Why don't we have ACTUAL universal healthcare like the rest of Europe?

https://www.boards.ie/discussion/comment/118056004#Comment_118056004

I'm not sure which think tank you mean, can you link me to it? I attached references to EHCI report, I was just using it as a benchmarking tool. I'd acknowledge any Swedish political affiliation or power model if it were necessary, while simultaneously recognising the Swedish model of healthcare as being ranked at number 8 on the list. Perhaps it is their way of "providing open and transparent benchmarking and recommendations of strategies for improvement and change" but that doesn't mean that the information is not worth reviewing and learning from. Just in case anyone feels the need to review for themselves I'll leave the link here https://healthpowerhouse.com/

(I don't think Ireland is in any danger of giving up it's "Socially Democratic Republic" status anytime soon.)

https://www.boards.ie/discussion/comment/118056011#Comment_118056011

I found the details by reverse searching from the name of the report provider, Health Consumer Powerhouse, and in fairness that didn't take terribly long. Their "indicators" might be picked to suit their purpose, which is to support conservative political parties in marketising public services (in this case, healthcare) - or indeed they might not. Do you know for sure? Conservatism is a valid political view, by the way, but I just wouldn't want anyone assuming that the report was either unbiased or produced by an unbiased provider. It's easy to track who founded the HCP think tank, his previous involvement with the Timbro think tank which promotes conservative, tax-cutting and market-oriented approaches to public service provision in Sweden, and his prior involvement with the Swedish versions of IBEC or other industry and business groups, as well as his time as a local Moderate Party representative (the former Swedish Conservative Party).

I'm not being critical of HCP or the report in and of themselves, as I haven't the capacity to peer-review their work (well actually, I do, but it would take me a wee while and I'd want to be getting paid for it). My point is that unless you know a lot about their credentials and the technical details of the indicator definition and data gathering methodology, it's hard to be sure that their "league tables" are objective and independent. It's not as if it was a large-scale research project written by an academic research team at a university and peer-reviewed by others.

Whether or not you think Ireland is about to change its approach to healthcare, I'm sure you'll acknowledge that it's a known technique in political agenda-setting to present ideas, concepts and report data as objective analyses that are independent of particular political viewpoints, when in fact they are anything but. I'm not definitively saying that this is what HCP are doing, but until one knows that they aren't, it's a useful filter through which to read the data.

https://www.boards.ie/discussion/comment/118056017#Comment_118056017

This is very rabbit hole kind of stuff.

"Their "indicators" might be picked to suit their purpose, which is to support conservative political parties in marketising public services (in this case, healthcare) - or indeed they might not. Do you know for sure? "

No, but next time I see Mr Hjertqvist, I'll ask him what he was doing on the night Harriet Vanger disappeared.

I honestly didn't do a Lisbeth Salander on what I just figured was "independent" and "transparent" research, my bad. While it may be affiliated with a Swedish backed team, it's more likely as a result of "The National Board of Health and Welfare (Socialstyrelsen) is a government agency under the Ministry of Health and Social Affairs that compiles information and develops standards to ensure good health, social welfare and high-quality health and social care for the whole population." That's sort of their job, or at least where their tax payers money goes to improve their health services. Imagine if Ireland was only able to provide similar outcomes, due to similar research and development.

Unfortunately we don't have the resources and our tax pennies are constrained to propping up other areas of a flailing system. Such data can also really only be acquired by means of international co-operation and Ireland would not be best placed to obtain it all by itself.

I did a brief google just to check for any references and on first search there was a match for reference to an Irish Examiner report dating back to 2007, so the EHCII report isn't new and has been around a while at this stage. https://www.irishexaminer.com/news/arid-30330224.html (Not that it makes it any more or less "trustworthy", but definitely tried and tested.

Peregrinus

https://www.boards.ie/discussion/comment/118055964#Comment_118055964

This suggests, though, that the problem in Macedonia was one of information and communication - medical specialists and diagnostic facilities had spare capacity that was going unused because GPs couldn't readily find out about it in a timely fashion. Unless this is also the cause of waiting lists in Ireland, introducing an e-booking system is not going to have the same results in Ireland.

