Why can government consistently underfund hospitals?

shtpEdthePlum

https://www.echolive.ie/sponsored/arid-40253432.html

Why does CUH have to put out a public appeal and get charity donations so it can take care of elderly patients with dementia and delirium?

Surely that's what our bloated HSE should be funding?

Meanwhile ten more private hospitals have appeared in Cork in recent years while the public health service is in shlt. You'd swear there was an agenda to get people to rely solely on the private health sector.

Why pay taxes (or even health insurance) at all when everyone except the ultra rich can expect extremely poor value for money no matter what service they opt to use?

Not a problem that impacts those in government, granted, but the rest of us plebs are all affected by this and there are way more of us than there are of them. This all seems very very wrong to me. Something something children's hospital.

rock22

shtpEdthePlum wrote: »

https://www.echolive.ie/sponsored/arid-40253432.html

Why does CUH have to put out a public appeal and get charity donations
.......


Meanwhile ten more private hospitals have appeared in Cork in recent years
......

Not a problem that impacts those in government, ..

This all seems very very wrong to me. ..

I think you have answered your own question.
( My views comes from a lifetime working in the public health system )

Smee_Again

They’re not underfunded, the system is poorly managed.

21 Billion budget for 4.5 million odd people

Del2005

rock22 wrote: »

I think you have answered your own question.
( My views comes from a lifetime working in the public health system )

You missed the important bit. The HSE is well funded but there's too many admin/management people. We merged 8 health boards to form the HSE yet had zero redundancies, so at least 6 people have no jobs to do while still getting paid and getting incremental pay rises for doing nothing.

shtpEdthePlum wrote: »

Surely that's what our bloated HSE should be funding?

LessOutragePlz

shtpEdthePlum wrote: »

https://www.echolive.ie/sponsored/arid-40253432.html

Why does CUH have to put out a public appeal and get charity donations so it can take care of elderly patients with dementia and delirium?

Surely that's what our bloated HSE should be funding?

Meanwhile ten more private hospitals have appeared in Cork in recent years while the public health service is in shlt. You'd swear there was an agenda to get people to rely solely on the private health sector.

Why pay taxes (or even health insurance) at all when everyone except the ultra rich can expect extremely poor value for money no matter what service they opt to use?

Not a problem that impacts those in government, granted, but the rest of us plebs are all affected by this and there are way more of us than there are of them. This all seems very very wrong to me. Something something children's hospital.

I'd love to know where all the money goes myself.

The HSE had a budget of over €17bn in 2020.

https://www.hse.ie/eng/services/news/media/pressrel/hse-publishes-national-service-plan-2020.html

For that amount of funding you'd be expecting a decent service without ridiculously long waiting times.

Don't think it will be fixed anytime soon as no one takes responsibility for it or any of the errors made.

They'd rather fight every case in court before admitting any liability.

Bubbaclaus

Smee_Again wrote: »

They’re not underfunded, the system is poorly managed.

This. I'm pretty sure our health budget per capita is the highest in the EU, or certainly there abouts. HSE needs major overhaul.

View

The “problem” is that you have practice medical treatment running in parallel to the public one and the same personnel operating in both. Hence there is an inherent conflict of interest in the system.

No one would pay for private medical care if the public health care provided the same level of care and attention and on an identical timescale. Why would you pay a premium for an identical level of care?

Hence, in order to “justify” you paying that premium for private care, the public health care provided by the personnel involved must be worse than the private health care they provide you with, even when they are provided in the same hospital. Bluntly, their private medical earnings are dependent on you hightailing it from the public system and seeing them as a private medical patient.

And, as that is what happens, our current medical system is in fact working well for the beneficiaries of it. Why should they change a system that suits them well?

The HSE is funded just as well as the NHS. Consider than when you hand over €50 quid to the doctor and another €40 to the chemist. Or when you're waiting 3 years to see a consultant.

[Deleted User]

[Deleted User] wrote: »

The HSE is funded just as well as the NHS. Consider than when you hand over €50 quid to the doctor and another €40 to the chemist. Or when you're waiting 3 years to see a consultant.

Working class getting screwed at every corner

shtpEdthePlum

I'm not working class, I pay for health insurance and I'm getting screwed as well. I seldom get sick as I'm young and relatively healthy but I wouldn't even get a private room in a private hospital even though I pay for the privilege.

