An "Irish NHS" - what needs to change?

Kermit.de.frog

I feel a lot of NHS propaganda seeps in here from Britain due to proximity and size difference which distorts reality for a fair few people who echo the same message. The reality is it is not that much better than the standard of service you get here with the HSE.

CramCycle

Kermit.de.frog wrote: »

I feel a lot of NHS propaganda seeps in here from Britain due to proximity and size difference which distorts reality for a fair few people who echo the same message. The reality is it is not that much better than the standard of service you get here with the HSE.

The only tangible difference for most is the charge at point of access. I do wonder, a and e charge if really stuck you can just not pay but I wonder would a GP refuse you access if you couldn't afford payment.

Geuze

CramCycle wrote: »

The only tangible difference for most is the charge at point of access. I do wonder, a and e charge if really stuck you can just not pay but I wonder would a GP refuse you access if you couldn't afford payment.

If your income is low that you can't afford a GP, you would probably have a GMS card?

Although you may be referring to people whose incomes are above the GMS cut-off, but not high.

CramCycle

Geuze wrote: »

If your income is low that you can't afford a GP, you would probably have a GMS card?

Although you may be referring to people whose incomes are above the GMS cut-off, but not high.

Pretty much, and there are a reasonable number of people who fall into that group. They are in that bracket where (and I am making huge assumptions, plenty of people who tick none of these boxes) they are typically young, so not often that ill but they have large expenditure on low pay, which is doable until something goes wrong. I was in that boat for years in my youth. Some though never have a huge increase in wage with age, never get quite enough for a mortgage so are paying large rent for life. The system will catch you but it catches you through sheer dumb luck and a lot of people don't realise they have to effectively cheat the system. Basically 55euro for a GP plus the script after the fact won't break the bank (although it might) but it will mean you don't have a comfortable end to the week or month. And for some, their cost/benefit analysis will say, don't go, and for most that will be fine but for some it can be a life altering choice. Also I just looked at the threshold limits for the card, there is a huge amount of people who earn more than that but don't have enough to cover a GP or A&E visit. €304 a week if living alone, so roughly €1350 a month net, take rent, food, travel etc out of that and in Dublin that 55euro is your petty cash. And that's just the GP visit card, not a medical one. A full time minimum wage job makes you ineligible effectively. I mean you cheat the system by not paying the A&E fee, or lying to your GP and saying you will sort them out later, if you are in that bad a shape.

McGiver

Geuze wrote: »

GDP is inflated by MNC activity here.

Look at healthcare exp pp instead.

We overspend.

Exactly by about 40% and rising. Anybody who mentions GDP (or an indicator derived therefrom) and Ireland in one sentence is either ignorant or a manipulator.

GNI* is all what we must use, as the OECD, IMF, EU, Government of Ireland and the Revenue do.

And yes, if you look at GNI per capita health care spending in Ireland it would be probably the highest, but realy poor bang for the buck...

Note: irish Debt/GNI ratio is 105%+ post-covid, just if someone wanted to say that Ireland cleared all its debt. It's heavily indebted, Dail/Gov reports say that in black and white.

McGiver

Geuze or anyone with a good knowledge of the HC here - why there is a tendency to look up to NHS and use it as the gauge to measure everything against it?

In terms of policy, why copy the UK NHS? And then also coy it badly. Why not look at the Netherlands or France or Belgium or Austria?

maccored

the NHS is pretty ****e. why copy it at all?

McGiver

maccored wrote: »

the NHS is pretty ****e. why copy it at all?

NHS has very many great experts for sure, in London, which is an Alpha++ global city, no surprise!

But overall it's s**e, compared to the continental Europe, based on my own experience, if you ask me.

maccored

McGiver wrote: »

NHS has very many great experts for sure, in London, which is an Alpha++ global city, no surprise!

But overall it's s**e, compared to the continental Europe, based on my own experience, if you ask me.

according to my parents and siblings living in the north, it's pretty bad. My mother has a two month wait to get her bloods done. even here is better than that

Grueller

RandomViewer wrote: »

Dobby was the reason for most of the objections, in a lot of cases people had already paid large fees for a water connection and development fees when they built the house, NCT came in without a hitch 12 years earlier, people saw blatant criminal corruption in Irish water and objected, as I said the ESB had an existing database and another levy on the bill would have gone unchallenged,

What about those with their own private water supply?

riclad

The NHS is not perfect but it's better than the American system where people are going on gofundme for basic medical treatments
And people here can also pay private medical insurance
Eg in America it can cost 5000 dollars for a woman to have a baby in hospital
There are long waiting lists for operations in the hse or to see a consultant

McGiver

riclad wrote: »

The NHS is not perfect but it's better than the American system where people are going on gofundme for basic medical treatments
And people here can also pay private medical insurance
Eg in America it can cost 5000 dollars for a woman to have a baby in hospital
There are long waiting lists for operations in the hse or to see a consultant

Yes, and? Everyone knows the US system is unsustainable. Pointless mentioning it.

Ireland is in Europe, in the European Union. Why using the NHS as a benchmark or even a model for the HSE?

Look beyond the UK, look into European systems. The Dutch one is very reasonable for example. So is the German, both have let's say "market" elements, but are well regulated on the gov level.

AndrewJRenko

https://boards.ie/discussion/comment/117606758#Comment_117606758

This was FG policy for years, follow the German or Dutch universal insurance model. Except when they got into power and started doing the proper policy research, they worked out that it wasn't going to work on a small island like ours.

Economics101

https://boards.ie/discussion/comment/117634623#Comment_117634623

I agree that FG may not have done enough homework on universal insurance. This doesn't mean that it was a bad idea. I would say that an insurance model takes a lot of power away from HSE and DoH administrators and civil servants. It would also take power away from health service unions (who at times appear to run the show) - imagine if your hospital's revenue was not from a guaranteed state grant, but from what the hospital could earn.

