Let's fully privatize health care and abolish HSE

Fred Cryton · 01-09-2023 1:11pm #1

The State spends close to €25bn per year on health...that's €5,000 per person in the country

Why don't we instead fully privatize the sector, and instead the taxpayer will pay up to €5,000 per person per year towards their private health insurance. That would be an average, so a young person might cost €1500 while an elderly person would get gold plated €10,000 per year insurance.

This would be taxpayer funded healthcare, but implemented by the private sector.

All existing State hospitals would be leased to the private sector, and the private sector would build all additional facilities.

The beauty of this is the private sector would drive efficiencies - they would not be long getting rid of the dead wood middle management, and construction of new hospitals would be managed effectively (unlike NCH). It would professionalize things, reduce waste and inefficiencies, and would actually be value for money for the taxpayer. With the added bonus that middle class people wouldn't have to take out their own insurance.

What's not to like? If we have learned anything it's that the public sector in Ireland is completely incapable of delivering, so lets take it away from them.

01-09-2023 1:13pm

You only have to look at the US health care system to see why this would be a bad idea

markodaly · 01-09-2023 1:19pm

You are forgetting about the 10' of thousands of pen pushers who wouldn't have a job. These people vote, so politicians will never go for a plan like that.

ancapailldorcha · 01-09-2023 1:25pm

The US has one of the most inefficient systems in the world so it's clearly untrue that simply privatising the system would generate efficiency. Heck, parts of the NHS were outsourced and it was often a complete fiasco.

mazdamiatamx5 · 01-09-2023 1:35pm

Er, no

TooTired123 · 01-09-2023 1:49pm

https://www.boards.ie/discussion/comment/121056240#Comment_121056240

Literally, over 10,000 need to be dispensed with. But No minister for health is going to do that. He or she would be lynched. There are people employed in HSE admin who refused to go digital but couldn’t be sacked because the union said so. So they do nothing, really, admin duties at best.

ednwireland · 01-09-2023 1:51pm

https://www.boards.ie/discussion/comment/121056240#Comment_121056240

this, why does the op think is so inefficient. wait till the regional boards come in yet another layer of management with no structural changes.

lawred2 · 01-09-2023 1:58pm

https://www.boards.ie/discussion/2058311789/lets-fully-privatize-health-care-and-abolish-hse

"private sector will drive efficiencies"

what utter delusion... in a captive rigged market the private sector only serves as a vehicle to move money from the public purse to a shareholder's wallet.

amazing that people still hold these 1980s era Reagan and Thatcher delusions

Apiarist · 01-09-2023 2:00pm

The beauty of this is the private sector would drive efficiencies - they would not be long getting rid of the dead wood middle management, and construction of new hospitals would be managed effectively (unlike NCH).

Erm, why would it happen? When you are literally holding the keys to life or death, you can charge whatever you want, so we are not talking about making healthcare better and more affordable.

The "efficiency" in private healthcare can achieved by ensuring that people get and stay chronically ill, so that you can extract constant, predictable revenue from them. Old people who are too sick must pay all their life savings to a health provider and then die as soon as they have no more money left. That's efficiency.

What HSE needs is a feedback mechanism -- something that rewards HSE for keeping people healthy and if someone gets sick, they are treated and get better as soon as possible.

McGrath5 · 01-09-2023 2:01pm

Dreadful idea. Privatization results in a worse service/outcome for patients, all in the name of keeping shareholders happy.

On a separate note, why is Boards becoming more and more conservative leaning?

01-09-2023 2:10pm

https://www.boards.ie/discussion/comment/121056459#Comment_121056459

On a separate note, why is Boards becoming more and more conservative leaning?

We're not allowed talk about it

banie01 · 01-09-2023 2:15pm

Private healthcare does very little better than public apart from queue jumping and decor. Ireland has severe issues with the number of admin and management staff employed. Universal health care should be a fundamental human right, and anyone espousing a fully private delivery model? With the State paying the premia and private industry providing the service? Is missing a very salient point: healthcare delivery should never be about billable items. Instead, it should be about patient care and outcomes.