Harry Palmr

Literally thousands of well paid and unneeded positions are siphoning off hundredsof millions every year. The entire system is being run by people not talented enough for private enterprise while using a mixed bag of Windows NT era software. No two aspects of the health service can communicate without intensive manual inputs. PPARS may have grabbed the headlines back in the early 00s but many more examples litter the HSE, some what which have almost certainly cost lives.

How do you fix Angola?

Geuze

We overspend on healthcare, relative to the age profile of the population.

This is well known.

Have a read of this:


https://twitter.com/seamuscoffey/status/1376932341751418889

Atlantic Dawn

Deleted User wrote: »

The HSE is funded just as well as the NHS. Consider than when you hand over €50 quid to the doctor and another €40 to the chemist. Or when you're waiting 3 years to see a consultant.

And then when you try to even make an appointment with a doctor who is oversubscribbed with medical card patients you can't even get an appointment for a week plus. Last time I wanted to make an appointment I had to ring near 10 practices to make an appointment, what I found most frightening is not a single one of them actually asked me what was wrong with me, shocking.

Mr. teddywinkles

Atlantic Dawn wrote: »

And then when you try to even make an appointment with a doctor who is oversubscribbed with medical card patients you can't even get an appointment for a week plus. Last time I wanted to make an appointment I had to ring near 10 practices to make an appointment, what I found most frightening is not a single one of them actually asked me what was wrong with me, shocking.

Funny thing is if you have a medical card ya ain't treated much different. Ya get prescribed shoddy medication too.

Atlantic Dawn

Mr. teddywinkles wrote: »

Funny thing is if you have a medical card ya ain't treated much different. Ya get prescribed shoddy medication too.

But with a medical card you could decide to go 100 times in a year for paper cuts, bruises etc and clog up the entire system, someone having to pay €60 a visit might risk avoiding going until they pass out or cancer spreads througout their body and they have to go. Neither system works.

rock22

While it is probably true that the health service is well funded and probably overstaffed it's problem is that is structurally inefficient and those who control it want to keep it that way.
We don't have a private and a piblic health system, we have a two tier system. That means that those better off can access the service as needed via health insurance while pushing poorer but more needy patients to the end of the queue. And all done under the cover of a 'single system'

Some poster complained about the fees to GPs and Pharmacists. But that money never finds it way to the HSe, unlike any fees collected by the NHS. Many workers in the public hospitals find themselves providing service for the private hospitals with no say oin the matter, because the consultants they answer to in the public service also work, and in some cases own, the private hospitals.

The last great review of the service was by Michael Martin who spent an absolute fortune on reviews and reports 9 including glossy books to every staff member in the health boards (about 120000) and then implemented nothing. He was followed by Mary Harney who's only interest was in privatisation of the health service. The results of her decisions to outsource to cheaper and less well regulated laboratories in the US and Mexico ultimately caused the Cervical screening catastrophe.

Unbelievably , Michael Martin was rewarded for his incompetence by being elected leader of FF and is no Taoiseach .

I am sure Paul reid would love to get rid of a lot of excess baggage from the HSE but he has not that power, it rests with the government and this government will not be making any such decision. In fact, for all the government with access to private health service they are ppresumably quite happy with the current system.

rock22

rock22 wrote: »

Some poster complained about the fees to GPs and Pharmacists. But that money never finds it way to the HSe, unlike any fees collected by the NHS.

There are no fees collected by the NHS.
My point wasn't that we fund the HSE through everything, it was that the direct funding from government is higher for the HSE than the NHS.
Under the NHS you get everything, everything covered. Even dentistry. Even cosmetic stuff, completely free, that if you got in the South you can't even claim tax back on.
The NHS's funding covers eyesight, dentistry, GPs, consultants, prescriptions all completely free at the point of use.
The HSE's funding covers what exactly? Some of the care for maybe 25% of the population. Get brought in by an ambulance? That'll cost you.

Geuze

Deleted User wrote: »

The HSE's funding covers what exactly? Some of the care for maybe 25% of the population. Get brought in by an ambulance? That'll cost you.

The taxes used to finance the HSE cover all public healthcare..

There are four fees that some people pay

(1) A&E fee = 100
(2) Overnight fee in hosp = 80
(3) GP fees
(4) Pharma up to 114 pm

Geuze

Deleted User wrote: »

The HSE's funding covers what exactly? Some of the care for maybe 25% of the population. Get brought in by an ambulance? That'll cost you.

