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What is wrong with the health service, HSE

[Deleted User]

https://www.irishtimes.com/news/health/health-services-may-be-cut-in-some-areas-under-new-plan-1.3731979.

How is this happening, the tired old answer is usually too much middle management there has to be more to it? the article is depressing reduce staff recruitment as one of the big answers no nuanced or sophisticated business orientated solutions or advocating solutions that will make issues worse, for example making people wait for the fair deal will inevitably mean people who are ready to be discharged will end up staying in hospital blocking a bed and preventing admission for someone who need it.

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Podge_irl

AndrewJRenko wrote: »

Many health services are fundamentally unprofitable. Mental health services, addiction services, treating chronic illnesses etc. You can make great money with a nice simple, predictable orthopaedic or cardiac procedure, so private medical providers cherrypick the services they provide.

Sure, that's a fair point. My preference is a good, all-encompassing public health care system. I just think that talking about for-profits "making money off the misery of the sick" is overly emotive language. There are many, many good services provided in all manner of fields where people end up making money off it.

Although no system is perfect, it does work quite well here in Switzerland. There is no public heath system per se, but it is mandatory for every working person to have health insurance. The unemployed and other groups are covered by the state. You can indeed pay more to get "better" treatment, though a lot of it is focused more around perks then core treatment - e.g. better insurance can get you a private rather than public room. I don't personally have an issue with that kind of stratification.

Sam Russell wrote: »

Is that the kind of private health care you want?

What could be done is the pay the state funded acute hospitals on a per procedure basis so it funds what they do.

The current system for hospitals funds them whatever they do (or do not do). This system encourages waiting list because a patient on a waiting list costs nothing, while treating them does. Perhaps if they were paid less the longer the waiting list, it might incentive them to reduce those waiting lists.

I don't particularly want private health care.

The NHS does something akin to this with under-performing hospital trusts. I'm not entirely sure its seen as overly effective.

Matt Barrett wrote: »

The big problem is why would a specialist want shorter waiting lists when he or she can offer up their private practice for those who are willing to pay for quicker service?

I thought they were cutting down on this?

Geuze

Podge,

a few questions about the Swiss system:

Can people switch insurers?
How many insurers are there?
Are the insurers for-profit?

Who provides the hospitals? State, for-profit or not-for-profit churches, etc.?

Are GPs self-employed like here?
Does insurance cover the GP fees?

James Brown

Podge_irl wrote: »

Sure, that's a fair point. My preference is a good, all-encompassing public health care system. I just think that talking about for-profits "making money off the misery of the sick" is overly emotive language. There are many, many good services provided in all manner of fields where people end up making money off it.......

It's factual language. The key word here is profit. The patient should come before profit. Cost effectiveness and value for the tax payer should never be confused with profit for private concerns or the state for that matter.
If you are talking private enterprise you are talking a two tier system.

Podge_irl wrote: »

...

I thought they were cutting down on this?

Hopefully. It's a big problem. If they are great. Well done unions and nurses.

FreudianSlippers

It's fantasy politics to continue to post about how you believe the world should work as opposed to how the world actually works. How long do we need to be subjected to these posts which are based in no way in reality?

blanch152

Matt Barrett wrote: »

. We don't need 'for profit' to be efficient.

So we get the Children's hospital cost overruns in an inefficient public sector as a result.

FreudianSlippers

blanch152 wrote: »

So we get the Children's hospital cost overruns in an inefficient public sector as a result.

If the Children's Hospital was a private company it'd be done and on budget.

Podge_irl

Matt Barrett wrote: »

It's factual language. The key word here is profit. The patient should come before profit. Cost effectiveness and value for the tax payer should never be confused with profit for private concerns or the state for that matter.
If you are talking private enterprise you are talking a two tier system.

It is about as factual as saying that Tesco make money off the misery of the hungry.

James Brown

Podge_irl wrote: »

It is about as factual as saying that Tesco make money off the misery of the hungry.

Can you elaborate? I don't see how private health would not be making money off of sick people. Your Tesco analogy would work if people only had Tesco to go to and Tesco were charging as much as they could get away with. Public is supposed to serve the public not shareholders. Tesco is not beholden to the tax payer.
We already have public and private options in health so can you clarify?

Podge_irl

Geuze wrote: »

Podge,

a few questions about the Swiss system:

Can people switch insurers?
How many insurers are there?
Are the insurers for-profit?

Who provides the hospitals? State, for-profit or not-for-profit churches, etc.?

Are GPs self-employed like here?
Does insurance cover the GP fees?

Yes, easily
Not sure, but well over 10.
Yes, they are just private insurance providers. There "basic" offering is mandated to cover a certain amount and they make no money on that, but they can offer other plans over and above the minimum. They also can not refuse to insure anyone at the basic level.