Also, as is also trotted out in the state-funded private healthcare argument, the model in the Netherlands, which until 2006 ran a similar 2-tier structure to our current model, I don't think that change to a single-tier government-funded model has worked out as well as hoped. I would look toward the Scandinavians, particularly the Finns, for a better model of what we should do. They spent @9% of their GDP on health in 2020 versus Ireland at @7.1% in the same period. They spend more and proportionally more per patient, but? That increase spend is borne out in far better patient experience and overall value, delivering faster service and better outcomes. The Finnish system is one of the best in the world. It is the model we should look to emulate and improve upon. It doesn't mean blindly copying and hoping for the best. It means learning what they do right, what our clinicians feel needs to be improved and throughout that review, ensuring that the patient is placed at the centre of any changes.

Better outcomes, better value for the taxpayer and better management of health resources.

EDIT added recent reports on Ireland & Finland.

https://health.ec.europa.eu/system/files/2021-12/2021_chp_fi_english.pdf

https://health.ec.europa.eu/system/files/2021-12/2021_chp_ir_english.pdf

purifol0 · 01-09-2023 2:16pm

https://www.boards.ie/discussion/comment/121056198#Comment_121056198

I was wondering how long it would take before someone piped up with this stupidity.

The US pay more per person for healthcare than we do. As in their health service is better funded than ours.

Abolishing the HSE would mean that my tax could stay in my pocket and when I need treatment I simply buy it ANYWHERE. Like I am forced to do now, except now I have to save to do so.

Out of all the medical issues I have ever had, all the HSE would do is put me on a list and get back to me years after I was already sorted, only to tell me they may have an appointment.

The problem the US has is less about healthcare or hospitals and more about the regulation of the insurance industry as a whole.

The Irish HSE is staffed to the brim with lifers in non patient facing roles, and work practices that are set by unions so that most of the nurses dont have to actually spend much time nursing and instead are desk bound. Go ask any Irish nurse how long they spend filling out forms every day, and then ask them if their union would allow software to do it.

Sleepy · 01-09-2023 2:22pm

Strike that. Reverse it.

Ban private Health Insurance, increase taxation at a commensurate level with what the public currently spend on it and funnel that cash directly to Health System. Added efficiency gains as the public hospitals would no longer need to handle the administrative cost of dealing with the insurance companies.

purifol0 · 01-09-2023 2:22pm

https://www.boards.ie/discussion/comment/121056459#Comment_121056459

**** LOL. Public sector healthcare hasnt given me a damn thing since I had my tonsils out, everything else I needed I had to pay for out of my pocket. How is never ever ever receiving treatment, versus paying money and receiving it the next day a worse outcome???

The HSE calling my injuries "elective surgery" and then classifying me as bottom of the list is the biggest slap in the face I faced as a taxpaying citizen yet. I worked in construction and stretched & torn tendons and ligaments in my leg (injury sustained not in work), meant I was going to have to go on the dole as I simply could not do my job.

And unlike those in the HSE, I cannot get paid unlimited sick pay with other peoples taxes.

purifol0 · 01-09-2023 2:27pm

https://www.boards.ie/discussion/comment/121056459#Comment_121056459

People aren't happy with paying massive taxes and reciveing (or nor receiving) piss poor services for it. Its a pretty simple concept.

Public healthcare is a great idea, but its implementation here is absolutely not worth the cost. The state and its employees have proven over decades they cannot be trusted with our money to provide the service they are paid to do, and instead are trousering the cash and blocking reform.

The upshot - half of Irish adults pay for private health insurance

Source: Switcher.ie "The latest figures from the Health Insurance Authority (HIA) report that 2.46 million people in Ireland have private health insurance, which is nearly half the population in Ireland (48%)"

01-09-2023 2:28pm

https://www.boards.ie/discussion/comment/121056547#Comment_121056547

The US pay more per person for healthcare than we do. As in their health service is better funded than ours.

And yet has worse outcomes

As I said, the US is a brilliant example of why this is a stupid idea

If you are healthy and have a good income and can afford the silly insurance prices, the US system is awesome. If you can't, good luck

Sleepy · 01-09-2023 2:28pm

The Health Insurance industry is a parasite that literally profits from human pain and suffering. Disgusting that we ever let it become a thing.