If I stay four nights in hosp, I pay 320, way below the true costs.

Taxes cover the balance.

All out-patients is tax-financed, no fees.

All maternity is tax-financed, no fees.

Good loser

When it comes to 'insiders' being pinned down on what's wrong with the HSE i.e. why is it so expensive and still people are unhappy with the service the answer is 'vested interests'. Nobody seems willing to specify in detail what these are.

More than once I've heard that cataract surgeon (Ml O'Keefe?) say that he worked/works in private and public health and that in the private sector he can get twice as much work done in half the time. If true that means private sector productivity is four times greater.

Del2005

Good loser wrote: »

When it comes to 'insiders' being pinned down on what's wrong with the HSE i.e. why is it so expensive and still people are unhappy with the service the answer is 'vested interests'. Nobody seems willing to specify in detail what these are.

They use taxis to transfer files FFS. If they can't transfer data efficiently, how inefficient are they on the difficult stuff?

Geuze

Geuze wrote: »

The taxes used to finance the HSE cover all public healthcare..

There are four fees that some people pay

(1) A&E fee = 100
(2) Overnight fee in hosp = 80
(3) GP fees
(4) Pharma up to 114 pm

And 3 year waits to see consultants.
On top of that, half of people have health insurance.
The NHS meanwhile covers all that, with shorter waiting lists. It also covers all dentistry and optical.
It's really incredible the difference in what the two systems can achieve.

Fred Cryton

View wrote: »

The “problem” is that you have practice medical treatment running in parallel to the public one and the same personnel operating in both. Hence there is an inherent conflict of interest in the system.

No one would pay for private medical care if the public health care provided the same level of care and attention and on an identical timescale. Why would you pay a premium for an identical level of care?

Hence, in order to “justify” you paying that premium for private care, the public health care provided by the personnel involved must be worse than the private health care they provide you with, even when they are provided in the same hospital. Bluntly, their private medical earnings are dependent on you hightailing it from the public system and seeing them as a private medical patient.

And, as that is what happens, our current medical system is in fact working well for the beneficiaries of it. Why should they change a system that suits them well?

You pay a premium to get a better level of care than you would in the public sector. What about that do you not understand.



Are you seriously suggesting that there's some deliberate intention from doctors in the public sector to deliver a bad service, in order to justify the premium for the better private sector care?


Riiighhht....there's a new level of paranoia right there.

L1011

Deleted User wrote: »

And 3 year waits to see consultants.
On top of that, half of people have health insurance.
The NHS meanwhile covers all that, with shorter waiting lists. It also covers all dentistry and optical.
It's really incredible the difference in what the two systems can achieve.

NHS GP and dentistry services are in tatters - and were before COVID - in many areas.

Significant number of UK residents have private health insurance due to waiting lists.

rock22

Fred Cryton wrote: »

You pay a premium to get a better level of care than you would in the public sector. What about that do you not understand.


...

Riiighhht....there's a new level of paranoia right there.

I don't understand any of that, having worked in health care all my life.
Can you explain how the care is 'premium' if you pay more?

RobAMerc

I worked in the HSE for a number of years - I can tell you it is populated by the most inept clowns I have ever come across in 25years of my career. Some of the ineptitude and tail chasing is sickening.

Secondly, there is a deference to "consultants" like they are gods, meaning they are given undue reverence when answering questions they are not equipped to answer ( and medical consultants have the ego to always think they have the answer ) - the same people also have 0 interest in fixing the system as they are best positioned to benefit from the current quagmire

3rd - literally 0 people in the HSE are there to look after the publics health, EVERYONE there are only interested in the publics health if it helps further an agenda that suits them ( normally their own status or power ). Status also can mean number of staff - which means duplication of positions and a tolerance for people doing absolutely 0 as long as they are a bum on a seat.

The HSE is simply a layer of management smeared across a number of disparate specialties and services run as fifedoms and which are totally independent ( bar funding from HSE ) and despise the HSE's very existence. This means each service goes away and does its own thing independently of the greater good of the HSE - for example, they buy their own IT systems which often are capable but extremely expensive to integrate with other specialties IT systems. ( not entirely true, but clever companies take advantage )

Another issue is there is a legacy of strong groups of vested interests, employee unions, hospital groups, GP groups, religious orders etc that make getting anything done difficult, even for a competent management team - which the HSE dont have.

clustefluck

L1011

L1011 wrote: »

NHS GP and dentistry services are in tatters - and were before COVID - in many areas.

