks in July and the first 2 weeks in August (all non-negotiable); unlimited single sick days; 9ish (kids yee know) - 5pm sharp; morning and afternoon tea breaks (Barrys Green Label please with Chocolate Kimberleys except when I'm on a diet); an ergonomic work station with sea view in a private ensuite office; strobe lighting and disco ball during the winter; unlimited internet access with desktop icons for Ryanair and thedailymail.co.uk; champagne reception on arrival..........Yeah, sure I can start tomorrow! Tell the taxi driver not to beep when they arrive. I'm not a morning person". :cool:

Traumadoc

Agree with the one tier system, but it would cost a fortune.
VHI would become prohibitive for many and force them to give it up and use the public system.

Put money into postgraduate training, not more medical schools/medical graduates.

Delancey

Traumadoc wrote: »

Agree with the one tier system, but it would cost a fortune.
VHI would become prohibitive for many and force them to give it up and use the public system.

Surely the annual double-digit increases in Private Insurance are already doing this , figures from the regulator show people are ditching VHI, etc because of the cost.

opinion guy

Traumadoc wrote: »

Agree with the one tier system, but it would cost a fortune.
VHI would become prohibitive for many and force them to give it up and use the public system.

Put money into postgraduate training, not more medical schools/medical graduates.

Why does it have to cost a fortune though ?
There is an argument that private healthcare is currently skimming the easy to treat high profit cases from the public system, scopes, low risk angio's etc whilst the more expensive stuff goes public.

Traumadoc

Many public hospitals are depending on private patients for extra income.

I know it does not make sense , but if the hospitals loose private income there will be less money to treat all patients.

As the private patients will now be forced to go to private hospitals, private insurance costs will increase.
So more people will give up on private insurance and instead rely on the public system.

Yes it is FUBAR, but it may be the bullet we have to bite.

opinion guy

Traumadoc wrote: »

Many public hospitals are depending on private patients for extra income.

I know it does not make sense , but if the hospitals loose private income there will be less money to treat all patients.

As the private patients will now be forced to go to private hospitals, private insurance costs will increase.
So more people will give up on private insurance and instead rely on the public system.

Yes it is FUBAR, but it may be the bullet we have to bite.

Do private hospitals hand over their money to public ones ??? I wasn't aware of that.
Beacon and Blackrock hand over cash ???? Don't they have shareholders etc to keep happy ? I mean the idea is to make profit right ?

If you have a one tier system then their won't be private insurance. Well perhaps a universal insurance that everyone has to pay. But if you cut out the profit takers (insurance companies, private hospitals) then surely the entire enterprise should be cheaper.

In any given week the same number of people will be sick. There is a total national cost associated with that each - currently split between public and private with the private skimming profits. Scrap that. Have just public with universal not-for-profit insurance. Instantaneously you are no longer paying the wages of insurance company staff nor swelling their profits - money which is essentially wasted in that it doesn't achieve anything for the patient. You also would not be doubling up on hospital admin staff with both public and private roles and should in theory make the entire system more efficient.

I mean thats how it seems to me. I'm probably being oversimplistic. But I fail to see why sick people should be paying the wages of insurance company employees and keeping their shareholders happy when that money should be spent on their healthcare.

opinion guy

Traumadoc wrote: »

As the private patients will now be forced to go to private hospitals, private insurance costs will increase.
So more people will give up on private insurance and instead rely on the public system.

This is already happening by the way. Mine went up 40% this year. I had to downgrade it to afford it

RobFowl

opinion guy wrote: »

Do private hospitals hand over their money to public ones ??? I wasn't aware of that.
Beacon and Blackrock hand over cash ???? Don't they have shareholders etc to keep happy ? I mean the idea is to make profit right ?

I think you've missed the point entirely.
Public hospitals also treat private patients (often admitted as emergencies).
They get paid by the VHI/Aviva/Quinn for these patients and this money effectively subsidises the hospital.

Delancey

RobFowl wrote: »

I think you've missed the point entirely.
Public hospitals also treat private patients often admitted as emergencies.
They get paid by the VHI/Aviva/Quinn for these patients and this money effectively subsidises the hospital.

Very true , the problem however is that as the HSE suffers more from cuts there will be further increases in the amounts charged to private patients in public hospitals ( I suspect the Labour Party will help drive this for ideological reasons ).
Increased charges are passed on to subscribers as higher premiums resulting in even more people leaving Private care.

The only reason that private subscribers numbers have not fallen more in the last 4 years is primarily because of fear - fear of waiting months or years for medical attention they will get rapidly as private patients.
Remove the fear and the market for private insurance will evaporate overnight.