There are university hospitals and private hospitals and you can basically just pick where you go.

Dunno about GPs employment to be honest. A lot of them seem to be in medical centres. Insurance will cover it but nothing is completely free. You always have to pay a certain amount, at least up until you hit a cap.

Podge_irl

Matt Barrett wrote: »

Can you elaborate? I don't see how private health would not be making money off of sick people. Your Tesco analogy would work if people only had Tesco to go to and Tesco were charging as much as they could get away with. Public is supposed to serve the public not shareholders. Tesco is not beholden to the tax payer.
We already have public and private options in health so can you clarify?

I agree, they would be making money off sick people. The same way shops make money off hungry people or do the likes of food banks no longer exist? Tesco are charging as much as they can get away with. It would be weird if they weren't.

This started from the suggestion that public services could learn from being run more like a private business. You claimed that the problem with private businesses is that all they care about is profits and would thus just be making money off people's suffering. The aspect you are not getting, is that most private businesses have to make profit while also competing for customers - this can often result in a driving upwards of standards with focuses on efficiencies. The idea that there is nothing to be gained by looking at some private health practices and emulating successful aspects of it, and indeed completely dismissing them, is incredibly blinkered.

listermint

FreudianSlippers wrote: »

If the Children's Hospital was a private company it'd be done and on budget.

If the childrens hospital was a private company it wouldnt have been built in James Street from a cost analysis perspective and access to your customers.

FreudianSlippers

listermint wrote: »

If the childrens hospital was a private company it wouldnt have been built in James Street from a cost analysis perspective and access to your customers.

The Mater was a much better site.

James Brown

Podge_irl wrote: »

I agree, they would be making money off sick people. The same way shops make money off hungry people or do the likes of food banks no longer exist? Tesco are charging as much as they can get away with. It would be weird if they weren't.

Yes we have options, however if we didn't, what they could get away with would likely differ greatly to current marketplace competitiveness.

Podge_irl wrote: »

This started from the suggestion that public services could learn from being run more like a private business. You claimed that the problem with private businesses is that all they care about is profits and would thus just be making money off people's suffering. The aspect you are not getting, is that most private businesses have to make profit while also competing for customers - this can often result in a driving upwards of standards with focuses on efficiencies. The idea that there is nothing to be gained by looking at some private health practices and emulating successful aspects of it, and indeed completely dismissing them, is incredibly blinkered.

You spell it out yourself bolded above. It's two different aspects on the same topic. Both can equally be true.
The idea of private business competing and therefore creating the best options for the customer often doesn't work. From car insurance to a loaf of bread we've private enterprises collaborating to fix pricing. While private business has it's lessons to teach we can take them on board without having to follow the private route. It's a matter of treating the tax payer as they are shareholders, but without the drive for profit, replacing it with value for tax monies. We can't take the risk with health that the market will provide a fix. Look at housing.

listermint

FreudianSlippers wrote: »

The Mater was a much better site.

Subjectively to james's yes. but to other sites no it was not.

James Brown

listermint wrote: »

If the childrens hospital was a private company it wouldnt have been built in James Street from a cost analysis perspective and access to your customers.

The part the state played was bad management of private contracting.
Or I wonder which pool of civil servants are they drawing the brickies from?

FreudianSlippers

listermint wrote: »

Subjectively to james's yes. but to other sites no it was not.

Connolly and greenfield sites lack the fundamental requirements for such a hospital: adult surgical suites, paediatric health services and training/education link with a university med school. I also suggest that country people who were praising the M50 have not been on the M50 - it's a traffic nightmare.

listermint

FreudianSlippers wrote: »

Connolly and greenfield sites lack the fundamental requirements for such a hospital: adult surgical suites, paediatric health services and training/education link with a university med school. I also suggest that country people who were praising the M50 have not been on the M50 - it's a traffic nightmare.

Tallaght hospital had all of them, and huge amount of land beside it which we not have planning permission for 450+ apartments.

And ive lived the majority of my life on the M50. Putting a hospital in the city centre was a fools errand for all. The majority of your 'customers' are not and will not be from within the M50. These are inescapable facts.

FreudianSlippers

Kind of forgot about Tallaght. Do we know why it was rejected (or was it never considered) - Connolly was rightly rejected, it's an awful choice and a terrible hospital.

listermint

FreudianSlippers wrote: »

Kind of forgot about Tallaght. Do we know why it was rejected (or was it never considered) - Connolly was rightly rejected, it's an awful choice and a terrible hospital.

no idea, we may never know. Mad decision all the same. would have cost less than half the figure we have now. and has all the transport links one could want.

[Deleted User]

FreudianSlippers wrote: »

listermint wrote: »

If the childrens hospital was a private company it wouldnt have been built in James Street from a cost analysis perspective and access to your customers.

The Mater was a much better site.

