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An "Irish NHS" - what needs to change?
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Well I would think there’s some element to it. I haven’t seen a breakdown on geography of vacant consultant posts but I doubt it’s in Dublin, Limerick, cork, Galway or even Waterford. Which makes me thing that the reason are not all salary related.
I’m a healthcare progressional also - couldn’t pay me enough to work in letterkenny. All the actions in the big hospital. But there might be a salary that people would move there for. But then you have different salary levels (as there already is).
You earn far less in the country hospitals., also the country loading for consultants not working in the East of the country was removed in 2008. But that said there are difficulties recruiting in Dublin/Cork as well- but there wont be any closures of Dublin/Cork hospitals because they cannot recruit - the same cannot be said for country hospitals.0 -
Healthcare professional as well. I think there's definitely a geography element to it as well, if you're from Galway, Cork, Dublin then there's a reasonable chance you'll have gone to college there, you might intern there, your friends & family will be there so why would you want to base your life in somewhere like the midlands where you dont have many facilities or connoections of things like the sea never mind working in a smaller hospital that might not work as well (I'm being policially correct here, I could describe these hospitals in other ways!) with less resources.
And of course therein lies the problem. ‘We’ are only good at our jobs because we’re in big hospitals with lots of support, lots of dedicated professionals and lots of interesting patients. We stand on the shoulders of giants who made the hospital what it is and we just add to it.
Staff in those other hospitals don’t have that luxury. No ‘big’ consultant jobs. No nice things said about them. Comments from the likes of me looking down their nose at them. It’s no wonder they don’t function so well. And yet they are of critical importance to the health service. Model 3s and model 2s are so important. Imagine what they’d be like if we could transfer our best healthcare professionals from all disciplines in the big hospitals (inc managers) down there.0 -
You earn far less in the country hospitals., also the country loading for consultants not working in the East of the country was removed in 2008.
Can you explain that? How would consultants on comparable contracts (a, b or c) earn less in a hospital in the country rather than city?0 -
Mostly it is the onerous call usually one in 3, you get the same pay as someone on a one in 10 call in Dublin.
Dublin/Galway/Limerick/Cork would have higher levels of private patients - plus access to private hospitals, one of which is co- located with the public hospital.
But there’s onerous calls in Dublin. The children’s hospitals - some surgical services.
Max fax in sjh if I remember correctly.
And there’s not been b or c contracts in a while in thought. Public only contract in SVUH is the same as LUH, is it not?
By the way - why aren’t you working??!!!!0 -
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When it comes to solutions, I have a few suggestions.
1) Train enough doctors.
At minimum we need to double the number of doctors we train, why are we not doing this?
Fund the places in colleges and put the infrastructure in place to produce enough doctors to meet our needs. we piss billions up the wall when mere millions are not being spent to address a root cause of the issue.
2)Retaining graduates from medical school.
I think most people would agree that graduates in medicine are a resource that the state has invested a significant amount of time and money training but year after year nothing is done to retain such vital resources in the state.
We should be offering those good enough to get into medicine zero fees, free accomodation and a per-diem to students that constitute a critical resource that we require.
However, these benefits should only be offered on the basis that those in reciept of them are obliged to work within the Irish hospital system for 10 years. If that doesn't suit them and they want to hop on the first plane to the UK or the US instead then then would be required to pay back the cost of their education in full or chose to pay it in full from the outset.
3) Wages in medicine need to go down and so do the hours worked.
You can make a hell of a lot of money as a doctor, if you're prepared to burn out fast.
Some kind of balance needs to be created where we pay less but provide medical professionals better conditions in compensation for that. No doctor should have to work more then a 40hr week and shift work should accomodate a life.
That means more doctors working fewer hours on less pay. I personally know a couple of doctors that have left high paying jobs to have a work life balance.0 -
When it comes to solutions, I have a few suggestions.
1) Train enough doctors.
At minimum we need to double the number of doctors we train, why are we not doing this?
Fund the places in colleges and put the infrastructure in place to produce enough doctors to meet our needs. we piss billions up the wall when mere millions are not being spent to address a root cause of the issue.
2)Retaining graduates from medical school.
I think most people would agree that graduates in medicine are a resource that the state has invested a significant amount of time and money training but year after year nothing is done to retain such vital resources in the state.
We should be offering those good enough to get into medicine zero fees, free accomodation and a per-diem to students that constitute a critical resource that we require.
However, these benefits should only be offered on the basis that those in reciept of them are obliged to work within the Irish hospital system for 10 years. If that doesn't suit them and they want to hop on the first plane to the UK or the US instead then then would be required to pay back the cost of their education in full or chose to pay it in full from the outset.
3) Wages in medicine need to go down and so do the hours worked.
You can make a hell of a lot of money as a doctor, if you're prepared to burn out fast.
Some kind of balance needs to be created where we pay less but provide medical professionals better conditions in compensation for that. No doctor should have to work more then a 40hr week and shift work should accomodate a life.
