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Health system

ted1

So taking a break from the main GE thread I thought we’d start a separate health thread and see how we fix the system

I’m Currently paying about 2,500 a year so 5,000 before tax for private health insurance for myself , wife and three kids.

Don’t have day to day , so spend and additional 600 euro cash on doctors a year.

So the question is, if there was a good health system would you be willing to pay an extra 2 thousand ( per family, say700 for an individual) in taxes for a proper system as opposed to our current system ?
And if so would that fix the system ?

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beauf

Never spent so much time in doctors and hospitals as when kids are small and parents are old. Also when people are sick. Who'd have thought that....:)

1641

Graces7 wrote: »

Have you any stats on that please? I am nearly 80 and would class as poor.

Why charge? It will cause problems, believe me, to those of us on very limited income due to age or other situations. The entire point of the medical card is that accessing care is free to those in need.
Your idea goes against the whole meaning iof the medical card.

The NHS gets it right. All the way. Free access to health care from cradle to grave. It is a total necessity not a commodity.

For someone calling for stats it is interesting that you nearly always use yourself as the frame of reference for everything. "I am nearly 80 and would class as poor" = older people are always poor. I think that would class as a logical fallacy! (And even for you we have no way of verifying. Every one on Boards is a suffering saint, you know!)

As for stats. According to the CSO figures for 2018 the "at risk of poverty rate" following social transfers for the over 65s was 24%. For the sake of comparison the corresponding rates for 18 - 24 year olds was 30%, and for 25-65 year olds it was 27.5%. And for 12 - 17 year olds it was 40%. So over 65s are certainly not the poorest group.

How long do you have to wait if you need to see a GP by the way? In the "free" NHS the average wait is 15 days :https://www.theguardian.com/society/2019/aug/12/nhs-patients-waiting-over-two-weeks-to-see-a-gp-shows-survey.

[Deleted User]

Graces7 wrote: »

Have you any stats on that please? I am nearly 80 and would class as poor.

Why charge? It will cause problems, believe me, to those of us on very limited income due to age or other situations. The entire point of the medical card is that accessing care is free to those in need.
Your idea goes against the whole meaning iof the medical card.

The NHS gets it right. All the way. Free access to health care from cradle to grave. It is a total necessity not a commodity. Paid for by taxes; no quibbles and no discrimination.

It’s obviously a while since you lived in the Uk! Two week wait for GP or visit emergency doctor where you can sit for hours.

Not every retired person is dependent on the state pension! A good proportion would have a private pension, own their own home etc.

_Brian

Mantis Toboggan wrote: »

Nothing will change as long as the HSE remains, it's not fit for purpose. Needs to be scraped.

I’m old enough to remember the old health board system we are going back to. It was corrupt. There was at least one politician on every board and if you knew them you could get pushed up the waiting lists easily. It gives control
Back to local people who are easily pressured by people they know.

1641

_Brian wrote: »

I’m old enough to remember the old health board system we are going back to. It was corrupt. There was at least one politician on every board and if you knew them you could get pushed up the waiting lists easily. It gives control
Back to local people who are easily pressured by people they know.

Whatever about actual corruption, it was full of "strokes" and "favours" by politicians on the Board. It was the way to get and keep votes. Similarly the politicians were preoccupied with keeping "local services". This was always a higher priority then overall service quality.

The National Cancer Strategy has been one area of success under the HSE. Their would have been little hope for the level of "rationalisation" involved under the old Regional Health Board system.

wobbie10

Smaller kids catch everything.Every bloody germ that passes them by, they welcome it in!!So of course there are more under 6s visit.A better measure might be how many of those visits result in a prescription (and even that is fairly subjective), a split of how many visits a child comes in for per year of their age under 6, or a look at the spread of visits of a representative group of children across a year-are you seeing some more often than others, do they have things like asthma or other complaints, and then you might be able to single out which, or if, kids are being brought in too often.

Be wary of quoting broad statistics like that.[/QUOTE]

As a parent of 2 small kids myself i know that when they first go to creche they catch everything going. However most of these ailments dont require a visit to the doctor. They are the "worried well" and book an appointment because its free. Parents have forgotten how to manage small illness themselves and feel the need to pass on the responsibility.
1st sign of a temp and they are on the phone making appointments. Very often the child has gone to school / creche that day so need appointment after 3.00
:P
The after hours doctor on call is as overwhelmed with these types of visits. This out of hours service is meant to be for emergencies, but not anymore.
This leads to seriously sick patients not getting the care they need.