So, the first question is, do Irish medical specialists and/or Irish diagnostic facilities have unused capacity? If and only if the answer to that question is "yes", then the next question is "why is that capacity going unused?" And only if the answer to that question is "because the people who have need of that capacity can't find out about it" does the Macedonian solution look like something that would benefit Ireland. Otherwise you need to craft a solution that addresses the causes of waiting lists in Ireland.

riclad

If you need to see a specialist or a consultant you, ll probably have to wait a year or else hope you can afford to pay to go private so our system is not perfect I think it's important that we have the option to pay for private healthcare

Many people in American go on gofundme a website to seek donations to pay for medical operations that are not covered by medicare which varys from state to state

Every country is experiencing supply chain issues due to workers effected by covid and shortage of truck drivers etc

https://www.boards.ie/discussion/comment/118056031#Comment_118056031

That report does outline precisely (and I'll probably go into more detail with it because brain likes to do that at 4am) that the problem is what they lovingly call MDD, or management deficiency disorders. To understand the information and communication element you'd probably have to be familiar with how administration system currently works in the HSE. It's less a question of surplus diagnostic facility capacity and more an issue of gatekeeping and the referral system. I will try my best to unpack that, I know it's long but it does help to give an outline and maybe answer some of your questions on the subject.

refer you to

5.3 Waiting lists: A Mental Condition affecting healthcare staff and administrators?

Over the years, one fact becomes clear: gatekeeping means waiting. Contrary to popular belief, direct access to specialist care does not generate access problems to specialists by the increased demand; repeatedly, waiting times for specialist care are found predominately in systems requiring referral from primary care, which seems to be rather an absurd observation. (there's a figurative map here)

Also visible to the naked eye, there is a striking absence of a financial connection with good waiting time situation in healthcare. This could explain the limited effect of showering a billion euros over Swedish County Councils to make them reduce waiting times. It seems that waiting times for healthcare services are a mental condition affecting healthcare administrators and professionals rather than a scarcity of resources problem.

One of the most characteristic systems for GP gatekeeping, the NHS in the UK, spent millions of pounds, starting in 2008, on reducing waiting and introduced a maximum of 18 weeks to definitive treatment after diagnosis. The patient survey commissioned by the HCP for the 2012 and 2013 Indices did show improvement, much of which seems to have been lost by 2018. This is different from Ireland, where patient organisation survey responses are still much more negative than (the very detailed) official waiting time data. For this reason, after several years of accepting official Irish waiting time statistics, the EHCI since 2015 has scored Ireland on patients’ versions of waiting times. 

5.3.1 Why is there no correlation between accessibility and money? Answer: Because it is inherently cheaper to run a healthcare system without waiting lists than having waiting lists! Contrary to popular belief, not least among healthcare politicians, waiting lists do not save money – they cost money! Healthcare is basically a process industry. As any professional manager from such an industry would know, smooth procedures with a minimum of pause or interruption is key to keeping costs low! 

Chiparus

Healthcare just like the utilities previously, is ripe for privatisation, certainly the profitable bits, why do you think certain people who have been the subject of tribunals are so intent on buying private hospitals?

The Public Health Service is poorly mananged, by relatively underpaid and undertrained managers struggling in an under resourced system, any good ones are head hunted paid handsomely by the private sector.

is_that_so

https://www.boards.ie/discussion/comment/118054583#Comment_118054583

So not the gubberment. It's not really nonsense and you seem to have great faith in all of those imaginary KPIs. For now there's cheap money to fund it but it will ultimately require higher taxation to pay for such things, especially with the CT hits of the new OECD tax deal. We don't like higher taxes and some people imagine that common pot is never ending.

https://www.boards.ie/discussion/comment/118055981#Comment_118055981

I’ve been meaning to google that tax claim for Sweden. Here’s what wiki says.