Traumadoc

Exactly, why do 50% of the population feel the need to have private insurance in a health system with free access for all.

Fear.

Sitric

If the 50% who pay can afford VHI were as equally invested in the public system as the 50% who cannot afford it, we would have a much better health system. Once the influential members of our society do not have to rely on the public system, it becomes less of a priority.

I must say I agree with opinion guy, if we had a single tier system, there really is no role for the insurance companies, why have that extra layer of administration? Collect the money needed as tax rather than via the insurance system.

To stay more directly on topic (though I enjoy when a proper discussion develops from the OP) , the one thing I would change would be to switch from paper to electronic hospital files. Buy a bunch of workstations, buy some medical record software (do not develop in house software for each different hospital, there are plenty of simple, effective record systems in place all over the world, no need to reinvent the wheel) and move from paper records that need to be called from file rooms to a decent system where a patients records can be accessed from any workstation in the hospital.

whydoibother?

There will always be two tiers while people have the option to pay for health care or not. In order to get people to pay for something that they could get for free, it has to be better.

I would have one big health care system with means tested contributions like a tax. I'm normally not remotely socialist, so this is an odd opinion for me, but I do think there is something wrong with consigning some people to a second class system, which must necessarily be inferior in order for a better private system to exist.

This is probably too radical to be realistic, but at the very least I would stop allowing doctors to use hospital facilities for free for their private patients. That would reduce public waiting lists considerably. I would have a rule that it is first come, first served in a hospital and method of payment, public or private, is not to be considered until after the event.

nesf

Honestly I'd like to see a dramatic shift from a centralised and highly unionised system to a decentralised system with far more freedom given to individual hospitals to decide their own services and negotiate their own pay and conditions with staff. Take the current public hospitals and make them independent non-profit hospitals and let them compete with each other. Along with this I'd like to see the INO broken up and made much weaker.

Basically I don't trust the State to oversee the actual running of our hospitals. I think we'd be far better off if the hospitals were given much more independence and were left to focus on patients not meeting centralised budget targets. Money following the patient and all that.


The other major thing, which I hope FG bring in, would be mandatory health insurance (creating a one tier system while allowing the wealthy to pay for perks that don't directly affect actual care that much, just stuff like private rooms, nicer meals or whatever) combined with free at point of access GP care covered by the insurance.

Basically if FG actually follow through with their promises on health I'll be a fairly happy man.

Delancey

While the idea of a de-centralised Health Service has its attractions it also has its drawbacks - there would I believe be difficulties in maintaining standards and we would end up seeing huge variations in outcomes , example : big % differences in the number of C Sections performed.
Pay differences would be a nightmare - the likes of SIPTU would raise hell if porters in another hospital were earning 1% more than others , to say nothing of a difference of 10% or 15%.

Unions are a huge barrier to improving the Health Service and I include the Nurses and Consultants in that !

nesf

Delancey wrote: »

While the idea of a de-centralised Health Service has its attractions it also has its drawbacks - there would I believe be difficulties in maintaining standards and we would end up seeing huge variations in outcomes , example : big % differences in the number of C Sections performed.
Pay differences would be a nightmare - the likes of SIPTU would raise hell if porters in another hospital were earning 1% more than others , to say nothing of a difference of 10% or 15%.

Unions are a huge barrier to improving the Health Service and I include the Nurses and Consultants in that !

Indeed, the unions need to be broken. Thatcher style. If she did one thing right etc.

bleg

Bring the public sector up to the level of the private sector.

opinion guy

RobFowl wrote: »

I think you've missed the point entirely.
Public hospitals also treat private patients (often admitted as emergencies).
They get paid by the VHI/Aviva/Quinn for these patients and this money effectively subsidises the hospital.

Yeah you are right I did misinterpret it originally. I actually did realise before I finalised my post but I decided to leave it as I think my argument still stands.
What I am suggesting is that instead of people paying money to private insurance companies - with a large chun of it being used to pay wages and make profits, that there is a mandatory universal health fund that everyone pays into in a means-tested way - this should be cheaper to each individual than vhi since a) it all would be used for patient care instead of wages/profits and b) since it would be mandatory more people would pay it than currently have health insurance.

opinion guy

bleg wrote: »

Bring the public sector up to the level of the private sector.