That means more doctors working fewer hours on less pay. I personally know a couple of doctors that have left high paying jobs to have a work life balance.
Some good points there.
Very difficult to get students to pay after they leave college.
Maybe get rid of the undergraduate courses and make medicine a graduate school thing. Higher fees and more mature students.
The students going in to medicine at age 22/23/24 would be graduates from science etc and would be more committed to a career in medicine.
IMHO from meeting both med students who went the undergraduate course and others who went the post-graduate route the latter seem happier with their choice- as in they had more time to think about it.
Sweeping generalisations so feel to disagree0 -
This in practice would be damaging to the health service. Ireland is small and critically dependent on trainees going abroad on fellowships during HST or post-CCST to larger centres to gain further experience/sub-specialisation and then return to Ireland to bring those skills back.2)Retaining graduates from medical school.
I think most people would agree that graduates in medicine are a resource that the state has invested a significant amount of time and money training but year after year nothing is done to retain such vital resources in the state.
We should be offering those good enough to get into medicine zero fees, free accomodation and a per-diem to students that constitute a critical resource that we require.
However, these benefits should only be offered on the basis that those in reciept of them are obliged to work within the Irish hospital system for 10 years. If that doesn't suit them and they want to hop on the first plane to the UK or the US instead then then would be required to pay back the cost of their education in full or chose to pay it in full from the outset.
The reality of this is that trainees entirely self fund this fellowship and take a massive pay cut in doing so (in most countries a fellowship would be about 50% of a registrar salary) so they save for many years (or take out a loan) for this experience abroad.
While a good deal (probably most I'd say) do come back at some point, many stay abroad for a multitude of reasons relating to the HSE. Working conditions for doctors are absolutely shocking and this remains so as a consultant. Another big factor is that the jobs just aren't where people want to work- we have far too many small regional hospitals that do bog standard medicine/surgery and it's difficult for someone that's gone on fellowship in Harvard or Melbourne or London to come back and work in a small rural centre with none of the complexity they've spent years specialising in.0 -
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But there’s onerous calls in Dublin. The children’s hospitals - some surgical services.
Max fax in sjh if I remember correctly.
And there’s not been b or c contracts in a while in thought. Public only contract in SVUH is the same as LUH, is it not?
By the way - why aren’t you working??!!!!
Sorry just got home an hour ago. Onerous call in Dublin is only in specialities in which there are no positions outside of Dublin eg Max fax or paediatric neurosurgery.
As for b or c contracts , most contracts offered now are B contracts some C contracts but a lot of positions are changed quickly after appointment form B to C.
The only A contracts ( public only) are in Emergency medicine or psychiatry.
If you want to go through them: look at the information booklets
https://publicjobs.ie/en/job-search?category=3&searchphrase=
But you can see most advertised consultant positions are B.0 -
Can you explain that? How would consultants on comparable contracts (a, b or c) earn less in a hospital in the country rather than city?
In terms of C , it is down to the large number of patients with PHI and the large number of private hospitals.
For B contract it is down to the large number of private patients that use the public hospital and may be billed
For A contracts there is less , but although A contracts may not engage in Private practice - they may work in private hospitals so long as they do not bill the patients eg private emergency departments
17% of contracts are the A , the rest are B or C or I or II0 -
When it comes to solutions, I have a few suggestions.
1) Train enough doctors.
At minimum we need to double the number of doctors we train, why are we not doing this?
Fund the places in colleges and put the infrastructure in place to produce enough doctors to meet our needs. we piss billions up the wall when mere millions are not being spent to address a root cause of the issue.
2)Retaining graduates from medical school.
I think most people would agree that graduates in medicine are a resource that the state has invested a significant amount of time and money training but year after year nothing is done to retain such vital resources in the state.
We should be offering those good enough to get into medicine zero fees, free accomodation and a per-diem to students that constitute a critical resource that we require.
However, these benefits should only be offered on the basis that those in reciept of them are obliged to work within the Irish hospital system for 10 years. If that doesn't suit them and they want to hop on the first plane to the UK or the US instead then then would be required to pay back the cost of their education in full or chose to pay it in full from the outset.
3) Wages in medicine need to go down and so do the hours worked.
You can make a hell of a lot of money as a doctor, if you're prepared to burn out fast.
Some kind of balance needs to be created where we pay less but provide medical professionals better conditions in compensation for that. No doctor should have to work more then a 40hr week and shift work should accomodate a life.
That means more doctors working fewer hours on less pay. I personally know a couple of doctors that have left high paying jobs to have a work life balance.
We already train more than enough doctors , - the highest in the eurozone pro rate ( not including non- nationals)- but there are better and more opportunities in the UK , Australia, Canada, US New Zealand so many leave .
The department of health hates doctors and nurse does not value them- sees them as an inconvenience.