Either way we have 30 appointments available each day so when they're gone they're gone:D

[Deleted User]

1641 wrote: »

For someone calling for stats it is interesting that you nearly always use yourself as the frame of reference for everything. "I am nearly 80 and would class as poor" = older people are always poor. I think that would class as a logical fallacy! (And even for you we have no way of verifying. Every one on Boards is a suffering saint, you know!)

As for stats. According to the CSO figures for 2018 the "at risk of poverty rate" following social transfers for the over 65s was 24%. For the sake of comparison the corresponding rates for 18 - 24 year olds was 30%, and for 25-65 year olds it was 27.5%. And for 12 - 17 year olds it was 40%. So over 65s are certainly not the poorest group.

How long do you have to wait if you need to see a GP by the way? In the "free" NHS the average wait is 15 days :https://www.theguardian.com/society/2019/aug/12/nhs-patients-waiting-over-two-weeks-to-see-a-gp-shows-survey.

If its an emergance you will get seen sooner and they have walk in clinics

1641

mariaalice wrote: »

If its an emergance you will get seen sooner and they have walk in clinics

As you will here. If it is an emergency you will be seen quickly even if the list is full that day. But the "standard" waiting list is nothing like 15 days.

Graces7

Deleted User wrote: »

My dear old grandad used say that there were 11 commandments. Number 11 saying “Poor man, help thyself”.

Words fail.

Graces7

1641 wrote: »

For someone calling for stats it is interesting that you nearly always use yourself as the frame of reference for everything. "I am nearly 80 and would class as poor" = older people are always poor. I think that would class as a logical fallacy! (And even for you we have no way of verifying. Every one on Boards is a suffering saint, you know!)

No, I was replying to a point that implied that over 70s were not poor..Please read posts

And yes, I use my own situation as it is the only one I can trust, rather than vague statements in other posters

oH DEAR! Back to jibes. Undermines what you say. Thought better of you.

Over and OUT .

Graces7

Deleted User wrote: »

It’s obviously a while since you lived in the Uk! Two week wait for GP or visit emergency doctor where you can sit for hours.

Not every retired person is dependent on the state pension! A good proportion would have a private pension, own their own home etc.

Stats for your statements would be good. Rather than ideas and views/

And your last sentence has no relevance to what I said.

It was the same when I was in the UK but urgent needs were always seen. Always.

And it was not the level of service I was talking about but the equality of service regardless of what money you had.

Need as priority; equality on medical terms.

And why the constant focus on money? The idea of giving a medical card that gives free care than demanding folk pay? Thankfully that will not happen outside of boards ie!.

Over and out. Have heard enough!

JohnnyFlash

Graces7 wrote: »

Stats for your statements would be good. Rather than ideas and views/

And your last sentence has no relevance to what I said.

It was the same when I was in the UK but urgent needs were always seen. Always.

And it was not the level of service I was talking about but the equality of service regardless of what money you had.

Need as priority; equality on medical terms.

And why the constant focus on money? The idea of giving a medical card that gives free care than demanding folk pay? Thankfully that will not happen outside of boards ie!.

Over and out. Have heard enough!

You complain about the health service yet insisted on being housed on an island. Spare me the pity.

Geuze

Deleted User wrote: »

Not all medical card holders are “poor”. The over 70’s for example.

However, I do feel that every medical card holder should be charged a minimum of €5 per doctor visit.

Yes, the GMS means-test for over 70s is too generous compared to the under 70s means test.

facehugger99

wobbie10 wrote: »

They are the "worried well" and book an appointment because its free. Parents have forgotten how to manage small illness themselves and feel the need to pass on the responsibility.

We had a childminder when the kids were smaller. She was a single-mum with a kid around our ones ages.

She had a free medical card and we used to find it almost hilarious the amount of times she would access the GP - it was free so every cough, sneeze or mild temperature spike would entail a GP visit. Now obviously it wasn't actually 'free' at all but someone else was picking up the tab.

Parents that are paying €50-€60 quid a visit tend to be a bit more circumspect.