What does this mean ? There is a viewpoint that the public sector is better than the private in certain ways. Most docs I know will say if they were seriously ill they would far prefer to be in the public hospital - of course having private insurance in the large public hospital is doubtless best combination

lonestargirl

Sitric wrote: »

To stay more directly on topic (though I enjoy when a proper discussion develops from the OP) , the one thing I would change would be to switch from paper to electronic hospital files. Buy a bunch of workstations, buy some medical record software (do not develop in house software for each different hospital, there are plenty of simple, effective record systems in place all over the world, no need to reinvent the wheel) and move from paper records that need to be called from file rooms to a decent system where a patients records can be accessed from any workstation in the hospital.

The 2 new St Luke's Radiation Oncology Centres at St. James's and Beaumont are completely paperless. They use Aria, which is a rad onc EMR that can do all the standard medical record stuff as well as interecting with the tretment machines as a record-and-verify system. Information security is quite strict too - encrypted USBs, pull printers etc.

lonestargirl

The one thing I would change about the health system is have 'money follows the patient' model. The current system that penalises you if you go 5% over budget, even if you treated 15% more patients is just silly.

opinion guy

lonestargirl wrote: »

The one thing I would change about the health system is have 'money follows the patient' model. The current system that penalises you if you go 5% over budget, even if you treated 15% more patients is just silly.

Wasn't this a FG/Lab election promise ?
When is it due to kick in ?

nesf

opinion guy wrote: »

Wasn't this a FG/Lab election promise ?
When is it due to kick in ?

4 or 5 years after going into office I think. Not 100% sure though.

nesf

lonestargirl wrote: »

The one thing I would change about the health system is have 'money follows the patient' model. The current system that penalises you if you go 5% over budget, even if you treated 15% more patients is just silly.

Yeah, the current system is utterly insane. A perfect example of bureaucracy gone horribly wrong.

maninasia

Sitric wrote: »

If the 50% who pay can afford VHI were as equally invested in the public system as the 50% who cannot afford it, we would have a much better health system. Once the influential members of our society do not have to rely on the public system, it becomes less of a priority.

I must say I agree with opinion guy, if we had a single tier system, there really is no role for the insurance companies, why have that extra layer of administration? Collect the money needed as tax rather than via the insurance system.

To stay more directly on topic (though I enjoy when a proper discussion develops from the OP) , the one thing I would change would be to switch from paper to electronic hospital files. Buy a bunch of workstations, buy some medical record software (do not develop in house software for each different hospital, there are plenty of simple, effective record systems in place all over the world, no need to reinvent the wheel) and move from paper records that need to be called from file rooms to a decent system where a patients records can be accessed from any workstation in the hospital.

Can't believe they don't have an integrated electronic medical records system yet, very very backward.

There is no need for insurance providers on top, true, my favourite option is a universal health care insurance managed by a government agency. The patient chooses the hospital to attend, the hospital can be public/private and gets reimbursed equally by the national health insurance fund.

Private hospitals have a part to play because they offer more options and can operate with less restrictions and more efficiently, private investment can help cover the lack of investment in needed new facilities due to capital budget constraints and offer up to date infrastructure and different working practices.

More options are better. Patient choice is better. There's nothing wrong with the money follows the patient model, it encourages hospitals to upgrade their services to compete for patients. It encourages hospitals to be 'service oriented'. The key there is having a fair reimbursement system that doesn't discriminate against patients for one reason or another.

ttmd

maninasia wrote: »

Can't believe they don't have an integrated electronic medical records system yet, very very backward.

While I think this would be a great development, my understanding is that there is significant obstacles to putting more centralized structures in place. I have had conversations with a friend of mine who has begun designing software for doctors and he has been advised that the legal obstacles to developing such systems are significant.

I did an audit on the occurrence of post surgical dvt in the United Kingdom a number of years ago and I was astonished at how poorly records were kept. Reading around the topic, I realized that they tried to have better electronic record keeping, but the project was a disaster. I dont know why - maybe they messed it up, maybe it very difficult to implement.

Also maybe its a wider problem - as far as I understand, no international standard seems to have been developed for electronic medical records.

This is a good article
http://www.guardian.co.uk/commentisfree/cifamerica/2011/apr/23/nhs-health

I liked this comment in the discussion of the article 'The tough nut to crack is having transferrable information across primary and acute sector (i.e. from GP to hospital to care home to community nurse). The future is probably some form of patient- or even citizen-controlled record granting access to appropriate health professionals, because it's just too difficult to centralise.'

Finally, I would in spite of the obvious difficulties, having better and easier access to medical records would be great. Not only would it would avoid clinical errors, time now spent maintaing and updating paper files could be better used doing something else.

ttmd

Just to clarify on the above post - I understand that other posters may have been talking about local systems but I think a centralized system would be great.

DrIndy

There are a lot of problems in the irish health sector - but there are a lot of good points too which we shouldn't ignore but build on.