We really need to start asking why public hospitals including Dublin ones cannot recruit consultants and why the department of health has made them fee so unwelcome- it is quite an achievement0 -
We already train more than enough doctors , - the highest in the eurozone pro rate ( not including non- nationals)- but there are better and more opportunities in the UK , Australia, Canada, US New Zealand so many leave .
GPs in France charge 25, versus 50+ here.
Consultants in France charge 46-60, versus 150+ here (I think 175/180-200 for first consultation, less afterwards?)
As the rates of pay are so high here, double what French doctors earn, why are doctors leaving here?
Is it to do with training/experience? As in, I will go and train in a large busy hosp abroad?0 -
GPs in France charge 25, versus 50+ here.
Consultants in France charge 46-60, versus 150+ here (I think 175/180-200 for first consultation, less afterwards?)
As the rates of pay are so high here, double what French doctors earn, why are doctors leaving here?
Is it to do with training/experience? As in, I will go and train in a large busy hosp abroad?
Perhaps you could ask why French doctors ( or indeed Northern Irish ones) are not coming here.
Irish Doctors are not leaving here to go to France, they re going to Australia, UK, Canada, US, New Zealand .
https://www.jpsmedical.com.au/emergency-jobs/emergency-medicine-consultant-head-of-department-clinical-director/3212922?source=Indeed
Remember the effective tax rate is less than 30%
Junior doctors in Australia would take home more than consultants in Ireland.0 -
GPs in France charge 25, versus 50+ here.
Consultants in France charge 46-60, versus 150+ here (I think 175/180-200 for first consultation, less afterwards?)
As the rates of pay are so high here, double what French doctors earn, why are doctors leaving here?
Is it to do with training/experience? As in, I will go and train in a large busy hosp abroad?
The cost doesn’t mean much though without considering overheads.
From speaking to GPs who are friends about it, the reason why the private GP charge is so high is to offset the pittance they get for GMS patients. This is even more true now that Under 6s are free. The GP gets a relatively small flat rate per year for under 6s and over 70s which are among the biggest users of the service. They have to make up the funding elsewhere thereafter.0 -
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Anita Blow wrote: »From speaking to GPs who are friends about it, the reason why the private GP charge is so high is to offset the pittance they get for GMS patients. This is even more true now that Under 6s are free. The GP gets a relatively small flat rate per year for under 6s and over 70s which are among the biggest users of the service. They have to make up the funding elsewhere thereafter.
Yes, I had heard this.
I know that GMS rates are fixed pa, not per consultation.
So high usage GMS patients means a low payment per consultation.
Fair enough.
I wonder what the weighted average fee is?
I wonder is this why I see a GP surgery in Galway charging 40 - they don't have any/much GMS patients to pull down their average price?0 -
Yes, I had heard this.
I know that GMS rates are fixed pa, not per consultation.
So high usage GMS patients means a low payment per consultation.
Fair enough.
I wonder what the weighted average fee is?
I wonder is this why I see a GP surgery in Galway charging 40 - they don't have any/much GMS patients to pull down their average price?
Yes it's much more nuanced than just charging per patient. It's not as if a GP is making €60 per every 10/15 minute consultaiton throughout the day.
Some GPs have a larger percentage of private patients e.g. certain parts of south dublin whereas other areas have larger percentages of public patients. This can even vary greatly across smaller towns like Athlone, Tullamore!
The fees for GMS patients that GPs receive e.g. capitation rates are pretty low e.g. €125 for under 6s (i.e. no matter how many times an under 6 patient presents, the GP will just receive €125 for the year and some attend a lot more than others!).
For completeness of information however, there are also other fees that GPs receive from the HSE e.g. Special Type Consultations (STCs) for doing things like putting in certain long active contraceptives or emergency ECGs and also things like the mother and child scheme (antenatal scheme) and childhood immunisation scheme.0 -
About ⅓ of all GP consultations are musculoskeletal.
https://www.england.nhs.uk/ourwork/clinical-policy/ltc/our-work-on-long-term-conditions/musculoskeletal/
Chartered physiotherapists are experts in musculoskeletal assessment, diagnosis and triage. Approx 24 Advanced practice physiotherapists in physio led triage has removed 125000 people from the ortho and rheum waiting lists. Which is the most successful waiting list management intervention ever in our state. It’s funny how there’s no investment in another 24. We’re cheap and effective. And yet - I’ve heard moaning from senior orthopods - at national conferences - that it’s made them busier. Instead of 1in5 needing surgery it was now 1:3 - or numbers to that effect. Patient centred, eh.
https://www.imj.ie/wp-content/uploads/2020/09/Reduction-of-Orthopaedic-and-Rheumatology-Outpatient-Waiting-Lists-The-National-Musculoskeletal-Physiotherapy-Triage-Initiative.pdf
http://advancedpractice.physio/
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2106-7
Investment in healthcare professionals other than doctors and nurses; Investment in our training, our practice and our interventions; could have significant benefit from all involved.