And free.
What is the idea of "in tatters" over there? Because I've heard of 6 month waiting lists being disastrous, if that's their bar then their "in tatters" may compare fairly well to here.

Significant number of UK residents have private health insurance due to waiting lists.

Would be interested what kind of proportion. Apparently we're at 2.2/4.9million.

Anita Blow

Good loser wrote: »

More than once I've heard that cataract surgeon (Ml O'Keefe?) say that he worked/works in private and public health and that in the private sector he can get twice as much work done in half the time. If true that means private sector productivity is four times greater.

I think the reason for that is not as simple as it may seem. There absolutely is an element of private hospitals being more efficient. There's also a lack of investment in critical infrastructure that is often a bottleneck to progressing patient care (Notably MRI/CT scans). Also at play though is that private hospitals take bog-standard cases with minimal chance of complications while off-loading complex care to the HSE. I'm a doctor who has worked in both public and private hospitals, and more often than not if a complication arises that is in any way significant or would result in a prolonged admission, the patient is transferred to a public hospital for their care.

The HSE is over-funded for what we get. Management needs to be cut, hospital administration amalgamated, more doctors/nurses/AHPs recruited and capital funds rolled into key infrastructure like scans & homecare packages/nursing homes/hospital at home. That would sort many of the blockages in patient flow

Lumen

Del2005 wrote: »

They use taxis to transfer files FFS. If they can't transfer data efficiently, how inefficient are they on the difficult stuff?

This is also done in the UK, or at least was a couple of years ago when I sat in a taxi whose driver regularly transported individual files whilst the patient travelled separately.

rock22

Deleted User wrote: »

There are no fees collected by the NHS.
My point wasn't that we fund the HSE through everything, it was that the direct funding from government is higher for the HSE than the NHS.
Under the NHS you get everything, everything covered. Even dentistry. Even cosmetic stuff, completely free, that if you got in the South you can't even claim tax back on.
The NHS's funding covers eyesight, dentistry, GPs, consultants, prescriptions all completely free at the point of use.
The HSE's funding covers what exactly? Some of the care for maybe 25% of the population. Get brought in by an ambulance? That'll cost you.

There are absolutely fees in the NHS(here are some of them)

I agree however wit hprvious posters that eh HSE is grossly overstaffed in administration . That was a decision of our politicians, few redundancies were sought or achieved in amalgamating the 11 health boards.
What is more, there has been an expansion of the administrative staffing at a time when basic nursing roles were being reduced.
But having to provide services for private health and private hospitals is a hidden cost and is directly caused by our two tier system

VinLieger

We always talk about the creation of the HSE and condensing the regions as the reason for the over staffing as regards admin but that was 16 years ago, surely there has to be a number of people that have retired or moved on bringing this over staffing down? Or is it a case that new people were also then hired to fill these pointless roles?

Good loser

RobAMerc wrote: »

I worked in the HSE for a number of years - I can tell you it is populated by the most inept clowns I have ever come across in 25years of my career. Some of the ineptitude and tail chasing is sickening.

Secondly, there is a deference to "consultants" like they are gods, meaning they are given undue reverence when answering questions they are not equipped to answer ( and medical consultants have the ego to always think they have the answer ) - the same people also have 0 interest in fixing the system as they are best positioned to benefit from the current quagmire

3rd - literally 0 people in the HSE are there to look after the publics health, EVERYONE there are only interested in the publics health if it helps further an agenda that suits them ( normally their own status or power ). Status also can mean number of staff - which means duplication of positions and a tolerance for people doing absolutely 0 as long as they are a bum on a seat.

The HSE is simply a layer of management smeared across a number of disparate specialties and services run as fifedoms and which are totally independent ( bar funding from HSE ) and despise the HSE's very existence. This means each service goes away and does its own thing independently of the greater good of the HSE - for example, they buy their own IT systems which often are capable but extremely expensive to integrate with other specialties IT systems. ( not entirely true, but clever companies take advantage )

Another issue is there is a legacy of strong groups of vested interests, employee unions, hospital groups, GP groups, religious orders etc that make getting anything done difficult, even for a competent management team - which the HSE dont have.

clustefluck

Interesting and rings true.
So how do you feel about the future projections for the HSE as outlined in the Sláinte Care proposals?
Is it effectively importing the NHS system into this jurisdiction?