We do need universal health care - be it public or through mandatory private insurance and a model of funding follows care delivered rather than lump sum payments (as is current for medical cards). Medicare in Australia is a good model - if a GP in australia want to charge a bit more, then they can and the patient pays $10-20 more per visit. they also pay per procedure like per ECG, Blood test, chest x-ray, CT, MRI etc... to encourage GPs to do more investigations before referring to hospital. Since GP's in Ireland have for all intents and purposes zero access to public investigations - then all they can do is refer.

The hospital system could do with an overhaul too - but once again - funding follows the patient and develop emergency medicine more - good EDs keep people out by sorting them themselves.

Consultants must be public only, private only, not both.

Non-medical staff need to work longer hours and on call. Post operative patients not seen by dieticians for TPN do worse for longer over the weekend. Stroke patients not assessed by a speech therapists are fasted unneccesarily for a weekend until their swallow is cleared or are given the unneccesary risk of aspiration from a nasogastric tube. Why aren't CT's and MRI scanners not running until midnight or over the weekend - its a wasted resource? If you can do the investigation on a saturday - they could go home on a sunday.

But we have a lot of good too - we work very hard and just about cope with the limited resources we have.

dissed doc

DrIndy wrote: »

We do need universal health care - be it public or through mandatory private insurance and a model of funding follows care delivered rather than lump sum payments (as is current for medical cards).

We already have universal health care. No-one is refused medical treatment in Ireland.

What we need is universal *payment* for healthcare, as most of the cost is shouldered by a small percentage of the population through taxation.

Consultants must be public only, private only, not both.

That is fine as a theory. But, few consultants now want to be public only in Ireland due to the continuous breaches of contract by the government, and furthermore, without the consultants seeing private patients through public hospitals (remember those "private" patients already pay for public access just like those who pay nothing at all), many hospitals in Ireland would close as the income from taxation is simply not there.

Regardless, the NHS, the Netherlands, etc., doesn't have public vs private restrictions, and it is some delusional belief that the exact same system in the NHS (patient with private insurance ocmes into public A/E - consultant gets paid, hospital gets paid) doesn't exist. It does, and it is just like in Ireland. What on earth does public only or private only have to do with anything except drive up another barrier in aptient care as doctors invariably drift towards working in higher paid private specialities. It's such a simplistic view really, and has absolutely no bearing on health care improveming, rather, the opposite.

Non-medical staff need to work longer hours and on call. Post operative patients not seen by dieticians for TPN do worse for longer over the weekend. Stroke patients not assessed by a speech therapists are fasted unneccesarily for a weekend until their swallow is cleared or are given the unneccesary risk of aspiration from a nasogastric tube. Why aren't CT's and MRI scanners not running until midnight or over the weekend - its a wasted resource? If you can do the investigation on a saturday - they could go home on a sunday.

It costs money, and too few pay for it.

j.mcdrmd

dissed doc wrote: »

We already have universal health care. No-one is refused medical treatment in Ireland.

What we need is universal *payment* for healthcare, as most of the cost is shouldered by a small percentage of the population through taxation.

I think that if everyone with private health insurance gave it up tomorrow the whole health service would collapse. It is the people paying twice, by taxation and paying for health insurance that are propping up the system.

dissed doc wrote: »

That is fine as a theory. But, few consultants now want to be public only in Ireland due to the continuous breaches of contract by the government, and furthermore, without the consultants seeing private patients through public hospitals (remember those "private" patients already pay for public access just like those who pay nothing at all), many hospitals in Ireland would close as the income from taxation is simply not there.

Imo it is wonderful that public patients, medical students and Nchd's have access to consultants who work both privately and publicily. If public and private medicine never interact how will that effect transfer of skills so crucial to the doctors and patients.

dissed doc wrote: »

What on earth does public only or private only have to do with anything except drive up another barrier in aptient care as doctors invariably drift towards working in higher paid private specialities. It's such a simplistic view really, and has absolutely no bearing on health care improveming, rather, the opposite.



It costs money, and too few pay for it.

Maybe some people want to set up another barrier in patient care?

nesf

Actually a more specific thing I'd change is the state of psychiatric services in Cork city. You've two main options at the moment, a lock up facility where you don't see the outdoors until you're discharged, or a convalescence hospital which has no psychiatric nurses or psychiatrist in the hospital full time as well as having nothing to do outside of one's room.

We're badly in need of a decent psychiatric hospital in Cork. Locking up the suicidal into a fairly small group of rooms long term (I know one lad who was stuck in there without leave at any point for six months) is just not acceptable.