Imagine an advanced practice physiotherapist is every GP practice in the country. The patients would be seen quicker, be assessed, diagnosed and treated better, and would have better clinical outcomes. Physios have can order and have limited ability to interpret bloods and images. Physios have limited prescribing rights for common analgesics. Patients who need to be reviewed by the GP can be - and sure what with all the time they’ll have with a ⅓ of their patients taken from them. Everyone’s a winner!0 -
There is no reason Europe could not have a NHS style service.
We could do away with all private care in Europe and nationalize all health care in Europe.
No one person no matter how rich they are should have the right to buy better quicker treatment.0 -
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There is no reason Europe could not have a NHS style service.
We could do away with all private care Europe and nationalize all health care in Europe.
No one person no matter how rich they are should have the right to buy better quicker treatment.
You do not get better treatment that is a myth quicker treatment is a different matter.0 -
About ⅓ of all GP consultations are musculoskeletal.
https://www.england.nhs.uk/ourwork/clinical-policy/ltc/our-work-on-long-term-conditions/musculoskeletal/
Chartered physiotherapists are experts in musculoskeletal assessment, diagnosis and triage. Approx 24 Advanced practice physiotherapists in physio led triage has removed 125000 people from the ortho and rheum waiting lists. Which is the most successful waiting list management intervention ever in our state. It’s funny how there’s no investment in another 24. We’re cheap and effective. And yet - I’ve heard moaning from senior orthopods - at national conferences - that it’s made them busier. Instead of 1in5 needing surgery it was now 1:3 - or numbers to that effect. Patient centred, eh.
https://www.imj.ie/wp-content/uploads/2020/09/Reduction-of-Orthopaedic-and-Rheumatology-Outpatient-Waiting-Lists-The-National-Musculoskeletal-Physiotherapy-Triage-Initiative.pdf
http://advancedpractice.physio/
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2106-7
Investment in healthcare professionals other than doctors and nurses; Investment in our training, our practice and our interventions; could have significant benefit from all involved.
Imagine an advanced practice physiotherapist is every GP practice in the country. The patients would be seen quicker, be assessed, diagnosed and treated better, and would have better clinical outcomes. Physios have can order and have limited ability to interpret bloods and images. Physios have limited prescribing rights for common analgesics. Patients who need to be reviewed by the GP can be - and sure what with all the time they’ll have with a ⅓ of their patients taken from them. Everyone’s a winner!
As long as they are very highly trained a physiotherapist misdiagnosed me.0 -
mariaalice wrote: »You do not get better treatment that is a myth quicker treatment is a different matter.
In a lot of cases though, quicker treatment = better treatment.0 -
mariaalice wrote: »You do not get better treatment that is a myth quicker treatment is a different matter.
Don't be so naive of course you can get better treatment if your willing to pay for better treatment.
Better and quicker treatment are 2 of the same thing to me. In the year 2021 shocking its allowed to go on.0 -
mariaalice wrote: »You do not get better treatment that is a myth quicker treatment is a different matter.
100%. The same people who treat private, treat public. They don’t practice to a poorer ability depending on whether you pay. They might make you feel nice about yourself to justify to charge.
People who work private only however - I’ve perhaps an unfair perception that - in general - they wouldn’t be ‘as good’ as public or public/private.
No evidence for that. Just a notion I’ve developed.0 -
Don't be so naive of course you can get better treatment if your willing to pay for better treatment.
Better and quicker treatment are 2 of the same thing to me. In the year 2021 shocking its allowed to go on.
Better treatment and better outcomes are different.
If you get cancer services early (and we are very good at that in ireland) then you’re outcomes are better. If you’ve to wait months for an endoscopy so as to see whether you need to access cancer services (which we’re not so good at) are time dependent. Earlier is generally better and this is what private pays for - time. But regardless of when you present, the treatment is the same. If a patient only gets their endoscopy 12 months post referral - the ‘assessment’ and ‘treatment’ that they get is too quality.
I know it’s a much of a muchness but I think it’s an important difference. You pay for time, not quality. Time does not always relate to outcomes. Cancer is the obvious thing to point to but there are a wealth of other services that private doesn’t provide - or are too expensive. Rehab for example.0 -
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There is no reason Europe could not have a NHS style service.
We could do away with all private care in Europe and nationalize all health care in Europe.
No one person no matter how rich they are should have the right to buy better quicker treatment.
Does Europe have a problem with public versus private waiting times? If it does it's only a small fraction of what goes on in Ireland, and probably in the UK too, where some have private insurance, partly to avoid NHS queues. I would hesitate to call it queue-jumping, because privately insured patients bring more resources into the system as a whole (public+private).
As for "nationalise all health care", that sort of totalitarian leftwing claptrap would never survive a constitutional challenge, never mind European human rights.0 -
mariaalice wrote: »As long as they are very highly trained a physiotherapist misdiagnosed me.
