Free GP care for Under 6s?

BoJack Horseman

medicine12345 wrote: »

What barriers to entry? There has been alot in the news lately about how they cant get GPs to take on certain medical card lists in some areas. Any GP could set up there own private practive. There are loads of young GPs qualifying everyyear in Ireland but the current situation isn't feasible so they go to Canada, Australia, etc instead..

Why aren't there masses of new young GPs setting up practices who don't take on medical card patients?
(Accepting medical card patients being a choice).

Iwasfrozen

Clearlier wrote: »

What kind of barriers to entry are you thinking of? A huge barrier for example is the length of time it takes to train as a GP but I'd like my GP to have completed their training.

What unions are you thinking of? It's illegal for GP's to collectively bargain.

I don't see price fixing in operation. Prices are high but there's not insignificant variation.

Any trained GP should be able to set up a surgery, the more surgeries there are the more competition there is the more prices will fall. Cost is at the moment a huge barrier to entry and the government should provide more support to small businesses.

Clearlier

Iwasfrozen wrote: »

Any trained GP should be able to set up a surgery, the more surgeries there are the more competition there is the more prices will fall.

What makes you think that they can't?

Edit - re: cost (I replied before you had completed/edited your post it seems) - doctors have a pretty high earning potential. It really wouldn't be that hard for one to raise the necessary funding if there was a business opportunity.

medicine12345

BoJack Horseman wrote: »

Why aren't there masses of new young GPs setting up practices who don't take on medical card patients?
(Accepting medical card patients being a choice).

Theres a few in certain areas in dublin. Not sure, guess there mightn't be enough private patients who come on a regular basis elsewhere

medicine12345

Iwasfrozen wrote: »

Any trained GP should be able to set up a surgery, the more surgeries there are the more competition there is the more prices will fall. Cost is at the moment a huge barrier to entry and the government should provide more support to small businesses.

They can.

creedp

exgp wrote: »

The reason many GPs are against it is they would rather see the money that's being spent on this under 6's scheme being spent on people that can't afford to see their GP by increasing the income limits for granting a medical card and also spending the money on children with life long disabilities such as DOwn's syndrome and not on a lot of under 6 year olds whose parents can afford to pay.

€50 for ten minutes may seem a lot but the average private patient only sees their Dr four times a year; that's €200. Universal Health Insurance has been estimated to cost €1650 per person per annum. For a family of four-€6600.000

Funny I've never seen that argument used against the previous decision to provide universal free GP services to wealthy over 70's. Maybe the fact that GPs were offered capitation rates which were a multipe of those applying to under 70's was sufficient to overcome their concerns about providing services to sick children.

exgp

RainyDay wrote: »

This is spinning.i Universal coverage has to start somewhere.

If GPs are really concerned about what people can afford, they can drop their prices.

It isn't spin. GPs spend a lot of their time trying to get medical cards for their patients as well as services. They are well aware of patients problems with the system. As for Universal Coverage, this has been the policy of the Irish College of GPs since the eighties.

As for lowering fees, some practices have but with FEMPI cuts of 43% on GMS fees many practices are in trouble. Rates, taxes and the cost of living have gone up. I know GPs who have emigrated and there are many GP positions unfilled.

RainyDay

exgp wrote: »

It isn't spin.

I disagree. The 'what about the sick kids who are over-6' could just as easily apply to the other proposal - what about the wealthy kids with Down Syndrome who the GPs want to get an automatic medical card, at the expense of the poor little 4 year old who's Mammy on minimum wage can't afford to bring him to the doc, but still doesn't have a medical card. It's a moot point.

You have to start somewhere with universal coverage.

nice_guy80

We need more recruits in medicine in Ireland

there are too many barriers to entry - limited place and training positions. Too many foreign students enrolled thus denying Irish students place - the foreign students are a cash cow for colleges.

the medical profession (IMI) keep the numbers of recruits down as it keeps the status quo in terms of the level of pay these recruits can expect to earn due to the supply and demand for doctors.

the whole area needs to be looked at

exgp

RainyDay wrote: »

I disagree. The 'what about the sick kids who are over-6' could just as easily apply to the other proposal - what about the wealthy kids with Down Syndrome who the GPs want to get an automatic medical card, at the expense of the poor little 4 year old who's Mammy on minimum wage can't afford to bring him to the doc, but still doesn't have a medical card. It's a moot point.

