Free GP care for Under 6s?

nice_guy80

exgp wrote: »

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

and yet the IMO and colleges restrict the number of trainee places in college for Irish people and little chance for someone to transfer to medicine from other disciplines

It's either get 600 points in the leaving, or nothing.
Cause, we all know 600 points means you're gonna be cut out to be a doctor

medicine12345

nice_guy80 wrote: »

and yet the IMO and colleges restrict the number of trainee places in college for Irish people and little chance for someone to transfer to medicine from other disciplines

It's either get 600 points in the leaving, or nothing.
Cause, we all know 600 points means you're gonna be cut out to be a doctor

there have been 100s of extra places added in recent years, id estimate up to 1500 qualify every year, do you not read the places etc, they all emigrate as soon as they qualify as the conditions are so bad here. What do you mean transfer from another discipline, google graduate medicine 100s and 100s of places available every year, 1 in every 2 people who apply get in.
Also you havnt had to get 600 points for years, google HPAT
in fairness someone with 600 points would be more cut out that someone with 200, 400, etc or what is your logic here?

exgp

nice_guy80 wrote: »

and yet the IMO and colleges restrict the number of trainee places in college for Irish people and little chance for someone to transfer to medicine from other disciplines

It's either get 600 points in the leaving, or nothing.
Cause, we all know 600 points means you're gonna be cut out to be a doctor

Absolutely untrue.

exgp

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?

I am not sure that I am following your line(s) of thought. Am I correct in thinking that you are in favour of giving medical cards to the healthy and possibly wealthy under 6s rather than expanding the GMS scheme to favour low income families and children with severe medical problems? If there is a finite amount of cash, then you have to choose between the two; I know, and most GPs know, where the money would be better spent.

Icemancometh

nice_guy80 wrote: »

and yet the IMO and colleges restrict the number of trainee places in college for Irish people and little chance for someone to transfer to medicine from other disciplines

It's either get 600 points in the leaving, or nothing.
Cause, we all know 600 points means you're gonna be cut out to be a doctor

I'd be interested to know what role the IMO, or the colleges for that matter, have played in restricting the number of trainee places. Can you post a link? They must be doing a pretty bad job considering the significant increase in medicine degrees with the addition of UL and all the GEM programs though.

Clearlier

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?

I didn't mention better outcomes. I said that it would be a better allocation of resources. I was thinking of fairness rather than outcomes. When I lived in ireland both my wife and I were lucky enough to earn good salaries. If we thought our son needed to see the doctor money wasn't really a factor in our decision making. I think that it would be fairer to give medical cards to people with fewer resources than we had than to give us one for our infant. Discretionary medical cards would cover a scenario where someone is chronically ill requiring multiple visits from a doctor. The discretionary bit allows for people with a little bit more money to get a card where otherwise the costs would be a significant imposition. If there's evidence of a way to deliver better outcomes I'd be very open to it and interested to read about it.

exgp

Icemancometh wrote: »

I'd be interested to know what role the IMO, or the colleges for that matter, have played in restricting the number of trainee places. Can you post a link? They must be doing a pretty bad job considering the significant increase in medicine degrees with the addition of UL and all the GEM programs though.

With over forty years in the system I can assure you that the answer to your question is absolutely none. The reverse is true. GP training places were cut, purely to save money, by Mary Harney and how many times have you heard Orla Hardiman pleading for extra neurologists

RainyDay

exgp wrote: »

I am not sure that I am following your line(s) of thought. Am I correct in thinking that you are in favour of giving medical cards to the healthy and possibly wealthy under 6s rather than expanding the GMS scheme to favour low income families and children with severe medical problems? If there is a finite amount of cash, then you have to choose between the two; I know, and most GPs know, where the money would be better spent.

I think you're giving me more credit than I deserve. It's not an area I know much about at all. I'm simply pointing out that whatever method you use to ration limited resources on the road to universal GP care, those who are left out are going to make a big song and dance about it.