All physios are very highly trained. A number are more highly trained. Physios already diagnose MSK conditions for decades. My point above is that scope can be increased for greater capacity for patients. Doctors misdiagnose also. Lots of them. Lots of times. Issues with competence can be referred to regulators. I can get you corus details if you wish.
‘Missed disgnosis’ and working diagnosis can also be misunderstood.0 -
Economics101 wrote: »Does Europe have a problem with public versus private waiting times? If it does it's only a small fraction of what goes on in Ireland, and probably in the UK too, where some have private insurance, partly to avoid NHS queues. I would hesitate to call it queue-jumping, because privately insured patients bring more resources into the system as a whole (public+private).
As for "nationalise all health care", that sort of totalitarian leftwing claptrap would never survive a constitutional challenge, never mind European human rights.
A European free health service is the way to go.
Private health care services are not acceptable. Individuals should not have the right for better quicker services.
Citizens have the right to challenge change constitutions this can be slow but can and does happen.
I agree its a European human rights issue. A issue thats in favor of the rich.0 -
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Yes, each year that passes is another year of an unequal health service.
So it’s getting more unequal each year?
Do you mean life expectancy? Or do only mean access?
Weve been living longer every year for the past 100. But women live longer than men through all those years. So I suppose that’s unequal.0 -
So it’s getting more unequal each year?
Do you mean life expectancy? Or do only mean access?
Weve been living longer every year for the past 100. But women live longer than men through all those years. So I suppose that’s unequal.
Access is becoming more unequal to many parts of health services.
Yes we are living longer and those with better access to health services expect and do live longer.
If the services was equal and we all get the same treatment why would some have private health care? My guess is because they get a better service.0 -
Access is becoming more unequal to many parts of health services.
Yes we are living longer and those with better access to health services expect and do live longer.
If the services was equal and we all get the same treatment why would some have private health care? My guess is because they get a better service.
I’m still not clear in what instances is it becoming *more* unequal?
I presume when you mean equal, you mean in relation to access, not equal outcome. Women live longer than men, do you think women have more access to healthcare services and that’s why they live longer?
When you speak about access? Do you mean timely or equal in relation to finance only? There’s access policy written that is unequal - ie we only see these types of people first (take your pick of identifies in modern ireland) and these type of people second. Timeliness - based on increase demand and poor supply - is not the same as inequity in my view. Paying for the privilege of being seen early cos you can pay for it is unequal. By definition you are not being treated on the basis of need but on the basis of your ability to pay. Healthcare professionals who provide a private service perpetuate that. It’s in there interest for the such a private service to continue. Of course it is. I’m sure someone will tell me that they’re providing a service that the state doesn’t - and I can accept that but it’s always like they’re doing us w favour. I can’t tell you the amount of expensive exams, bloods and images that docs in private suites order. The same dose wouldn’t do it in the public clinic. It’s also in the interests of those who can pay (the vaccine sequencing has been a great leveller as to who is prioritised on the basis of need and risk). It’s also in the interest of government as they don’t need to invest what’s needed to remove the scale of private practice in Ireland.
Access to healthcare is not necessarily related to your health. A wide range of socioeconomic factors are related to your health. The poorest in society have the poorest health - they all have medical cards, all have access to GPs and all have access to medicines.
The kings fund estimate that only about 10% of a person health is related to healthcare. The rest being wealth, education, housing, etc etc.
Also, we’re not living longer. We’ve always lived to the same ages. Instead, it’s people who used to die at 50 no longer die at 50, people who used to die at no longer die at 60. It’s not that we live longer, we just die later. A much of a muchness you might say, but I thought I’d make the point. M
People chose private healthcare for a wealth of reasons. I don’t have it. I don’t see the point of it. I can’t tell you how many public patients I’ve treated for them all to say ‘I have VHI that’s why I’m being looked after so well’. It’s not. They were admitted as public patients - cos that’s where you go when you’re sick - a public hospital. (EDs don’t close which is why blackrock ‘ED’ is not an ED. It’s hard to call the beacons Ed and Ed when it’s on the first floor). Health insurance is like car insurance - if you don’t use it in that year it’s not worth much to you. I also don’t see the point any person ‘going private’ for their pregnancy. Same doctors, same midwives, same hospitals. If you’re unwell, you’ll be treated by expert clinicians regardless if you private consultant says it’s a good idea to eat your placenta. Irish women could single handedly wipe out private practice in Ireland for one single area of healthcare in one fell swoop.
That’s was all just a bit of a ramble.0 -
Economics101 wrote: »I would hesitate to call it queue-jumping, because privately insured patients bring more resources into the system as a whole (public+private)..
I’m interested in this bit. You might comment further.
As I see it, it is queue jumping - but based on ability to pay not need. You could be in the zone 3 in an ED getting a stitch put in, or in the waiting room waiting to be seen - but when a zone 1 comes in they jump the queue.