You have to start somewhere with universal coverage.

I agree with you, we do need to start somewhere with universal coverage but not with universal health insurance. I also agree with you on your point about the needy four year old and the wealthy Down's syndrome child. That's why I think the money available should be targeted at the needy.

exgp

nice_guy80 wrote: »

We need more recruits in medicine in Ireland

there are too many barriers to entry - limited place and training positions. Too many foreign students enrolled thus denying Irish students place - the foreign students are a cash cow for colleges.

the medical profession (IMI) keep the numbers of recruits down as it keeps the status quo in terms of the level of pay these recruits can expect to earn due to the supply and demand for doctors.

the whole area needs to be looked at

The medical profession has been begging for more recruits since the seventies.

RainyDay

exgp wrote: »

I agree with you, we do need to start somewhere with universal coverage but not with universal health insurance. I also agree with you on your point about the needy four year old and the wealthy Down's syndrome child. That's why I think the money available should be targeted at the needy.

So where do you want to start for universal GP coverage?

exgp

RainyDay wrote: »

So where do you want to start for universal GP coverage?

By widening the income limits for medical cards.

RainyDay

exgp wrote: »

By widening the income limits for medical cards.

And what about the very sick children who are above your widened income limits? How could you leave them out. Won't someone please think of the children?

See how it works. Whatever solution you come up with, it's wrong.

Eric Cartman

A lot of parents get very protective over their kids , youll have parents bringing kids to the gp every time they sneeze with this, a terrible idea

sillysocks

As a parent of two children under 6, who is unemployed (my husband does work), I actually wonder would it not have been a better system to just have a small maximum amount GPs could charge for childrens visits. Even for example 10 eur per visit. The waiting times at our GP are always long (which I know is down to their time management) but it worries me how more difficult it'll be to get an appointment and what wait times there will be if appointments are free.

The €50 charge does put me off bringing the children to the doctor sometimes, and a lot of times if I wait a day or two they improve and don't need the doctor anyway, but if there's no charge it would definitely be more tempting to bring them in more often 'just in case' rather than waiting to see.

RainyDay

Eric Cartman wrote: »

A lot of parents get very protective over their kids , youll have parents bringing kids to the gp every time they sneeze with this, a terrible idea

Seems to work OK in the UK. Bringing kids to the GP is not exactly a fun activity for anyone.

medicine12345

last_one_left wrote: »

its appears the GP,s have planned there propaganda campaign against this potential threat to their sheltered careers

from the wailing about being over worked ( deregulate the sector and allow more practices to open , no ! , its not true that there are no barriers to entry regardless of the line trotted out by those who work in the sector )

to complaining about increased taxes , staff to be paid , premises to be paid for , electricity bills to be paid ( as if any business in the state exists without the same expenses )

give us a break and get off the stage , GP fees hardly dropped a penny during the crash , they earn much higher incomes than their counterparts in most EU states , they are a sheltered sector of the economy and its high time their priveledged status was confronted

There is nothing stopping more GPs opening up or coming here from the EU, america, etc they don't want to as its not financially viable. What do you propose doing, letting anyone open a GP practice and claim to be a GP?
Yes any business has wages, taxes etc and any business can charge what they like to cover it - so why should they accept an amount for a patient that gives them unlimited access if its not viable.
What planet are you on, GPs have had have had major cuts during the recession, their medical income has dropped by 40% and yet there aer far more medical card patients - 40% of the population, also they have dropped private fees (the GPs I know of anyway).
In what way are they privileged?
Stop spouting populist nonsense with no actual facts to what you're saying

Clearlier

last_one_left wrote: »

its appears the GP,s have planned there propaganda campaign against this potential threat to their sheltered careers

from the wailing about being over worked ( deregulate the sector and allow more practices to open , no ! , its not true that there are no barriers to entry regardless of the line trotted out by those who work in the sector )

to complaining about increased taxes , staff to be paid , premises to be paid for , electricity bills to be paid ( as if any business in the state exists without the same expenses )

give us a break and get off the stage , GP fees hardly dropped a penny during the crash , they earn much higher incomes than their counterparts in most EU states , they are a sheltered sector of the economy and its high time their priveledged status was confronted

What regulations do you want to remove? Be specific please. It's all well and good to make claims like a politician makes empty promises but if you want any credibility you've got to back it up.