Sweden has a progressive income tax, the rates for 2021 are as follows (based on yearly incomes):

Sweden Income Tax Rates

Taxable income is reduced by general deductions which means that the marginal tax in practice varies between 7% on incomes just above 20,008 kronor to 60.1% on incomes above 675,700 kronor.[4] For an average salary, on an additional pay of 100 kronor, the employee first pays 32 kronor in income tax (direct, 32%).

for an average salary here, or just above, the rate is ~50%. We probably need a third tier though.

https://www.boards.ie/discussion/comment/118056247#Comment_118056247

You literally didn't address anything in my post. We pay enough tax for a good-to-excellent health service as it is.

is_that_so

https://www.boards.ie/discussion/comment/118057223#Comment_118057223

And that's a QED on the tax! What's to address? You said nothing apart from list off KPIs out of a management book.

https://www.boards.ie/discussion/comment/118057242#Comment_118057242

Yes, it is a QED on the tax, glad I've convinced you of that. I think it's great that you're open to changing your position and conceding that you were incorrect, kudos.

I really would love to know what your angle is here though. Is it that because Ireland's special we should pay twice as much as anywhere else for a similar level of service?

Imaginary KPIs. 🤣 Not really worth arguing with people who won't actually engage in logical debate or use actual information to make arguments. And do you think I'm defending the government or something? Because I did a tiny bit of googling last night and saw stuff about how we have about a third as many Urologists as New Zealand and 15% as many as Denmark. Mental health we're apparently at half the level of staff we should be at. https://www.independent.ie/irish-news/health/one-million-patients-on-public-waiting-lists-doctors-warn-38520498.html

I'm going to take a wild guess that we probably don't have 6 times as many ENT or gastroenterologists or anything else than Denmark. The figures in the article above are likely reflective of many parts of our system.

So there we have it, we spend plenty on healthcare as it is which only covers half our population yet we don't have enough of the right staff. That's on this government, the last government and a few more. And at the end of the day people tend to get what they deserve. As a country we shrug and say "Oh well" and nothing changes. And someone who points out clear an obvious facts is apparently just using made up KPIs straight from the management handbook. I'm sorry for pointing out the terrible value for money we're getting, I clearly love the government. Or something, who knows what you're trying to say.

is_that_so

https://www.boards.ie/discussion/comment/118057326#Comment_118057326

And again, I'm not sure what it is you think I'm supposed to engage with, your superior ability to use Google? All you did was point out X,Y and Z is wrong but offer no solutions whatsoever. That’s a gripe and barely even makes the cover page of one of the myriad HSE reports.

As for engagement I believe our problems have far less to do with money than how the whole thing is structured at present. Start moving on ways to fix the basic holes there instead of airily waving at speed and cost and other fancy stuff will give us a better functioning health system.

My position on the tax is unchanged. I really haven't and I genuinely do not believe that Irish people would be prepared to agree to the amount of tax other countries use to operate their systems but each to their own.

Wanderer78

https://www.boards.ie/discussion/comment/118056081#Comment_118056081

..yes, and theres nothing extractive about the insurance industry!!!!

theteal

https://www.boards.ie/discussion/comment/118054855#Comment_118054855

Yes and 111 will get you a queue skip for the hospital - great service, we've had to use it a few times.

For urgent issues, you ring in the morning and you'll have an appointment for later that day - we did exactly this today, appt is at 16:00. Granted you're likely to be on hold for 30+ mins when you call but that's just the way it is.

I've had to wait a few weeks for a fungal toe appt in the past but I'm hardly banging the door down for that one. I had some minor non-critical surgery in 2019, from GP visit to slice and dice was <3 months.

Now they did mess me about when I was trying to get my knee sorted a few years ago, so they're by no means perfect but after a decade here I know that's the exception as opposed to the rule. People around here love to throw out the 3-4 week GP wait time line and I just have never seen it. However I do agree there should be nominal a charge for GP visits but I'm guessing a lot of the regular users of the service are benefits people who would have to be exempt from the charge were it to exist.

Geuze

https://www.boards.ie/discussion/comment/118057366#Comment_118057366

Yes, you are correct that Irish people don't like paying more tax.

They were asked to pay 160 pa for water, and marched on the streets over that.

Now, regarding healthcare, we already overspend on healthcare, relative to the age profile of our population.

We spend as much pp as older countries, which means we overspend pp, for our age profile.

So we don't need more spending.