As for the second bit, and perhaps an ideology on my part - they’re bringing more into the private system. Not the public system. Private patients pay for appointments (some return are not always necessary), you pay for tests (some are not always necessary) you pay for procedures (some are not always necessary). The public system buys private services - ntpf. We buy the straight forward easy stuff, rather than doing it ourselves. Sure it’s the same docs usually - walk down the underground corridor from SVUH to svph or Mater to Mater private. They don’t / can’t take the hard stuff and it’s not financially viable for them. They more we pay them. They more we don’t invest in us.
And while I take the point that private patients are public tax payers, a bit of me thinks that (in my naive ideology that I haven’t thought through well enough) why can’t they pay more taxes with that money rather than private insurance.
What I do know is our funding model is very broken. We find our health service through 4% health levy formally in the prai and now in asc. Not everyone pays into it. ?40% of the population has a medical card - which should be for the poorest but has become a political tool and is not fit for purpose and not based on need as Frank a Murray reported in a review of medical cards a few years back for RCSI. ?40% have private health insurance. Our entire primary health service has private companies as gate keepers (GPs) and private companies dispensing (pharmacists).
It all just feels wrong.
But again. What would I know.0 -
A European free health service is the way to go.
Private health care services are not acceptable. Individuals should not have the right for better quicker services.
In France and Germany much healthcare provision is by the private sector.
FR and DE may have universal health insurance, but the provision of healthcare is not 100% State.
Do not assume that because 100% of the population have insurance in some European countries, then that means that the State are providing all the healthcare.0 -
A European free health service is the way to go.
Private health care services are not acceptable. Individuals should not have the right for better quicker services.
Free???
Healthcare is FR and DE is based on insurance.
People pay insurance premium every month.
Germans pay 15% approx of salary for health insurance.
Free!!!!0 -
What I do know is our funding model is very broken. We find our health service through 4% health levy formally in the prai and now in asc. Not everyone pays into it.
Health spending is financed by tax.
The 2% Health Levy is gone, it was replaced by the USC, which is simply another tax.0 -
I’m interested in this bit. You might comment further.
As I see it, it is queue jumping - but based on ability to pay not need. You could be in the zone 3 in an ED getting a stitch put in, or in the waiting room waiting to be seen - but when a zone 1 comes in they jump the queue.
I think that ED (I assume this is A&E) is all public system, at least as far as anything serious is concerned, so not much in the way of "queue-jumping", here. The queue-jumping argument is much more relevant for elective procedures, and where consultant referrals are concerned.
No real argument about the quality of public v private care: it's all about speed of access. Part of the problem is that in our system, tax-funded hospitals by and large get resources which are not directly dependent on "output" (sorry to use such an industrial term), whereas private facilities depend directly on "output" for their income. The incentive problem is obvious, and even if you throw more money at the public system the incentive problem will still be there.
BTW if one were to nationalise all health facilities and forbid private treatment, some people would simply go abroad. More inequality. Or do you want to forbid foreign travel for medical treatment? We had a referendum on that a few years back!0 -
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It is queue jumping , or as Ryan air would call it " priority boarding"Economics101 wrote: »I would hesitate to call it queue-jumping, because privately insured patients bring more resources into the system as a whole (public+private).
As for "nationalise all health care", that sort of totalitarian leftwing claptrap would never survive a constitutional challenge, never mind European human rights.
However you cannot equate healthcare to airline tickets.
Would you be happy for me to get faster health care because I pay more income tax ?
Morally it is repugnant and hopefully with Slaintecare the use of PHI to jump the queues in Public hospitals will end.
As for "Nationalise healthcare" being leftwing claptrap - that is exactly what Nye Bevin did - it was a brilliant success..0 -
Morally it is repugnant and hopefully with Slaintecare the use of PHI to jump the queues in Public hospitals will end.
Hopefully, yes.
But I wonder will people be quick to give up their PHI?
Or will they first want to see the public hosps and their staff meet the 12/13 week Slaintecare waiting time targets?0 -
People chose private healthcare for a wealth of reasons. I don’t have it. I don’t see the point of it. I can’t tell you how many public patients I’ve treated for them all to say ‘I have VHI that’s why I’m being looked after so well’. It’s not. They were admitted as public patients - cos that’s where you go when you’re sick - a public hospital. (EDs don’t close which is why blackrock ‘ED’ is not an ED. It’s hard to call the beacons Ed and Ed when it’s on the first floor). Health insurance is like car insurance - if you don’t use it in that year it’s not worth much to you. I also don’t see the point any person ‘going private’ for their pregnancy. Same doctors, same midwives, same hospitals. If you’re unwell, you’ll be treated by expert clinicians regardless if you private consultant says it’s a good idea to eat your placenta. Irish women could single handedly wipe out private practice in Ireland for one single area of healthcare in one fell swoop.
