HSE waiting lists

chopper6

medicine12345 wrote: »

Of course private hospitals make a profit, the whole point is that people are willing to pay big money (or pay high insurance) in order to 'skip the queues'. And anyway aren't surgeons their own boss in these hospitals, just operating out of them so they can operate on who they like and charge what they want??

In your opinion do you think there are A)more competant surgeons in the public sector and that they could earn more money privtely?

medicine12345

chopper6 wrote: »

In your opinion do you think there are A)more competant surgeons in the public sector and that they could earn more money privtely?

I thought they tend to do a combination of both public and private?? So the same doctors are doing both??

chopper6

medicine12345 wrote: »

I thought they tend to do a combination of both public and private?? So the same doctors are doing both??

Yup...it's all about referrals..there might be one surgeon/specialist qualified in a procedure with the principal diffrence being he will get paid far more in the private pratice than in the salary-orientated public sector.

realitykeeper

chopper6 wrote: »

You seem to be having some sort of seizure.

Temper, temper.

realitykeeper

medicine12345 wrote: »

As another poster pointed out they get paid an annual salary so its not as if they are dragging out each day, they have nothing to gain by having these lists.
If this provided greater motivation to do more operations and the lists were reduced, where would the money come to pay them, the system is already in massive debt obviously...

A year is a unit of time. Paying per unit of time guarantees nothing. Paying per operation guarantees a link between what is paid and what is received in return. When the waiting lists are reduced to very low numbers, what you would find is that there would not be enough patients in need of operations to keep up with the surgeons demand for business. The excess supply of surgeons would then leave for greener pastures thus rendering the HSE more efficient with fewer wage bills to pay.
If the surgeons were to demand more pay in the short term for performing more operations they would first have to explain how they were suddenly able to perform so many more operations. Without an adequate explanation, all kinds of theories and related consequences could present themselves and that would not be in the interests of the surgeons.

medicine12345 wrote: »

Of course private hospitals make a profit, the whole point is that people are willing to pay big money (or pay high insurance) in order to 'skip the queues'. And anyway aren't surgeons their own boss in these hospitals, just operating out of them so they can operate on who they like and charge what they want??

Yes but there would be no queues to skip if the HSE paid surgeons per operation. Why should public patients have to wait when they pay good money through their taxes. When you think about it, if a public patient is ultimately going to be operated on then the delay serves no purpose in and of itself. If the patient dies while waiting then ultimately the surgeon doesn`t have to do that operation which is good for the surgeon who still gets paid but bad for the patient who is dead. Paying surgeons per operation would mean it is no longer in the surgeons interests if a patient dies while on a waiting list.

I`m not saying there is no place for private health care but the difference should be in the decor, the gourmet food and the movie channels - it should not be about waiting until your cancer is terminal before you get treatment.

Permabear

This post has been deleted.

dissed doc

realitykeeper wrote: »

A year is a unit of time. Paying per unit of time guarantees nothing.

Well it guarantees a certain amount of work done for the amount of time the consultants are contracted for. That is the purpose of a salary position and providing incentives like job security, money for further training, holidays, pension, etc., . The alternative is fee for service which becomes very expensive for state-driven services to afford.

At the moment the state pays 100k/year salary for a consultant surgeon. If he was fee for service, it would like cost a lot more (basing it off what it costs in the private sector). As surgery accounts for a tiny amount of overall healthcare expenditure, it would make little difference overall to how much tax you pay. Which, comparing to other countries european countries in terms of tax burden, is very little.

Paying per operation guarantees a link between what is paid and what is received in return. When the waiting lists are reduced to very low numbers, what you would find is that there would not be enough patients in need of operations to keep up with the surgeons demand for business. The excess supply of surgeons would then leave for greener pastures thus rendering the HSE more efficient with fewer wage bills to pay.

I think you are under the assumption that there is a finite amount of surgery that has to be delivered and once it is done, that is it. Unlike the Economics 101 supply and demand theory which works for something that has a maximum market penetration (e.g., iPhones, how many can afford it, of that how many do buy it, and then eventually the market is saturated and you need a new product). Healthcare never reaches saturation point (except non-essential cosmetic-related healthcare). There is endless demand, limited supply (of doctors to provide the care) and limited resources from insurance or taxpayers. There will never be an excess of surgeons for the care being demanded and what can be provided.