Geuze

Good loser wrote: »

Interesting and rings true.
So how do you feel about the future projections for the HSE as outlined in the Sláinte Care proposals?
Is it effectively importing the NHS system into this jurisdiction?

Slaintecare will make the HSE more like the NHS, yes.

beggars_bush

Basically the private medical sector leech off the public system and make a lot of money

Geuze

Good loser wrote: »

Interesting and rings true.
So how do you feel about the future projections for the HSE as outlined in the Sláinte Care proposals?
Is it effectively importing the NHS system into this jurisdiction?

Slaintecare plans to "disentangle" public and private care, by removing the private activity from public hosps.

I used to think that the NHS was purely public, but now I read that there is some private activity in NHS hosps in the UK.


Actually, I read now that:

"Since the Health and Social Care Act was passed in 2012, NHS hospitals have been allowed to generate up to 49% of their income
from private activity"


So the NHS is becoming more like the HSE!!

Banana Republic 1

shtpEdthePlum wrote: »

https://www.echolive.ie/sponsored/arid-40253432.html

Why does CUH have to put out a public appeal and get charity donations so it can take care of elderly patients with dementia and delirium?

Surely that's what our bloated HSE should be funding?

Meanwhile ten more private hospitals have appeared in Cork in recent years while the public health service is in shlt. You'd swear there was an agenda to get people to rely solely on the private health sector.

Why pay taxes (or even health insurance) at all when everyone except the ultra rich can expect extremely poor value for money no matter what service they opt to use?

Not a problem that impacts those in government, granted, but the rest of us plebs are all affected by this and there are way more of us than there are of them. This all seems very very wrong to me. Something something children's hospital.

ince the foundation of the state Irish governments have always abdicated from its responsibilities to the population. This can be seen in eduction. Health care, housing, defence, etc. The church ran and still does to an extent the education system and for years the hospitals. Now the church did a lot of reprehensible things but the state allowed them too.

Housing: for years this was always pushed onto the private sector and now we are we’re we are.
Defence: Ireland has no real capacity to defend itself from threats no air defence capabilities instead we rely on the RAF.

Everything is farmed out to the private sector and those firms take the country for every last quid.
If people actually didn’t vote for the same stuffed shirts things may change but until the gombeanism is overcome things won’t change

seamus

Smee_Again wrote: »

They’re not underfunded, the system is poorly managed.

Well yes and no.

When you compare us to gold-standard countries for medical care, our per-capita public health spending is lower. In the EU area we're about average, but that just puts us above poorer countries and behind comparably wealthy countries.

In terms of health spending as a % of GDP we're quite far behind.

We are using our resources very inefficiently. But we're also not spending enough.

The problem is that those who are most affected by issues in the public system are those with the least power to do anything about it.

All of the people who make the decisions about health spending and the people who have their ear, can all rely on private healthcare. So there is no incentive to make it better.

L1011

The State tried to take over healthcare from the church and were stopped, its only very slowly been released. They are still stopping any real moves to take over education.

Banana Republic 1

L1011 wrote: »

The State tried to take over healthcare from the church and were stopped, its only very slowly been released. They are still stopping any real moves to take over education.

When they say stopped...
How did Hugo Chavez overnight take control of the countries oil industry. He just did it.

That’s a bad example but when the state wants to do something in a hurry it’s done remember the bank bailout. The problem here is spineless politicians.

L1011

Banana Republic 1 wrote: »

When they say stopped...
How did Hugo Chavez overnight take control of the countries oil industry. He just did it.

That’s a bad example but when the state wants to do something in a hurry it’s done remember the bank bailout. The problem here is spineless politicians.

Being decried by the bishops was sufficient to ensure you weren't re-elected back then (outside of a few city seats); hence pushing ahead was not an option.

Atlantic Dawn

Atlantic Dawn wrote: »

And then when you try to even make an appointment with a doctor who is oversubscribbed with medical card patients you can't even get an appointment for a week plus. Last time I wanted to make an appointment I had to ring near 10 practices to make an appointment, what I found most frightening is not a single one of them actually asked me what was wrong with me, shocking.

Medical card patient here. Still have to wait over a week for an appointment with GP.