Regarding why people get health insurance. It's usually access, not the care that you pay for. My dad needed a hip replacement. Took a couple of months, he had insurance. My father in law needed a knee replacement, it took a couple of years because he didn't have insurance. So my father in law suffered for much linger as a result.
As to level of care/etc when it's the same doctors, my mum always tells me the story of when I was a toddler. I suffered with eczema awful, and went to clinic to be sorted. The consultant who saw me was gruff, barely reviewed me and sent me on my way. My mum then went to a private clinic, with the exact same consultant. He spent ages with me making sure all was sorted, because of course he did - he was getting paid for it.
And for pregnancy, you get access to your consultant throughout, there's a continuation and familiarisation that occurs that doesn't in the public system. We didn't go private when my wife was pregnant, but I can see why people would.0 -
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And for pregnancy, you get access to your consultant throughout, there's a continuation and familiarisation that occurs that doesn't in the public system. We didn't go private when my wife was pregnant, but I can see why people would.
Firstly - this just isn’t true. Sure who do you think holds the clinics and delivers the babies. If you think a private consultant is at every private baby’s birth you’ve another thing coming. What do you think a public consultant is doing when they’re not in private rooms? Also, you get reviewed based on need. If you’ve a healthy pregnant why do you need to be seen by an obstetrician at every appointment. People can waste €5k to make themselves feel better but paying does nothing for the outcome of th woman or the child NOTHING. Could you imagine the newspaper headlines if it did.
Secondly - I can see no clinical reason. We have the safest and best obstetric service in the world. The lowest (or close) maternal and baby mortality in the world.0 -
Hopefully, yes.
But I wonder will people be quick to give up their PHI?
Or will they first want to see the public hosps and their staff meet the 12/13 week Slaintecare waiting time targets?
The single payer model is insurances
based. People will have to pay for insurance. The GPs didn’t want what james Reilly was offering back in 2011. They wanted multiplayer in a tiny market. I understand Australia regret the change from single to multi.
Don’t know much more about it than that.0 -
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Economics101 wrote: »I think that ED (I assume this is A&E) is all public system, at least as far as anything serious is concerned, so not much in the way of "queue-jumping", here. The queue-jumping argument is much more relevant for elective procedures, and where consultant referrals are concerned.
No real argument about the quality of public v private care: it's all about speed of access. Part of the problem is that in our system, tax-funded hospitals by and large get resources which are not directly dependent on "output" (sorry to use such an industrial term), whereas private facilities depend directly on "output" for their income. The incentive problem is obvious, and even if you throw more money at the public system the incentive problem will still be there.
BTW if one were to nationalise all health facilities and forbid private treatment, some people would simply go abroad. More inequality. Or do you want to forbid foreign travel for medical treatment? We had a referendum on that a few years back!
I’m not sure what you’re on about in your last paragraph.
With regards output - there are outcomes and activity. The health outcomes of people in ireland are fairly high worldwide. We live long. Our women and babies don’t die in childbirth. Our children don’t die. But we have pockets. Some cancers we’re not so good. Others we’re very good. Suicides we’re not so good. Socioeconomic disparity we’re not so good.
But as for activity. We’re not so bad. Cancer services are good. Our ED is excellent (there is no such places as A&E). Our admission from ED to the wards is not great but when you consider that we’ve 50% (or so) less beds than scotland and we’re continually at 100% + occupancy rate then I think that’s pretty good output. Considering that investment in the health service hasn’t kept pace with our ageing population for years. In other words, the HSE wasn’t given commensurate increases in funding to match the increase in activity (more people getting older). I’m sure you’ll reference €20bn. If you know if a way to hire 16,500 highly trained healthcare professionals and build 5000 beds in a year - I’m all ears.0 -
I can categorically say I got better care in the private maternity system. It wasn't about making myself feel better. The individual care from my consultant when **** hit the fan was worth every cent. As was the the private room afterwards.Firstly - this just isn’t true. Sure who do you think holds the clinics and delivers the babies. If you think a private consultant is at every private baby’s birth you’ve another thing coming. What do you think a public consultant is doing when they’re not in private rooms? Also, you get reviewed based on need. If you’ve a healthy pregnant why do you need to be seen by an obstetrician at every appointment. People can waste €5k to make themselves feel better but paying does nothing for the outcome of th woman or the child NOTHING. Could you imagine the newspaper headlines if it did.
Secondly - I can see no clinical reason. We have the safest and best obstetric service in the world. The lowest (or close) maternal and baby mortality in the world.0 -
I can categorically say I got better care in the private maternity system. It wasn't about making myself feel better. The individual care from my consultant when **** hit the fan was worth every cent. As was the the private room afterwards.
As did my partner, the horror story that was Holles St a few years ago if you had any issues or were, god forbid, unmarried was nothing short of abuse. Second time we went private, never regretted it for a second, it was a totally different experience. Now you can argue that both children were delivered successfully, and no one died but there was a difference in overall care that simply should not exist.