Geuze · 01-09-2023 2:31pm

https://www.boards.ie/discussion/2058311789/lets-fully-privatize-health-care-and-abolish-hse

Much of the provision of h/c across the EU is left to the market, but people have compulsory insurance.

Taking DE and FR, everybody has health insurance, but the there is a mix of providers.

I think it's a reasonable idea to harness the efficiency of the private sector, but combine that with 100% access.

Geuze · 01-09-2023 2:32pm

https://www.boards.ie/discussion/comment/121056616#Comment_121056616

What about not-for-profit social health insurance, like in DE and FR?

purifol0 · 01-09-2023 2:33pm

https://www.boards.ie/discussion/comment/121056616#Comment_121056616

You can say this about most industries, thats why we need regulated capitalism. Irish govts were big into "light-touch regulation" for the financial sector pre 2008 for instance.

Geuze · 01-09-2023 2:34pm

https://www.boards.ie/discussion/comment/121056577#Comment_121056577

We already overspend on h/c, relative to the age of our population.

Examples:

HSE has 2,000 staff in HR, they say they need 800 (that was a few years ago)
62 payroll office in HSE
We paid GP double what UK did to administer COVID vaccine
A GP in FR charges 26, here it's more like 50-65
A consultant in FR charges 44-60, here it's more like 175-225

01-09-2023 2:35pm

Only in tight margin situations with discretional spending does the private sector deliver lower costs per unit of production.

With a limited market of a few players where the spend is mandatory private provision generally cost equal or greater than public provision. If you don't believe me ask the councils who were obliged to outsource many of their core services to competitive tenders. Prices went up and flexibility went down with penalty clauses again the councils been invoked routinely for simple changes to services.

The NHS is currently a poor example of public provision as it's currently suffering from chronic under investment to prepare it for privatisation. However it is one of the most efficient health services in the world in terms of cost per unit of production. This would still be true if it were adequately funded.

The Irish system is a terrible hybrid where a "private" system leaches off a chronically underfunded public system where paying a few grand allows you to jump the que and use publically funded infrastructure. If we went over to a purely private system with a government credit token per citizen it's guaranteed that the price gouging would be horrendous with no lower floor to hold prices down.

In short privatising public health is a loony idea.

silliussoddius · 01-09-2023 2:35pm

https://www.boards.ie/discussion/comment/121056198#Comment_121056198

I know where I’d rather get seriously sick. It’s very expensive and as long as you don’t get screwed over by the insurance company it’s very good. From some of what I heard about Ireland I wouldn’t want to be in serious need of health care.

I think everyone deserves access to healthcare but just proclaiming it and screwing up when delivering it isn’t good enough.

Geuze · 01-09-2023 2:36pm

https://www.boards.ie/discussion/comment/121056459#Comment_121056459

Much healthcare on the continent is provided by non-State providers, like churches/charities/for-profits, and it seems to work okay?

Economics101 · 01-09-2023 2:38pm

https://www.boards.ie/discussion/comment/121056577#Comment_121056577

Sounds like you are touting a Soviet solution to an efficiency problem. LOL

More seriously, most responses contrast our system with the US one. However the real comparison should be with the largely Social Insurance based systems found on much of the European continent. Health care providers are paid by patients' Social Insurance, and the providers can be state-owned, or private (both for profit and not-for-profit).

The UK NHS and our HSE both examples of the inefficiencies of central planning and suffer from similar shortcomings - notably huge delays in accessing treatment.

ancapailldorcha · 01-09-2023 2:43pm

https://www.boards.ie/discussion/comment/121056675#Comment_121056675

Misrepresenting someone's post makes it hard to take this seriously. You even had to throw "Soviet" in there.

How do you know that the HSE and the NHS are examples of "the inefficiencies of central planning?" What evidence do you have?

csirl · 01-09-2023 2:44pm

https://www.boards.ie/discussion/2058311789/lets-fully-privatize-health-care-and-abolish-hse

Given that nearly half the population have private health insurance and pay poor VFM GP and A&E fees, the spend per capita for those who avail of the free public system is closer to 10k per person.