Which barriers to entry do you wish to remove?

medicine12345

last_one_left wrote: »

" let anyone open a practice and claim to be a GP "

where did I say such a thing ?

we wouldn't allow anyone to open a butchers shop if they didn't adhere to hygiene standards ( ditto with restaraunts etc ) but there are no caps on the number of butchers shops which can open , ditto with hardware stores , hairdressing salons , cafes

I have a long term condition and I have attended a large number of GP,s and consultants in the past eight years , none have lowered their fees , the medical card issue is between GP,s and the government and is a subsidy to doctors and patients

as for the notion that no foreign doctors want to open a practice in Ireland due to weak financial incentive , GP,s here earn far more than in the uk , a richer country than Ireland

the faux claims of penury are starting to look a little pathetic

like I said earlier , the GP community has made a conscious decision to embark on a well oiled propaganda campaign against this threat to their income

what cap? it can be hard to get a medical card list but they cant fill some, also nothing stopping a any GP opening up and only seeing private patients
can you back up your claim that GPs here earn far more than in the UK? Anyway in the UK GPs have a guaranteed income and don't have to be business owners/managers aswell as doctors
who in their right mind wouldnt try to defend a 'threat to their income', GPs are humans too you know..

medicine12345

last_one_left wrote: »

I don't have to back up anything , any person who doesn't have a vested interest in the continuation of sheltering this sector of the economy , knows very well that there are a major shortage of GP clinics in this country and that GP service charges are immune to the realities of the broader economy

vast majority of GP,s didn't drop there fees by a red cent post 2008

That is a consequence of the current two tier system. GPs have to balance their books somehow. They are getting ~40% less per medical card patient and there are far more of them so therefore they can't afford to drop prices for the private patients, someone has to foot the bill....

medicine12345

last_one_left wrote: »

ive no time for sheltered anyone in an economy so you will be glad to hear that I reserve my ire for dentists , solicitors and the ESB too

of course GP,s are worried about a dip in income but stop potraying concern as being about the patient , phoney piety is puke inducing

How are those professions sheltered? Because you need a qualification and hard work to become them? Good! When I go to the dentist I want him to know what hes doing and the more regulation the better to stop chancers.
Read back over my posts, I never said anything about concern for patients

exgp

RainyDay wrote: »

And what about the very sick children who are above your widened income limits? How could you leave them out. Won't someone please think of the children?

See how it works. Whatever solution you come up with, it's wrong.

Have you not heard of discretionary medical cards? Use some of the money saved by not treating well off under 6s and increasing the budget for these.

Clearlier

last_one_left wrote: »

I don't have to back up anything , any person who doesn't have a vested interest in the continuation of sheltering this sector of the economy , knows very well that there are a major shortage of GP clinics in this country and that GP service charges are immune to the realities of the broader economy

vast majority of GP,s didn't drop there fees by a red cent post 2008

You do have to provide some evidence if you want to have any credibility. Broad generalisations are useless as a way to point out how to solve anything. There's a major shortage of GP surgeries in Ireland because nobody wants to be a GP and about 20% of those who do want to work as one choose to work part time. That's before you look at the number of Irish trained doctors that leave the country for better careers soon after qualifying.

The primary barrier to entry is that you have to be qualified to work as a GP. I'm not interested in removing that barrier.

RainyDay

exgp wrote: »

Have you not heard of discretionary medical cards? Use some of the money saved by not treating well off under 6s and increasing the budget for these.