Clearlier wrote: »

I didn't mention better outcomes. I said that it would be a better allocation of resources. I was thinking of fairness rather than outcomes. When I lived in ireland both my wife and I were lucky enough to earn good salaries. If we thought our son needed to see the doctor money wasn't really a factor in our decision making. I think that it would be fairer to give medical cards to people with fewer resources than we had than to give us one for our infant.

Tks for the clarification. I suppose I was hoping for something based on outcomes, though it can be very difficult to get public support for and agreement to such measures.

Icemancometh

exgp wrote: »

With over forty years in the system I can assure you that the answer to your question is absolutely none. The reverse is true. GP training places were cut, purely to save money, by Mary Harney and how many times have you heard Orla Hardiman pleading for extra neurologists

I may have been slightly facetious. Having said that, there are more GP training places now than ever before (between 150-160 I think), but this is only at replacement level, and many GP graduates are going part-time, emigrating or leaving medicine altogether. Given the patchy levels of uptake, implementation of the contract will be interesting.

Iwasfrozen

Free GP visits for children only encourage hypocondriac mothers to clog up the system. At least when they have to pay parents will only use the GP when they need to.

exgp

RainyDay wrote: »

I think you're giving me more credit than I deserve. It's not an area I know much about at all. I'm simply pointing out that whatever method you use to ration limited resources on the road to universal GP care, those who are left out are going to make a big song and dance about it.


Tks for the clarification. I suppose I was hoping for something based on outcomes, though it can be very difficult to get public support for and agreement to such measures.

I totally agree with you. But I think that when choices as to where money should be allocated, to me the answer is very simple and that is to the most needy.

RainyDay

exgp wrote: »

I totally agree with you. But I think that when choices as to where money should be allocated, to me the answer is very simple and that is to the most needy.

I guess then you have to define 'needy' - financially needy? health needy? preventative health needy?

exgp

Both of the above; better than spending what money we have on the healthy wealthy.

RainyDay

exgp wrote: »

Both of the above; better than spending what money we have on the healthy wealthy.

And what about the sick wealthy? And what about the healthy poor?

exgp

RainyDay wrote: »

And what about the sick wealthy? And what about the healthy poor?

Good morning RainyDay, good to see that you are still interested in this debate.
In reply I would say, briefly, that the wealthy are more likely to be healthy and vice versa. Secondly the wealthy well, by definition, are less likely to need the help of the state in dealing with their illnesses and thirdly that the healthy poor who do not trouble their GPs very often are neatly balanced by the unhealthy poor who the GP might see three or four times a week.

Iwasfrozen

RainyDay wrote: »

And what about the sick wealthy? And what about the healthy poor?

The sick wealthy can pay their own fees.

The healthy poor need free healthcare to fall back on should they get sick while the healthy wealthy don't.

We have limited resources and we should be spending them as efficiently as possible.

RainyDay

exgp wrote: »

Good morning RainyDay, good to see that you are still interested in this debate.
In reply I would say, briefly, that the wealthy are more likely to be healthy and vice versa. Secondly the wealthy well, by definition, are less likely to need the help of the state in dealing with their illnesses and thirdly that the healthy poor who do not trouble their GPs very often are neatly balanced by the unhealthy poor who the GP might see three or four times a week.

Yes, children from better-off children are generally healthier, but they do still get cancer, and CF, and disabilities. I recall a family of two working parents faced with €700 for a wig for their young girl after chemotherapy, and struggling big time. There were other cases in the press last year of families of children facing huge medication costs. I'm not sure why these weren't covered by the DPS scheme, but they weren't.

I'm not sure that we can walk away from these situations...

Iwasfrozen wrote: »

The sick wealthy can pay their own fees.

The healthy poor need free healthcare to fall back on should they get sick while the healthy wealthy don't.

We have limited resources and we should be spending them as efficiently as possible.

I agree about spending 'efficiently' - but there are many different ways of interpreting this term. I don't think your simplistic response is enough.

exgp

Surely it's simple enough. For low income families everything should be free. For more wealthy people, they should pay for the occasional sore throats and Flu etc but should be helped with long term illnesses.

creedp

exgp wrote: »

Surely it's simple enough. For low income families everything should be free. For more wealthy people, they should pay for the occasional sore throats and Flu etc but should be helped with long term illnesses.