I say this as someone who fully believes private care should not exist here, it should be fully nationalised, we should flood the healthcare system with doctors and nurses so that no one has to do overtime, so that none of them are constantly exhausted. As someone with many friends and family in the area, nearly all would be happier with no overtime in return for adequate staffing.0 -
I’m not sure what you’re on about in your last paragraph.
With regards output - there are outcomes and activity. The health outcomes of people in ireland are fairly high worldwide. We live long. Our women and babies don’t die in childbirth. Our children don’t die. But we have pockets. Some cancers we’re not so good. Others we’re very good. Suicides we’re not so good. Socioeconomic disparity we’re not so good.
But as for activity. We’re not so bad. Cancer services are good. Our ED is excellent (there is no such places as A&E). Our admission from ED to the wards is not great but when you consider that we’ve 50% (or so) less beds than scotland and we’re continually at 100% + occupancy rate then I think that’s pretty good output. Considering that investment in the health service hasn’t kept pace with our ageing population for years. In other words, the HSE wasn’t given commensurate increases in funding to match the increase in activity (more people getting older). I’m sure you’ll reference €20bn. If you know if a way to hire 16,500 highly trained healthcare professionals and build 5000 beds in a year - I’m all ears.
My last paragraph was in response to some other posters suggesting that total nationalisation of health services was somehow warranted: in what purports to be an open society it is an impossibility. And with reference to another poster, Nye Bevan did not nationalise everything: there were still private hospitals and doctors in private practice, albeit for a very small minority.
Sure we have an ageing population, which has required, and in future will require, more resources. But recurrent expenditure on the public system in Ireland has rocketed in the past 5 years, and we have the spectacle of agreed budgets being exceeded year after year. As for extra beds (5000?), a physical impossibility in a year. But even a multi-year capital programme will be a huge challenge. The Children's hospital debacle shows that something radical needs to be done in terms of capital programme management before more money is wasted. (My suspicion is that the detailed specifications are not properly worked out prior to contracts being signed: you need to "freeze" the specs at some stage - this holds for all complex projects).
As for my misnaming ED as A&E, big deal. When I was much younger they were known as Casualty Departments. Heavens knows what they will be called in a few years, although that decision will probably have to await the deliberations of a HSE Taskforce (or is it Working Group?) :rolleyes:0 -
I can categorically say I got better care in the private maternity system. It wasn't about making myself feel better. The individual care from my consultant when **** hit the fan was worth every cent. As was the the private room afterwards.
Well you can only ‘categorically’ say it from your perspective.
Are you suggesting then that the midwives treated you better during your labour than another women who didn’t pay (cos remember, you don’t pay the midwives anything - only the consultants)
Are you saying that private consultants treat their public patients poorer than their private patients.
Are you saying that the private consultant is on site 24/7 so s/he is there to deliver your baby.
There’s about 60000 births every year and you don’t speak for them. The clinical outcomes however do speak for all involved. There are no clinically meaningful differences in outcomes between public and private maternity care. If you are sick - diabetes, blood pressure issues, or other sort of complications - you will be seen by the experts in your care regardless of whether you want to waste €5k or not.
Why do women not advocate as strongly for private gynaecological care as they do for private obstetric care?
Why do the people who quote slaintexare not start a campaign to end private obstetric care? It’s not like the docs would have any choice in the matter if everyone just didn’t show up to their clinics.
I know plenty of women who’ve never gone public and ‘swear by’ the private system when they’ve nothing to compare it against. I know plenty of women who went to different maternity hospitals privately for each of their babies as ‘they heard’ that there was a better private doctor in another hospital. Blah blah blah. Or you ‘had a bad experience’ with x doctor or x system. And as is often the case, people confuse adverse outcomes with poor care. Pregnancy and labour are hard. It’s not 100% within the control of anyone - least not the docs and miwdwices. Clearly things happen - not getting an epidural in sufficient time etx. But healthcare and hospitals are risky places. And it’s not always possible to do whatever wants when everyone wants. If the same time money and effort went into the perinatal support, counselling, women’s health physio, lactation support as it does with going to a private consultant cos it makes you feel better then everyone would be better off. As it is you pay €5k and then when you need help you don’t have it.
I understand the importance of private rooms. We just don’t have enough. You only get a private room if it’s available. If there are sick oeople, women whose babies are dying or died - they get the room. And not on the basis of your money.
And as for ‘shot’ hit the fan. The midwife during labour wasn’t private. The equipment that was used wasn’t private. The anaesthetist who supported the obstetrician if it was that serious wasn’t private. The theatre team if it was that serious wasn’t private. The Reg wasn’t private. The paediatrician who reviewed your baby wasn’t private.
You paid the consultant to make you feel better. Your tax paid for everyone else to ensure you had a safe deliver for you and baby (which I hope you did). But don’t tell me €5k into that consultants pocket meant that you got better care than a women in the same situation as you did who didn’t pay.0 -
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