[Deleted User]

Pseudonym121 wrote: »

And then there’s the usual Irish humbugs of:
A) Auction politics - you’ll never lose votes as a TD or councillor by listening to Mary’s sob story and fighting for her to get a medical card. Remember the motivation of TDs and Councillors is rarely what’s best for the country and mostly about what will get them re-elected. Handing out medical cards is a vote winner.

TDs and Councillors don't get to hand out medical cards. They might get to write a letter to the Minister supporting it or asking for an update or submitting a PQ maybe. But it's not in their gift.

The cards are issued by the HSE based on the criteria.

salonfire wrote: »

Thanks for agreeing with my point.

Take away as much as possible from the HSE to what private hospitals will accept.

What remains of the HSE might resemble a functioning entity.

The benefits are better health care for patients and the deadwood staff of the HSE can be dumped out and costs massively reduced

Why would you want to include a profit margin on top of the actual cost of doing the procedure? We need to fix the public healthcare system and provide a decent service for everyone.

Geuze wrote: »

The data on GP visits has been published over and over again.

People with med cards visit more.

Would you like to share some examples of this stuff that was published 'over and over again'?

facehugger99 wrote: »

We had a childminder when the kids were smaller. She was a single-mum with a kid around our ones ages.

She had a free medical card and we used to find it almost hilarious the amount of times she would access the GP - it was free so every cough, sneeze or mild temperature spike would entail a GP visit. Now obviously it wasn't actually 'free' at all but someone else was picking up the tab.

Parents that are paying €50-€60 quid a visit tend to be a bit more circumspect.

You were paying her on the record and making your employer's PRSI payments on her behalf to qualify her, right? Must have been hard for her to fit in all those fun and exciting doctors visits in between her minding your kids and her own.

Mantis Toboggan wrote: »

1 million medical cards despite near full employment. That's what I can't understand. Thank you FG.

McJobs - crap wages, zero hours contracts.

Rodin

Graces7 wrote: »

Have you any stats on that please? I am nearly 80 and would class as poor.

Why charge? It will cause problems, believe me, to those of us on very limited income due to age or other situations. The entire point of the medical card is that accessing care is free to those in need.
Your idea goes against the whole meaning iof the medical card.

The NHS gets it right. All the way. Free access to health care from cradle to grave. It is a total necessity not a commodity. Paid for by taxes; no quibbles and no discrimination.

Whose taxes?
And if my taxes are being used for the health service don't I have a right to say people need to do their bit to not be a burden on the system?

Rodin

Graces7 wrote: »

Old saying.. If ifs and ans were pots and pans, beggars would ride horses..

You are so.... cynical! such a view of your fellow citizens! And yes, blame the patient rather than blame the dire state of the health service , I write as one blameless in every item yet unable to access any real primary care that is applicable. And like the neighbour here, hardworking, not overweight etc who had to wait three years in agony for an "urgent" hip replacement as he could not afford to pay up front and go north.

Bolded is utter hyperbole!

Sort the system please. Get the waiting lists down, improve services and only then expect over stressed folk to care.

Waiting lists would be shorter if there weren't so many unhealthy people!

Snow Garden

Pseudonym121 wrote: »

Snowgarden:

As re: emailing this to the new Minister of Health. LOL! I think it would be far better to email it to someone who actually cared about the citizens of the state instead ;-). Harris has been utterly useless in a way which exceeded even our ( Consultants and nurses ) lowest expectations.

Re: NHS.
I think that in the past the NHS was clearly better than the HSE. I think that over the past 15 years or so that gap has narrowed significantly and the NHS is now surpassed by the HSE in many areas.

For example the NHS talks about targets and seems to meet or nearly meet targets the HSE doesn’t meet - 4 hours to be seen in A&E or operations within x months but much of this is just window dressing put in to meet government targets instead of actually deliver care. I’ll explain how they do it below...

A) 4 hour target to be seen in A&E by a doctor. That’s really easy they just make it that the doctor pops in, sees you for 30 seconds and then orders bloods, bloods which are done in Ireland by a 30 second conversation between the nurse seeing you and the junior doctor. Hey presto, the doctor saw you, now wait another 4 to 6 hours while they firefight all the other crises and finally come back to you. End result the target of seeing you in 4 hours was met but you only had a meaningful interaction with a doctor ( defined as one which actually achieves a diagnosis and treatment plan ) after 8 hours or more. Looks good on paper though.