If the surgeons were to demand more pay in the short term for performing more operations they would first have to explain how they were suddenly able to perform so many more operations. Without an adequate explanation, all kinds of theories and related consequences could present themselves and that would not be in the interests of the surgeons.

Why not? Treat it like Uber with your market model. Lots of people want care at 2am on a Friday night? Cost per surgery for stabbing should go up according to demand. In fact, that is the real solution. Pay per fee that dynamically adjusts to the level of demand. Hold out for the cheaper appendectomy maybe €5k in 12 hrs time, or go for it now but it costs €10k because there is only one surgeon and you are paying per fee.

But of course what you want basically is a highly trained doctor, of which there is limited supply, to be paid per procedure at a rate that you personally can afford and whenever you like. Failing to see that the supply of the doctor is the rate limiting step.

Yes but there would be no queues to skip if the HSE paid surgeons per operation. Why should public patients have to wait when they pay good money through their taxes. When you think about it, if a public patient is ultimately going to be operated on then the delay serves no purpose in and of itself. If the patient dies while waiting then ultimately the surgeon doesn`t have to do that operation which is good for the surgeon who still gets paid but bad for the patient who is dead. Paying surgeons per operation would mean it is no longer in the surgeons interests if a patient dies while on a waiting list.

Thankfully, being paid or not paid does not come into the decision making process for surgery. For example, some procedures have high mortality rates than others. Your idea would mean surgeons would pick ones with lower mortality. Or would you also force them to do procedures against there will? A conscripted workforce?

I`m not saying there is no place for private health care but the difference should be in the decor, the gourmet food and the movie channels - it should not be about waiting until your cancer is terminal before you get treatment.

I put it to you, that you already pay most likely very little for healthcare and resent having to pay it at all. Look at your paycheck and deduct 15%. That is around what you should be paying to get equivalent care that leads to quick appointments e.g., in Germany.

realitykeeper

dissed doc wrote: »

... I think you are under the assumption that there is a finite amount of surgery that has to be delivered ...

Hospital consultants like to work in private hospitals on a pay per fee basis, in fact they don`t seem to want to do anything else. So all I am suggesting is the hospital consultants get paid per procedure in the public hospitals as well. No need for a salary then and won`t that make them feel happy?

You keep saying there are lots of other costs in the HSE but this is not about those other costs, this is about hospital consultants. You also say that there are no limits to to number of potential surgeries people could have and that some people might like a 2 AM breast augmentation with a side order of liposuction. I think most folks would be happy with a lesser service. The elimination of the existing waiting list which is for daytime surgery for hip replacement, heart bypass and such like.

dissed doc

realitykeeper wrote: »

Hospital consultants like to work in private hospitals on a pay per fee basis, in fact they don`t seem to want to do anything else. So all I am suggesting is the hospital consultants get paid per procedure in the public hospitals as well. No need for a salary then and won`t that make them feel happy?

it is purely conjecture on your part that hospital consultants like to work in private hospitals and conjecture and supposition about what people may or may not like is not a solid basis for deciding how health care gets delivered.

There is also no finite amount of surgery that is done; that model of economics does not apply as demand is never satisfied and supply can never be fulfilled.

You keep saying there are lots of other costs in the HSE but this is not about those other costs, this is about hospital consultants.

And the reason I mentioned the other costs is to put the original suggestion in perspective of both overall national healthcare costs and also individual cost. The overall impact would be negligible and individuals would pay more. You seem primarily hoping somehow that it also means consultants will get paid less but the reality is they would be paid a lot more.

You also say that there are no limits to to number of potential surgeries people could have and that some people might like a 2 AM breast augmentation with a side order of liposuction. I think most folks would be happy with a lesser service. The elimination of the existing waiting list which is for daytime surgery for hip replacement, heart bypass and such like.

I think you missed the point there. For some procedures there is a finite market, such as cosmetic procedures. For everything else the market is infinite; the time of the surgeon will always be rationed. It is completely impossible for everyone who needs surgery to have it when they want at any time because you would need a population of surgeons equal to the population of people requiring surgery. That is ludicrous. When robot doctors come in, the situation will change.