It would take an awful lot of cojones to take on these vested interests and win.

AndrewJRenko

https://boards.ie/discussion/comment/117634662#Comment_117634662

It would give all that power that you've taken away from the State to one or two private insurers, whose sole objective is to make money for their shareholders. Scary.

dulpit

https://boards.ie/discussion/comment/117634662#Comment_117634662

Why would we want a health service run by entities who's sole focus was on revenue? That's a horrible idea...

Economics101

https://boards.ie/discussion/comment/117635077#Comment_117635077

https://boards.ie/discussion/comment/117635799#Comment_117635799

I hope no-one thinks that I am talking about an un-regulated insurance market or a badly-regulated one (like the USA). Insurance-based systems properly regulated can produce good outcomes as in France, Germany and many other European countries. We need more power to the clients/patients and less to the civil servants, who. like almost everyone else pursue their own interests. Of course governments will always subsidise healthcare whether insurance-based or not. It would be hugely important to ensure that the benefits of these subsidies are not captured by the insurers.

I think that there is a fair potential for subsidy-capture in any system

AndrewJRenko

https://boards.ie/discussion/comment/117639071#Comment_117639071

We don't have the scale to get the economies of scale available to insurers in Germany, France and others.

salonfire

https://boards.ie/discussion/comment/117635077#Comment_117635077

I've heard it all now from you. Willing that people continue to suffer and die at the hands of our health service rather than see changes that simply go against your ideology,

I don't know how you can sleep soundly at night or live with yourself.

AndrewJRenko

https://boards.ie/discussion/comment/117648661#Comment_117648661

I sleep fairly well thanks, given that my analysis matches with just about every health expert in the country. It's nothing to do with ideology. It's just a fact that our market is too small for universal health insurance, as FG found when they had a huge majority in Government and still couldn't make it happen.

salonfire

https://boards.ie/discussion/comment/117648989#Comment_117648989

So if you, or someone close to you, had a life threatening condition that could be treated faster through private means (insurance or cash), you'd reject this treatment? You'd be happy to languish for months or years on the HSE? To the extent that it means risking your life.

After all, these private hospitals' objective is to make money. Too scary for you.

So lets have it out from you in black and white here now. State you are willing to let yourself or a loved one languish on the HSE rejecting any private intervention even to the extent of putting lives at risk or continued suffering? After all you think you are hard enough, big and brave enough to label making those whose objective is to make money as "scary".

AndrewJRenko

https://boards.ie/discussion/comment/117653347#Comment_117653347

You seem a bit confused. What has my personal choices or preferences within the limitations of the current health service got to do with discussions about how to build the best health service?

salonfire

https://boards.ie/discussion/comment/117653553#Comment_117653553

What a cowardly response. Just as I thought, when it comes down to it you're all balls and bravado labeling private enterprises as 'scary', but not willing to reject their service if it allows you faster, life-saving treatment.

AndrewJRenko

https://boards.ie/discussion/comment/117654296#Comment_117654296

I didn't label private enterprises as scary. I labelled putting private businesses in control of the country's health service as scary.

The problem is around the control bit.

dulpit

https://www.boards.ie/discussion/comment/117653347#Comment_117653347

I have health insurance, and if it let's me get access to treatment quicker I'll obviously take it. I saw that my father was able to get a hip replacement about 18 months quicker than my father in law got a knee replacement, because my father has insurance, my father in law doesn't.

The point though is that for some people at least, this feels wrong and immoral. Why should access to treatment be controlled by an ability to pay?

salonfire

https://www.boards.ie/discussion/comment/117658131#Comment_117658131

Nobody is saying that it is right. Equally it is not right and far more appalling that our heath service is run for the benefit of staff and run by unions. How else do you explain the waste and mismanagement. An insurance or competition drive model strips that power from staff.

salonfire

https://www.boards.ie/discussion/comment/117654462#Comment_117654462

You know there is a Government Dept for Health? So how would it be controlled by provate companies?

No, the reasoning behind your response was you don't want to see power removed from staff and unions. You're happy that others who cannot access private care continue to suffer with the HSE because that gives staff leverage. Just like the nurses walk-out.

But to save your own skin, you'd be quite willing to use private care yourself.

AndrewJRenko

https://www.boards.ie/discussion/comment/117658635#Comment_117658635

My comment was in response to "an insurance model takes a lot of power away from HSE and DoH administrators and civil servants. It would also take power away from health service unions". If power is taken away from HSE and DOH, then obviously it will rest with the commercial insurers. What you describe as 'power' for the unions is most likely decent terms and conditions for highly mobile employees who can and will take their skills and training to Oz or Canada or USA when they realise how badly they are treated by penny-pinching insurers treating sick people as a profit opportunity.

The real practical issue though, is what FG found when they tried to implement their policy - that Ireland just to small to create a competitive market for insurers.

dulpit

https://www.boards.ie/discussion/comment/117658574#Comment_117658574

If it's run for the benefit of staff and run by unions, how do you explain the terrible levels of pay for nursing staff?

mariaalice

The NHS do none hospital care much better, that is not saying the NHS is better its better in parts and having to pay to see the GP here has a big impact on this, having to pay means people present later with a non-urgent but important issue which has implications for hospital care. In the UK most chronic conditions are managed by GPs, there are other ridiculous issues here too, for example, you have to have a medical card to accesses a lot of of the services that the public health nurse offers!! A good example for the UK is the stand-alone sexual health clinics nobody should be going to see a GP for contraception. There is a very hotchpotch hospital-focused care in Ireland. Hospitals should only be for the very ill all other care should be in the community.