Slaintecare would be a re-allocation of spending: thousands of people drop health ins, pay a bit more tax to replace lost insurance income to hosps.

Taxes are higher in other countries, yes, as they have older populations, or a different welfare state, etc.

Wanderer78

https://www.boards.ie/discussion/comment/118057613#Comment_118057613

...and again, we re still not talking about the highly extractive elements of the insurance industry, yes there are wastes and inefficiencies in the public element of our system, that need to be addressed, but.....

Ben D Bus

https://www.boards.ie/discussion/comment/118054590#Comment_118054590

Co. Tyrone. GP only takes calls before 09:30. Start dialling at 09:00 and keep redialling and praying to get through. Same day appointments only and if you don't get through you have to try again next day. Even then it's only a telephone consultation unless you can convince the receptionist you're at death's door.

https://www.boards.ie/discussion/comment/118054583#Comment_118054583

Economies of scale will come into play here, I fear. That is a massive market which can be used to drive down costs of a whole raft of expenses.

Jafin

https://www.boards.ie/discussion/comment/118054485#Comment_118054485

Maybe every GP practice is different in the UK (or maybe things have changed in the past 10 years), but that wasn't the case when I was a student in London from 2011-2014. We could only make an appointment on the day we actually wanted to see the GP. I needed to see a GP near the end of my first year at college and when I rang up around 9am they said they were booked up for the day. I asked could I schedule an appointment for the following day and was told no, and that you could only make an appointment on the day you want to go in, so I had to make sure I was up and phoned them as soon as they opened the following day.

crossmolinalad

https://www.boards.ie/discussion/comment/118054455#Comment_118054455

And a heath insurance in Holland cost about a 150 euro a month for everyone No medical card or similar Same prize for everyone , young old , employed unemployed No thanks

conorhal

https://www.boards.ie/discussion/comment/118054599#Comment_118054599

GP's in this country are (in my experience) some of the laziest and most useless health professionals in Europe.

They are literally nothing more than 65 euro a pop gatekeepers for consultants and if they could actually do their job the hospitals wouldn't be so overburdened. I've had them roll their eyes at me for having the temerity for mentioning more than one ailment in a visit because they might have to spend more than the 15mins that they've allotted to your care to bilk 65 quid out of you for a consultants letter before moving on to the next sucker in the waiting room.

My folks will only go to their GP in Portugal because he’s brilliant, and of course he is, because he’s required to spend a month a year in the local hospital on his expertise and in A&E. Training is also mandatory so he’s up to speed and was able to instantly identify the medication that was (mis) proscribed to my mum as the cause of symptoms she’d been complaining about to doctors for years. Her GP there then prescribed an alternative medicine that her consultant here had never even heard of. That tells me everything I need to know about the scam that is the Irish healthcare system.

topmanamillion

https://www.boards.ie/discussion/comment/118057142#Comment_118057142

https://www.irishtimes.com/opinion/so-you-want-a-swedish-style-welfare-state-that-ll-be-more-tax-please-1.4188165

"If Ireland taxes like Swedes, the wealthiest will pay a little more, and everyone else will pay quite a bit more. The poorest will pay a lot more." - No chance that gets by here. People want more and better free services and they want Denis O`Brien, Dermot Desmond and Bono to pay for it.

https://www.boards.ie/discussion/comment/118058675#Comment_118058675

Well those weren’t the numbers I saw in the Wikipedia article, although I should probably go directly to the source.

(This is income tax. The rich mostly avoid that.)

jester77

I'm in Germany and pay over €700 a month for myself for one of the cheapest plans, kids are extra on top of that, a few hundred each. If you are full time employed, the employer would cover around 50% of that, otherwise you pay the full amount. I have to cover the first €600-700 per annum on that plan and then I can claim back some of the costs over that amount. Have never gotten remotely close to ever making a claim!