So those poor very sick children have to fill in application forms and fight their way through HSE bureaucracy and get turned down and reapply to get their medical card, while you're giving free service to healthy kids of people with reasonable incomes? How can than be right? And then it is only 'discretionary' - so there is no entitlement, just at the whim of an administrator? Won't someone please think of the children?

exgp

last_one_left wrote: »

" let anyone open a practice and claim to be a GP "

where did I say such a thing ?

we wouldn't allow anyone to open a butchers shop if they didn't adhere to hygiene standards ( ditto with restaraunts etc ) but there are no caps on the number of butchers shops which can open , ditto with hardware stores , hairdressing salons , cafes

I have a long term condition and I have attended a large number of GP,s and consultants in the past eight years , none have lowered their fees , the medical card issue is between GP,s and the government and is a subsidy to doctors and patients

as for the notion that no foreign doctors want to open a practice in Ireland due to weak financial incentive , GP,s here earn far more than in the uk , a richer country than Ireland

the faux claims of penury are starting to look a little pathetic

like I said earlier , the GP community has made a conscious decision to embark on a well oiled propaganda campaign against this threat to their income

If GPs are "embarking on a well oiled campaign" then they have left it a little late as the new deal comes into effect on Monday. I think that they are giving good arguments as to why they don't like it, as they are entitled to do.

Clearlier

last_one_left wrote: »

oh please , one of the recommendations by the IMF while providing a programme here a few years ago was that certain sectors of the economy be made more competitive

the legal and medical sectors were both pointed out , legal fees in Ireland are way higher for the likes of conveyancy than in the uk

See, I think you're touching on something here. What the IMF referred to were the barriers to entry to studying medicine. It would require a large investment in education but increasing the number of doctors produced could help - although given that so many leave it might be better to address the reasons that they leave.

Clearlier

RainyDay wrote: »

So those poor very sick children have to fill in application forms and fight their way through HSE bureaucracy and get turned down and reapply to get their medical card, while you're giving free service to healthy kids of people with reasonable incomes? How can than be right? And then it is only 'discretionary' - so there is no entitlement, just at the whim of an administrator? Won't someone please think of the children?

The idea behind discretionary cards is a good one IMO but have always been open to abuse. Increasing the threshold below which you become eligible for a medical card and having a transparent system for the issuance of discretionary cards would be a better allocation of resources than blanket free care to the under 6's.

This is all anecdotal (obviously) but having lived in both Ireland and the UK there are large cultural differences when it comes to attending a GP. In Ireland most people think twice before they go to see their GP because of the cost so there are relatively few spurious visits. The downside (and it's a significant one) is that sometimes it's too late by the time that they get there. In the UK it seems like everyone goes to their GP at the hint of a cold. The amount of spurious visits that I hear about beggars belief. There's very little judgement exercised about whether you need to go or not. The downside (and I've experienced this) is that sometimes they're so used to seeing routine nothings that they assume that everything is a routine nothing and move people out the door as quickly as they can in a semi-futile effort to clear the waiting room. I've read (although I have no link) that outcomes are better in the UK than in Ireland but I suspect that the cost is pretty high.

RainyDay

Clearlier wrote: »

Increasing the threshold below which you become eligible for a medical card and having a transparent system for the issuance of discretionary cards would be a better allocation of resources than blanket free care to the under 6's.

Why? How will this lead to better outcomes?

Clearlier wrote: »

This is all anecdotal (obviously) but having lived in both Ireland and the UK there are large cultural differences when it comes to attending a GP. In Ireland most people think twice before they go to see their GP because of the cost so there are relatively few spurious visits. The downside (and it's a significant one) is that sometimes it's too late by the time that they get there. In the UK it seems like everyone goes to their GP at the hint of a cold. The amount of spurious visits that I hear about beggars belief. There's very little judgement exercised about whether you need to go or not. The downside (and I've experienced this) is that sometimes they're so used to seeing routine nothings that they assume that everything is a routine nothing and move people out the door as quickly as they can in a semi-futile effort to clear the waiting room. I've read (although I have no link) that outcomes are better in the UK than in Ireland but I suspect that the cost is pretty high.

Is there any data showing that UK folks visit their GPs more frequently than Irish folks?

exgp

RainyDay wrote: »

Why? How will this lead to better outcomes?



Is there any data showing that UK folks visit their GPs more frequently than Irish folks?

Average visiting rate was 3.9 visits per patient pa in 1995 which rose to 5.5 by 2008. HSCIC.GOV.UK

We only have estimates for visiting rates for both GMS and private patient rates as records are not collated by the HSE.