OscarMIlde · 01-09-2023 2:47pm

Something people may not be aware of is that a lot of private clinics and private hospitals outsource their testing to public hospitals (which charge a fee for this service). In addition private hospitals often treat straightforward cases but will transfer the difficult ones which require intensive care or more specialised care to public hospitals, which have greater experience and hospital capacity to handle these patients.

Privatising public hospitals will do nothing to solve the real problems within the health service. The main ones are a lack of step down units particularly for elderly patients, lack rapid care clinics for minor injuries which cannot be treated by GPs but clog A&Es, a lack of transparency in waiting lists for individual hospitals resulting in patient delays for assessment, the lack of information sharing between hospitals resulting in duplicate tests being performed in different hospitals for the same patient and delays in information sharing when transferring patients from one hospital to another (say report scans if not on NIMIS, delays on blocks or flow reports/blood tests reports. There is also a massive staffing crisis affecting hospital staff resulting in unavoidable delays.

The government need major infrastructure improvements to reform the health service. They need to institute a single patient ID number like the NHS number people have in the UK that all hospitals will use instead of generating a unique ID in each hospital. They need to create regional step down facilities. They need to create a nationwide reporting system for information sharing between hospitals. They need to examine why there are recruitment issues and try to address them.

fminus · 01-09-2023 2:49pm

Stupid question: could the government start a new separate management structure outside the HSE - lets say beginning with a single hospital. (e.g. new children hospital). Give them their funding. Ensure they are streamlined from an organizational standpoint without any of the HSE bureaucracy. Then over time, slowly scale the new health org up, whilst winding down the HSE?

I've aware that probably sounds extremely naive. I just don't see the HSE being meaningfully restructured in my lifetime.

As someone who works in the private sector, irks me beyond measure that a bunch of pen pushers piss away billions in tax payer money within our health service. And for what it's worth, I am fully aware that thousands of public sector workers do tremendous job. I'm obviously talking about a subset of free loaders

the.red.baron · 01-09-2023 2:50pm

https://www.boards.ie/discussion/comment/121056708#Comment_121056708

why dont you come up with a country where it works so?

purifol0 · 01-09-2023 2:50pm

https://www.boards.ie/discussion/comment/121056675#Comment_121056675

Agree, but to add not only is the NHS better for patients and the public, this is less about central planning and more to do with not letting the unions dictate the terms of how everything should be run. The nurses union here are a disgrace when it comes to putting themselves first over patient care and lying about how much they actually earn for example. The consultants union rule the roost here, and can double job and poach patients from the public system for their private practive within the same hospital. Management here are afraid to say boo

Economics101 · 01-09-2023 2:51pm

https://www.boards.ie/discussion/comment/121056694#Comment_121056694

Well, the HSE are centrally planned state organisations which derive all their income from central government and have little or no incentive to improve performance. The evidence is largely in terms of the much better performance in terms of lower waiting times in places like France, Germany, Spain, the Netherlands. These comparisons have been made on numerous occasions.

I make no apology for the Soviet analogy. Central planning in the USSR and the HSE have been failures, for somewhat similar reasons: largely lack of incentives,

ancapailldorcha · 01-09-2023 2:54pm

https://www.boards.ie/discussion/comment/121056735#Comment_121056735

Since you had to invoke the USSR and have provided no evidence, I'm not convinced. The NHS is one of the most efficient systems in the world. Central planning isn't the issue.

purifol0 · 01-09-2023 2:56pm

https://www.boards.ie/discussion/comment/121056728#Comment_121056728

IT WORKS HERE!!!

Private healthcare has been fantastic for me and literally everyone else I work with. I don't know anyone in my office without private health care, because when things go wrong, they cannot wait years to sort it, and we are not getting any younger.

I'd be fucked if I got lung cancer without the public system, of course since that usually happens to smokers, I don't smoke!

This kind of thing is why what we really need is ringfencing of taxes. You buy smokes -> tax collected goes towards cancer care. Instead that doesn't happen, it all just goes into one big pot.

01-09-2023 2:58pm

https://www.boards.ie/discussion/comment/121056735#Comment_121056735

Your analysis side steps the fact that those better systems you reference spend more per patient. That's where they derive their advantage - not market based efficiency.