It would be very simple if you could define 'wealty' in a clear and non-discriminatory manner .. otherwise provide universal cover for core public health services with reasonable co-payments where appropriate (e.g. prescription charge)

exgp

creedp wrote: »

It would be very simple if you could define 'wealty' in a clear and non-discriminatory manner .. otherwise provide universal cover for core public health services with reasonable co-payments where appropriate (e.g. prescription charge)

I agree with you, universal coverage is the ultimate goal but we are implementing this in a stepwise manner and it is the design of these steps that this is all about.

Akrasia

exgp wrote: »

Surely it's simple enough. For low income families everything should be free. For more wealthy people, they should pay for the occasional sore throats and Flu etc but should be helped with long term illnesses.

I disagree with everything being free (And I'm in a 'low income family')

I favour universal healthcare but each gp appointment should cost a nominal charge (lets say a fiver)
Return appointments that are medically necessary should be free and referrals for medically necessary consultations should also be free

Prescriptions should also have a nominal fee per item (up to a low monthly limit) to avoid wastage (ie, people getting prescriptions filled for free without any intention of ever using them)

I know there are people out there for whome even a fiver is a financial burden, but it's better to pay the fiver and have a chance of getting an appointment within a reasonable timescale than having a free visit and not getting an appointment for days because the surgery is too busy prescribing antibiotics for runny noses.

ct5amr2ig1nfhp

Why should those who are being screwed at a higher tax rate get little or nothing for paying higher taxes?

I don't believe in free GP care (under 6's or OAPs). There should be a nominal fee per visit to stop abuse of the system.

10 EUR/visit and put the rest of the money into getting people off trollies and into beds.

exgp wrote: »

Surely it's simple enough. For low income families everything should be free. For more wealthy people, they should pay for the occasional sore throats and Flu etc but should be helped with long term illnesses.

Clearlier

Akrasia wrote: »

I disagree with everything being free (And I'm in a 'low income family')

I favour universal healthcare but each gp appointment should cost a nominal charge (lets say a fiver)
Return appointments that are medically necessary should be free and referrals for medically necessary consultations should also be free

Prescriptions should also have a nominal fee per item (up to a low monthly limit) to avoid wastage (ie, people getting prescriptions filled for free without any intention of ever using them)

I know there are people out there for whome even a fiver is a financial burden, but it's better to pay the fiver and have a chance of getting an appointment within a reasonable timescale than having a free visit and not getting an appointment for days because the surgery is too busy prescribing antibiotics for runny noses.

I think it wouldn't be beyond the bounds of possibility to design a system where everybody paid a fiver with an exception for those who couldn't afford it. The danger, politically, is that it probably wouldn't stay at a fiver for very long. I live in the UK where GP visits are free of charge (except for a few things) and if I have an urgent need for an appointment then I can phone first thing in the morning or first thing in the afternoon and get one for that day. If it's more urgent than that then A&E is available and might even be advisable. If it's not urgent then I can usually get one within a week - sooner if I'm willing to see any doctor. The biggest crack that I see are the situations where it's not madly urgent but you can't really wait a week. I'm sure that they exist because I know that I've had to get an urgent appointment for such a scenario but I can't remember what the scenario was. It's certainly not a perfect system (and I've previously suggested that a small charge would be a good way to persuade people to ration their use of health care resources) but it is possible to get appointments in a reasonable time scale.

Clearlier

Juliet Green Rollerblade wrote: »

Why should those who are being screwed at a higher tax rate get little or nothing for paying higher taxes?

I don't believe in free GP care (under 6's or OAPs). There should be a nominal fee per visit to stop abuse of the system.

10 EUR/visit and put the rest of the money into getting people off trollies and into beds.

Because you'd have to raise tax rates to give the money back - seems a bit pointless to me.

RainyDay

Akrasia wrote: »

Prescriptions should also have a nominal fee per item (up to a low monthly limit) to avoid wastage (ie, people getting prescriptions filled for free without any intention of ever using them)

[...]the surgery is too busy prescribing antibiotics for runny noses.