Why not write some numbers. See how many of a certain procedure are done every year and how many surgeons can do that procedure. No conjecture, just put down rough figures. You will see that the rate limiter is the lack of surgeons (worldwide). Hence cost goes up, and demand goes up always because it is not like buying a Samsung because the iPhone is not available, and this is why market economics don't work in healthcare.

LeBash

Black Swan wrote: »

If I were sick, I would much rather be treated in Ireland than Rwanda. The World Health Organisation ranks the world's health systems from 1 (best) to 190 (worst) by nations. Ireland ranks 19, the USA 37, and Rwanda ranks 172 (18th from the bottom of the list).

If I were being born, I would much rather be in Ireland than Rwanda. The World Fact Book ranks nations by deaths per 1000 live births from 1 (highest deaths) to 224 (lowest deaths). Ireland ranks 202 with only 3.74 deaths, USA ranks 169 with 6.17 deaths, and Rwanda ranks 23 with 59.59 deaths. Rwanda is only 23rd from the highest deaths per 1000, and roughly 16 times more deaths per live births than Ireland.

If I were giving birth to a child, I would much rather do so in Ireland than Rwanda. For 2013 WHO reported the proportion of deaths among women of reproductive age that were due to maternal causes as only 0.9% for Ireland, 1.5% for USA, but 13.6% for Rwanda. Maternal mortality in Rwanda was roughly 15 times higher than in Ireland.

That'll learn ya!

realitykeeper

dissed doc wrote: »

it is purely conjecture on your part that hospital consultants like to work in private hospitals

Ok so, maybe they don`t like it in which case they`re only in it for the money. The point is they choose to work in private practice despite being employed full time by the HSE at enormous expense to the taxpayer. Where do they get their energy? Could it be that the reason they work in private practice is because they don`t really work for the HSE - they just pocket the HSE salary and spend all their time doing private practice. After all, it all happens in the same buildings. Its not as if they have a boss looking over their shoulder making sure they deliver for the HSE and the health ministers are invariably clueless as to what is going on because they can`t micromanage.

Surely, if they must have a bolshevic public sector then they should at the very least have Stalinist type polit bureaucrats to watch their every move and ensure they are doing their jobs, or better still - just pay the surgeons per operation so there`ll be no need for the polit bureaucrats.

dissed doc wrote: »

There is also no finite amount of surgery that is done; that model of economics does not apply as demand is never satisfied and supply can never be fulfilled.



And the reason I mentioned the other costs is to put the original suggestion in perspective of both overall national healthcare costs and also individual cost. The overall impact would be negligible and individuals would pay more. You seem primarily hoping somehow that it also means consultants will get paid less but the reality is they would be paid a lot more.

It is true our government is stupid enough to pay them more, but at the end of the day the private hospitals make a profit despite the existence of the public hospitals. Therefore, the public hospitals should operate on the same basis. The surgeons have more freedom on a pay per operation basis and that freedom essentially renders them self employed. They ensure themselves, them pay their own taxes etc and just like in private practice they can opt to invest in equipment or buy it from the HSE. I think you would be surprised how much the HSE could save by paying consultant per operation.

dissed doc wrote: »

I think you missed the point there. For some procedures there is a finite market, such as cosmetic procedures. For everything else the market is infinite; the time of the surgeon will always be rationed. It is completely impossible for everyone who needs surgery to have it when they want at any time because you would need a population of surgeons equal to the population of people requiring surgery. That is ludicrous. When robot doctors come in, the situation will change.

Everyone has to die of something. So on that basis, yes the demand is potentially infinite. However, only a quack would try to exploit that and laws against quackery would be a good deterrent. I`ve just had a vision of hell, a world crammed with billions off very old people all being kept alive forever. Realistically, nobody really wants to live forever.

If surgeons are opposed to pay per operation in the public system then it is definitely a good idea.

Carawaystick

realitykeeper wrote: »

Hospital Managers are paid per hour. Perhaps it would be better to pay them per surgical procedure.This is also the way the managers have the incentive to do more and this will eventually clear the waiting lists.

fyp


Maybe even for all senior hse administrators.