Don't have the luxury of choice either, ringing around ten different practices for an appointment is not an option on GMS scheme.

Geuze

seamus wrote: »

Well yes and no.

When you compare us to gold-standard countries for medical care, our per-capita public health spending is lower. In the EU area we're about average, but that just puts us above poorer countries and behind comparably wealthy countries.

In terms of health spending as a % of GDP we're quite far behind.

We are using our resources very inefficiently. But we're also not spending enough.

We overspend on healthcare, relative to the age profile of our population.

We spend too much, as the prices are too high.

Our high spending does not deliver high volumes.

https://read.oecd-ilibrary.org/social-issues-migration-health/ireland-country-health-profile-2019_2393fd0a-en#page9



Seamus Coffey UCC has a nice series of charts on this topic:

https://twitter.com/seamuscoffey/status/1376932341751418889

Good loser

L1011 wrote: »

The State tried to take over healthcare from the church and were stopped, its only very slowly been released. They are still stopping any real moves to take over education.

Surely the State runs the healthcare system substantially and has for many years.

Geuze

Geuze wrote: »

We overspend on healthcare, relative to the age profile of our population.

We spend too much, as the prices are too high.

Our high spending does not deliver high volumes.

https://read.oecd-ilibrary.org/social-issues-migration-health/ireland-country-health-profile-2019_2393fd0a-en#page9



Seamus Coffey UCC has a nice series of charts on this topic:

https://twitter.com/seamuscoffey/status/1376932341751418889

~45% of the population also has private insurance. More money.

Good loser

Geuze wrote: »

Slaintecare plans to "disentangle" public and private care, by removing the private activity from public hosps.

I used to think that the NHS was purely public, but now I read that there is some private activity in NHS hosps in the UK.


Actually, I read now that:

"Since the Health and Social Care Act was passed in 2012, NHS hospitals have been allowed to generate up to 49% of their income
from private activity"


So the NHS is becoming more like the HSE!!

So, in your opinion, which way do you think this country should go.

Perhaps in hospitals all the routine surgery should be left to the private sector and the complicated stuff to the public sector.

It's nonsensical that there should be a 3 year waiting list for cataracts in the public system and none in the private.

PuddingBreath

Hi all,
I wondering if anyone can access the current levels of absenteeism amongst the Irish health system. Seeing as how they've being vaccinated I'd be hoping they were full steam ahead now.
I had a look online but couldn't find much.
I was a bit concerned last week when I heard doctors on the radio express concerns about a 4th wave, that it might be the straw that breaks the camel's back. surely they are getting on top of things now?

VinLieger

PuddingBreath wrote: »

Hi all,
I wondering if anyone can access the current levels of absenteeism amongst the Irish health system. Seeing as how they've being vaccinated I'd be hoping they were full steam ahead now.
I had a look online but couldn't find much.
I was a bit concerned last week when I heard doctors on the radio express concerns about a 4th wave, that it might be the straw that breaks the camel's back. surely they are getting on top of things now?

Its not about absenteeism in the case of a 4th wave its about our system still not having enough beds and capacity if things get out of control again as they did in January and February.

Brussels Sprout

The bottom line is that any serious reform of the HSE, in order to turn it into a more efficient organisation, would involve a lot of redundancies at the administrative level. That appears to be an impossibility (not sure if that's from a legal point of view or purely a political one). Taking that off the table makes an already difficult situation practically impossible.

awec

Brussels Sprout wrote: »

The bottom line is that any serious reform of the HSE, in order to turn it into a more efficient organisation, would involve a lot of redundancies at the administrative level. That appears to be an impossibility (not sure if that's from a legal point of view or purely a political one). Taking that off the table makes an already difficult situation practically impossible.

IMO it would take a single party government on a rock solid footing to tackle this one properly. We aren't likely to see any real changes so long as we have these coalitions held together by a thread.

KaneToad

Good loser wrote: »

When it comes to 'insiders' being pinned down on what's wrong with the HSE i.e. why is it so expensive and still people are unhappy with the service the answer is 'vested interests'. Nobody seems willing to specify in detail what these are.

More than once I've heard that cataract surgeon (Ml O'Keefe?) say that he worked/works in private and public health and that in the private sector he can get twice as much work done in half the time. If true that means private sector productivity is four times greater.

The problem is these surgeons working privately & publically in the same facility.