The esteemed national and international experts on the Dolphin committee disagree with you. Do you know something that they don't?

listermint

AndrewJRenko wrote: »

The esteemed national and international experts on the Dolphin committee disagree with you. Do you know something that they don't?

Yeah probably. Its hard to get consultants to work outside the M50 ring. Too far from their city centre haunts.

[Deleted User]

listermint wrote: »

AndrewJRenko wrote: »

The esteemed national and international experts on the Dolphin committee disagree with you. Do you know something that they don't?

Yeah probably. Its hard to get consultants to work outside the M50 ring. Too far from their city centre haunts.

So four of the committee members ARE consultants who've spent their entire careers hanging round with other consultants, but you know more about what consultants think than they do? Really?

FreudianSlippers

AndrewJRenko wrote: »

The esteemed national and international experts on the Dolphin committee disagree with you. Do you know something that they don't?

IIRC the committee considered the reworked Mater site and not the original proposal so, yes, I know about the original proposal which (if my memory serves - I can't look it up now) they did not consider.

Podge_irl

AndrewJRenko wrote: »

The esteemed national and international experts on the Dolphin committee disagree with you. Do you know something that they don't?

The esteemed national and international experts on the Dolphin committee originally picked the Mater site did they not? Or was the report done after the original application was denied?

Podge_irl

Matt Barrett wrote: »

Yes we have options, however if we didn't, what they could get away with would likely differ greatly to current marketplace competitiveness.

Yes, much like state owned services. It was private enterprise that brought air travel to the masses, not state airlines.

Matt Barrett wrote: »

The idea of private business competing and therefore creating the best options for the customer often doesn't work.

Sure. But public monopolies often don't work either.

A huge benefit of the Swiss system is that it is essentially another taxation, but one that is ringfenced for healthcare. It takes the politics out of the funding issue. People still pay a portion of the costs so aren't keen on hospitals performing unnecessary tests/procedures just to rack up the bill.

James Brown

Podge_irl wrote: »

Yes, much like state owned services. It was private enterprise that brought air travel to the masses, not state airlines.

Aye...

Ryanair ranked 'worst airline' for sixth year in a rowhttps://www.theguardian.com/business/2019/jan/05/strike-hit-ryanair-ranked-worst-airline-for-sixth-year-in-a-row

I'm not sure what your point is now. Are we still operating on the misconception I think everything about private business is bad or only as it refers to looking after the public interest with tax payer monies?

Podge_irl wrote: »

Sure. But public monopolies often don't work either.

A huge benefit of the Swiss system is that it is essentially another taxation, but one that is ringfenced for healthcare. It takes the politics out of the funding issue. People still pay a portion of the costs so aren't keen on hospitals performing unnecessary tests/procedures just to rack up the bill.

Just because our system is poorly run and rotating FF/FG governments choose to throw money at it and do little else, doesn't mean we need look to private concerns IMO. Looking at Ireland, how ever bad things are ran we need to be able to look to the state and elected officials lest they be able to hide behind contracts and roll out 'our hands are tied'. Just because our chosen brand of representatives are found wanting doesn't mean we can't find competent people with an interest in fixing things at some point, maybe even from the ranks of FF/FG.

[Deleted User]

Podge_irl wrote: »

The esteemed national and international experts on the Dolphin committee originally picked the Mater site did they not? Or was the report done after the original application was denied?

No, the Dolphin committtee picked St James.

FreudianSlippers wrote: »

IIRC the committee considered the reworked Mater site and not the original proposal so, yes, I know about the original proposal which (if my memory serves - I can't look it up now) they did not consider.

Oh, so if they had considered the original proposal, which had LESS capacity than the reworked proposal, and had already been rejected by the planning authorities, you think that might have been a more viable decision? They should have chosen a proposal that had already been refused planning?

As it happens, if you read Dolphin, you'll see they were well aware of the original proposal too.

charlotte.york

Podge_irl wrote: »

Yes, much like state owned services. It was private enterprise that brought air travel to the masses, not state airlines.

Sure. But public monopolies often don't work either.

A huge benefit of the Swiss system is that it is essentially another taxation, but one that is ringfenced for healthcare. It takes the politics out of the funding issue. People still pay a portion of the costs so aren't keen on hospitals performing unnecessary tests/procedures just to rack up the bill.

Swiss model is really up there. It is vary hard to make that argument in the political climate here.

ednwireland

did that ambulance strike go under the radar a bit, never realised it was on until i went past the ambulance station on my road.

not much point striking IMO if no one notices

listermint

AndrewJRenko wrote: »

So four of the committee members ARE consultants who've spent their entire careers hanging round with other consultants, but you know more about what consultants think than they do? Really?

So 4 of the decision makers were consultants, What was the make up of the rest of the committee.

Intrigued.