RedCardKid

https://www.boards.ie/discussion/comment/118054619#Comment_118054619

Re German system:

Approx. 15% of your salary at source, this is then matched by your employer at a slightly lower rate, meaning the real cost is approx. 27% on public meidcal insurance. That covers basic medical care, doctors visits, on ward hospital stays ...... prescriptions are capped at €5 per item. Certain things are only available if you pay privately, perfect example is a filling. Basic amalgam fillings are free, however 95% of dentists refuse to use them. A composite filling costs approx. €50-100, inlays €700 - 1200, professional teeth cleaning approx. €100. Lactose / fructose tests - carried out free of charge if you enter hospital overnigth, costs €60 - 80 if you go privately and it is over and done in 2 hours. Doesnt always make sense however that is how the system works ... had my eyes opened when I went over to work for a few years and ended up employing 30-40 people.

Private insurance is only available if you are self employed, a civil servant (subsidised at 50% by the government) or you earn approx. €70k plus per year and opt out of the public system. If you are privately insured you will pay all medical costs upfront and be reimbursed at a later date. If you stay away from doctors or hospitals for a year and have bills below €700-900 you get rewarded by the insurance company in the form of fee refunds, leading to more serious illness or a lack of screening amongst privately insured. 1k per month is cheap .... I have a workmate who is paying nearly €1600 for himself and two kids, he knows by 2023 he will be hitting €1900 as his daughters are hitting teenager years.

https://www.boards.ie/discussion/comment/118057603#Comment_118057603

Frequently the people on benefits, because it is free, misuse the system more. That goes for everything that is "free"... it will be abused

topmanamillion

https://www.boards.ie/discussion/comment/118059443#Comment_118059443

Seems like a bonkers system. People avoiding health checks so they can get refunds for no claims because the price is so exorbitant defeats the purpose of having health insurance. The HSE is as dysfunctional as a health service can get but there's definitely a degree of rose tinted glasses when people talk about foreign health services. Most of the ones that are functional, people are paying though the nose for access to them which is something Irish people aren`t prepared to do.

Geuze

https://www.boards.ie/discussion/comment/118059443#Comment_118059443

@RedCardKid ,

the public health insurance rates in DE are as follows:

• The public health insurance rates charged by the Krankenkassen are 14.6% (plus 1.3% average supplemental premium) of your monthly income up to a maximum salary amount of 4,837 Euros. This means that the average monthly premium on the market for 103 public Krankenkassen can be up to 770 Euros.

https://www.howtogermany.com/pages/fastfacts.html

Government Health Insurance System (GKV)

Most German residents (approx. 73 million people) are members of the government health system. If your gross salary is less than 64,350 Euros per year, or 5,362 Euros per month in 2021 then membership in the GKV is mandatory. The government health insurance scheme is administered by 103 Krankenkassen and they charge the same basic rate of 14.6 % plus a possible average supplemental rate of 1.3 % of your eligible gross salary with a cap set at a maximum monthly income of 4,837 Euros (2021 figures). If you earn more than this income threshold which is set each year, you do not pay a higher insurance premium. Assuming a maximum monthly health insurance premium of 770 Euros as an employee earning at or above the income threshold you are therefore a voluntary member and your own contribution will be approximately 385 Euros with your employer paying the other 385 Euros. The general minimum period of membership with any Krankenkasse is presently 12 months. You can switch government health fund providers by giving two months’ notice after 12 months membership or if a supplemental premium is increased. As a voluntary member of the GKV you can opt out at any time with a 2 month cancellation notice if you prefer a private health plan and have been accepted by the insurance company of your choice.

You seem to suggest it's 15% ee + 15% er, whereas it is 15.9% in total, split between ee and er.

https://www.boards.ie/discussion/comment/118058618#Comment_118058618

The Gp's are not the gatekeepers, they are just sending requests to a system who determines what happens to that request. The HSE is the gatekeeper of healthcare in Ireland.

The idea of a GP making a direct booking is a bit radical because it eliminates that need for a guided tour around the HSE mulitverse and actually means that the patient has the option to choose from a number of availabilities, even if they might need to travel further distances to obtain it. It gives more options and clears backlog and opens up opportunities to develop hubs designed for particular specialties while bringing GPs back into the fold and enabling them to do a better job. Having access then to results just as instantaneously gives them more control over their patients care and the ability to process it more effectively and efficiently. It might also justify any minimal basic GP based fee as it would increase their provision of care.