/rant

Dr Galen

In fairness Nesf we need decent psych services nationwide. It's a national disgrace the services we have at present.

opinion guy

Dr Galen wrote: »

In fairness Nesf we need decent psych services nationwide. It's a national disgrace the services we have at present.

....which can be added to a list of national disgraces:

http://www.boards.ie/vbulletin/showthread.php?t=2055566501&page=36

sam34

nesf wrote: »

Actually a more specific thing I'd change is the state of psychiatric services in Cork city. You've two main options at the moment, a lock up facility where you don't see the outdoors until you're discharged, or a convalescence hospital which has no psychiatric nurses or psychiatrist in the hospital full time as well as having nothing to do outside of one's room.

We're badly in need of a decent psychiatric hospital in Cork. Locking up the suicidal into a fairly small group of rooms long term (I know one lad who was stuck in there without leave at any point for six months) is just not acceptable.

/rant

sorry nesf, but that's just not true.

in cork city there are 3 acute psychiatric units, and which one you are admitted to depends on catchment area. ALL of them are staffed by a number of full time consultant psychiatrists and psychiatric nurses.

there is also the secure unit which serves all of cork city and county. again, this is staffed by consultants and psych nurses.

nesf

sam34 wrote: »

sorry nesf, but that's just not true.

in cork city there are 3 acute psychiatric units, and which one you are admitted to depends on catchment area. ALL of them are staffed by a number of full time consultant psychiatrists and psychiatric nurses.

there is also the secure unit which serves all of cork city and county. again, this is staffed by consultants and psych nurses.

I was talking about the lack of consultants in the alternative place they send patients not the acute units which is staffed by qualified people. And I'm speaking from experience here having been admitted to the alternative place. It may have changed in the past 9 years since I was there but from talking to other patients lately not much has changed. I was in a room with a guy with a broken leg when I was put into hospital in Cork, it wasn't a psychiatric ward.

The secure unit in the Mercy is hellish too to be blunt. I've had friends put in there (one for a 6 month stretch) and it's just not designed for long term stay at all.

ttmd

Dr Galen wrote: »

In fairness Nesf we need decent psych services nationwide. It's a national disgrace the services we have at present.

I hope I am not asking you to repeat yourself, but can you give a little more detail? Is it a general lack of resources or some more specific factors?

sam34

nesf wrote: »

I was talking about the lack of consultants in the alternative place they send patients not the acute units which is staffed by qualified people. And I'm speaking from experience here having been admitted to the alternative place. It may have changed in the past 9 years since I was there but from talking to other patients lately not much has changed. I was in a room with a guy with a broken leg when I was put into hospital in Cork, it wasn't a psychiatric ward

well if you were just talking about what you call the alternative place as being poor, you shouldnt have dismissed the entire psychiatric services in cork in one fell swoop, tbf...

nesf wrote: »

Actually a more specific thing I'd change is the state of psychiatric services in Cork city. You've two main options at the moment, a lock up facility .....or a convalescence hospital

......

We're badly in need of a decent psychiatric hospital in Cork

as i pointed out, there are other options than those two.

nesf wrote: »

The secure unit in the Mercy is hellish too to be blunt. I've had friends put in there (one for a 6 month stretch) and it's just not designed for long term stay at all.

there is no secure unit in the mercy. there is a locked ward,which might be what you' re referring to, but it is far from a secure unit. the secure unit for cork is based in carraigmor.

*infracts and bans self for going off topic*:pac:

nesf

sam34 wrote: »

well if you were just talking about what you call the alternative place as being poor, you shouldnt have dismissed the entire psychiatric services in cork in one fell swoop, tbf...



as i pointed out, there are other options than those two.






there is no secure unit in the mercy. there is a locked ward,which might be what you' re referring to, but it is far from a secure unit. the secure unit for cork is based in carraigmor.

*infracts and bans self for going off topic*:pac:

Fair enough, I did overgeneralise with my original post and was incorrect in it.

Just in bad form at the moment and annoyed by some of the services in Cork.

summer21

DrIndy wrote: »

There are a lot of problems in the irish health sector - but there are a lot of good points too which we shouldn't ignore but build on.


The hospital system could do with an overhaul too - but once again - funding follows the patient and develop emergency medicine more - good EDs keep people out by sorting them themselves.

Consultants must be public only, private only, not both.

At the very least they should only be both if in a co-located public / private hospital.
I am currently in patient as private patient in public hospital waiting to see a consultant who works in four other locations, and am told he won't be back here until next week...
So i am not sick but waiting for tests (for ongoing condition that i live with), so talking up a bed that someone else could use while i go slowly crazy.
Wheras if i could see who i need to see get test and get out.