If these problems actually exist, then surely the solution lies with the GP, and not with taxing sick people. If GPs are over-per scribing, then penalise the GP, not their many sick patients.

Akrasia

Clearlier wrote: »

I think it wouldn't be beyond the bounds of possibility to design a system where everybody paid a fiver with an exception for those who couldn't afford it. The danger, politically, is that it probably wouldn't stay at a fiver for very long. I live in the UK where GP visits are free of charge (except for a few things) and if I have an urgent need for an appointment then I can phone first thing in the morning or first thing in the afternoon and get one for that day. If it's more urgent than that then A&E is available and might even be advisable. If it's not urgent then I can usually get one within a week - sooner if I'm willing to see any doctor. The biggest crack that I see are the situations where it's not madly urgent but you can't really wait a week. I'm sure that they exist because I know that I've had to get an urgent appointment for such a scenario but I can't remember what the scenario was. It's certainly not a perfect system (and I've previously suggested that a small charge would be a good way to persuade people to ration their use of health care resources) but it is possible to get appointments in a reasonable time scale.

I'm sure there are ways to design exemptions, perhaps a way to recover the charges if it turned out that the appointment was necessary so that people who are genuinely sick can claim their money back, but the timewasters can't.

The problem with that would be that it would affect the doctor patient relationship if gps were expected to assess whether or not a patient was genuinely in need of medical attention when he/she booked the appointment.

The nominal fee would be pointless if large numbers of people had a routine exemption on the basis of income. I think a fiver for an initial appointment is fair, especially if all gp directed follow-ups are free.

This kind of charge would stop parents of children getting free gp care, and then a prescription for calpol which is filled for free at the pharmacy. And instead incentivise them to just go to the shop and buy calpol for minor illness without wasting everyone's time and money.

creedp

Akrasia wrote: »

This kind of charge would stop parents of children getting free gp care, and then a prescription for calpol which is filled for free at the pharmacy. And instead incentivise them to just go to the shop and buy calpol for minor illness without wasting everyone's time and money.

With the GP Visit Card the parent will still have to pay for pharmacy for the Calpol as its only the GP that is free. Even with the medical card the GP is free but a €2.50 prescription charge will apply for each prescribed item.

Akrasia

RainyDay wrote: »

If these problems actually exist, then surely the solution lies with the GP, and not with taxing sick people. If GPs are over-per scribing, then penalise the GP, not their many sick patients.

There are seperate problems with over subscribing of medications, but the main problem is to do with increasing demand on gp services when people can access their gp for free.

We've all had a cold where we thought, maybe I should go to the doctor to get something for this, 'just in case' but decided it's not worth it because of the 50 - 60 euro cost.

If the gp was free, more people would bring the kids to the doctor unnecessarily which spreads illness and wastes resources.

There is a psychological difference between free and cheap. If you saw a plate in a shop with free samples of cake, you might take one (or 3). But if you saw the same display with samples of cake for 2 cents each you'd probably not take any. it's not that the 2 cent was too expensive, you probably have a bunch of 2 cent coins in your pocket/purse that you'd be glad to get rid of.

With reasonable safeguards like the one above, we can maximise the effectiveness of the healthcare system without costing anyone access to healthcare.

RainyDay

Akrasia wrote: »

This kind of charge would stop parents of children getting free gp care, and then a prescription for calpol which is filled for free at the pharmacy. And instead incentivise them to just go to the shop and buy calpol for minor illness without wasting everyone's time and money.

Does this actually happen?

If so, could the GP just say 'NO'?

creedp

RainyDay wrote: »

If these problems actually exist, then surely the solution lies with the GP, and not with taxing sick people. If GPs are over-per scribing, then penalise the GP, not their many sick patients.

Have to agree with this. Every year the HSE spends scarce resources running advertising campaigns trying to educate people not to take antibiotics for colds. Personally, they'd be better off training/educating GPs on how to assertively tell their patients they cannot have antibiotics for their common cold. After all patients can't get their hands on antibiotics unless their GPs agrees its appropropriate.