01-09-2023 2:59pm

Absolutely NO WAY JOSÉ

I’ve been treated in both public & private systems, if you can call private a system. I found the greatest inefficiencies were communication from the private facility. I’m now mainly under a public hospital and have attended two of their very efficient clinics, in and out under 30 minutes, and the doctors phone me at home when they are concerned about something.

01-09-2023 3:05pm

I’ve a friend in USA and her husband, in his 60s, wasn’t feeling very good for a while. My friend was worried about him but it was expensive to go to a doctor and that kind of thing is saved up for “important stuff that can no longer be ignored”. A doctor said he’d need a chest X-ray, that cost an added little fortune, diagnosed him with bacterial pneumonia, which he had been dragging around with him in a very unwell state for two months. Antibiotics had him cured within a week. Because they are not wealthy, although they have a nice bungalow, they only have basic insurance and like so many Americans, avoid seeking medical care only when things become intolerable.

hoodie6029 · 01-09-2023 3:06pm

https://www.boards.ie/discussion/comment/121056433#Comment_121056433

Yep, private sector is responsible for delivering returns to the shareholder by whatever means, mostly legal. Patient care, responsibility to the community, etc. etc. go out the window.

After the fiasco of Eircom privatisation, there will never be another big privatisation here anyway.

purifol0 · 01-09-2023 3:06pm

https://www.boards.ie/discussion/comment/121056748#Comment_121056748

Correct, the issue is everyone gets paid no matter if a single patient is seen at all.

This is not a new issue for the public sector...

https://www.youtube.com/watch?v=JAk448volww

Economics101 · 01-09-2023 3:08pm

https://www.boards.ie/discussion/comment/121056775#Comment_121056775

That may be true when comparing the UK with mainland EU, For Ireland the expenditure numbers (per head of population) are closer to EU. However as Ireland has a relatively young polulation, you would expect them to be a bit lower.

corner of hells · 01-09-2023 3:12pm

https://www.boards.ie/discussion/comment/121056654#Comment_121056654

I’d like to add to this blokes post , in client registration, the part of the HSE that issues medical cards , LTI cards , looks after GPs ,pharmacies etc that engage with medical cards , 600 hundred staff are employed .600 .

SuperBowserWorld · 01-09-2023 3:12pm

Private health care has other strangeness and differences too ...

The emergency clinics are only open business hours. So don't have an emergency after 6 or at the weekend. And if they can't treat you there you get sent to public a&e.

They can pick and choose what services they provide, what conditions they treat and who they provide then too.

For conditions that don't require hospital stay, you still have to pay 50% of the cost.

Someone who has never spent a penny on private health in this country can join a company with private health care and can have all waiting periods waived.

If you have a heart problem then they seem to go all out on paying surgery, treatments, hospital stays etc. For other things, not so much.

You need to really read the small print, stuff like Lyme disease related illnesses, covid related etc etc may not be covered.

And as someone has said it leeches off the public health care system.

They have all kinds of little "deals" done with various hospitals. And a lot of horse trading it seems. Also, your milage may vary depending on which provider you choose. It's a minefield.

The EU should at least try to get countries in the EU with screwed up public health care to learn from and copy the best countries in the EU w.r.t public health care.

01-09-2023 3:13pm

https://www.boards.ie/discussion/comment/121056763#Comment_121056763

what is currently here is not what the op is advocating for

purifol0 · 01-09-2023 3:32pm

Now hang on, if we fully abolish the HSE that does not means we can't have state funded health care.

In the same way a if we abolish RTE we could still fund public broadcasting.

The LUAS is paid for publicly but managed by a private company and it works very well. The alternative was ask Irish Rail and that was vetoed by the government because they actually wanted it to work.

Our public sector is a very expensive joke for citizens not employed in it. And the HSE is now a behometh that any Minister for Health cannot control

banie01 · 01-09-2023 3:34pm

https://www.boards.ie/discussion/comment/121056637#Comment_121056637

There are literally hundreds of other countries in the world

Really? Despite the UN having 193 members, and 2 observer "States" , you opine that "there are literally hundreds of other countries" subsequent to calling other posters half-wits, you demonstrate an inability to understand "literally" or "hundreds"🤔