B)Surgery. What happens is that they simply book you in for surgery before the x months of the target time is up knowing full well that you won’t get surgery that day. They then cancel the surgeries due to unforeseen emergencies ( which they totally foresaw ) and send you home. The target time resets and they have another x months before they need to play the game again. I had a friend in the UK who was brought into a day ward on three occasions ( a day ward wasn’t appropriate for him because he would have had to stay for rehab post-op ) before finally being booked in to a proper ward on the 4th occasion - when he actually got the operation. Each time he was booked into the day ward they all got bloods and then were all ( about a dozen patients at a time) told their ops were cancelled and they should go home before the actual booked in day patients came in at 10am.

So, a lot of meeting of targets is just a shell game.

Mantis:
Why medical cards for 1 million people with full employment.

Well, there are a number of illnesses which get you a full medical card without means testing - cancer is one of them, schizophrenia and a whole host of psychiatric illnesses are other. I’m very happy to work in a country and pay my taxes to a system which does that and means that people with serious mental health problems continue to get free medicine and care even if they recover sufficiently to the point that they can get a job and the dignity and self-respect which comes with that. So a lot of medical cards are actually simply because a lot of people have them due to being very seriously unwell and that’s great.

And then there’s the usual Irish humbugs of:
A) Auction politics - you’ll never lose votes as a TD or councillor by listening to Mary’s sob story and fighting for her to get a medical card. Remember the motivation of TDs and Councillors is rarely what’s best for the country and mostly about what will get them re-elected. Handing out medical cards is a vote winner.

People lie and fake it and/or they just settle on benefits once they have them and choose not to return to work. I have many patients who are very happy being in benefits and actively resist engaging with therapies which could improve their lives for fear of losing the medical card and/or their disability allowance. They either refuse the therapy or don’t show up or make formal complaints if you refuse to fill in forms to say they’re as disabled as they claim to be.

There is no real system or support for clinicians who stand up to this so a lot of GPs just go along with it or pass the buck to specialists ( hospital Consultants ) who are in a better position to say no.

And now I must go back to the research -*boo* * hiss*.

I missed this reply Pseudonym121. It's depressing reading but thanks for the frank details.

[Deleted User]

AndrewJRenko wrote: »

Why would you want to include a profit margin on top of the actual cost of doing the procedure? We need to fix the public healthcare system and provide a decent service for everyone.

Aren't you lucky you can put ideology to the forefront of your concerns regarding healthcare.

Maybe if you were dragging one leg after you with a bad hip, you would be less concerned about ideology and more concerned about access and quality, and not whether someone makes a profit or not.

It's telling then that private hospitals can do the procedure and make a profit on top yet public hospitals can barely do the procedure.

Pseudonym121

salonfire wrote: »

Aren't you lucky you can put ideology to the forefront of your concerns regarding healthcare.

Maybe if you were dragging one leg after you with a bad hip, you would be less concerned about ideology and more concerned about access and quality, and not whether someone makes a profit or not.

It's telling then that private hospitals can do the procedure and make a profit on top yet public hospitals can barely do the procedure.

To be fair that really isn’t comparing apples to oranges. If you forced a mandate to treat everyone who presented to them on the private hospitals they’d crumble too.

It is very easy to be functional and provide a “great service” when you only have to see 8 patients ( all of whom have means -relative to what comes in the doors in public clinics ) in 4 hours to make a nice profit.

It is much more difficult to provide a “great service” when
You have to see everyone who comes in including the guys and girls off their heads with drink and drugs and people who won’t follow your evidence-based advice.

Force the private hospitals to see them and see how quickly they succumb.

I’m not pro or anti private hospitals. I’ve worked in the private sector a lot and in the public sector and am currently full-time in the public sector as I don’t want to do any more private work so I’m not anti them. I just know that under the same circumstances they’d crumble too.

When I did private work I saw 1/4 of the patients per day I see in my public clinic and I made significantly more money per day. I made as much in 8 working days as I did in a full four weeks as a public consultant and in those same 8 days I saw only about 2 to 3 full days of public patient equivalents. So as a per diem I could have worked as hard and made quadruple what I would have in the public sector - but then they’d have complained about waiting times so instead I saw fewer patients, enjoyed the fact that other staff would pick up lunch etc for me from any nearby place to maximise my time seeing patients - in the HSE I usually only get to have lunch once or twice a week at all because I’m finishing clinics during lunch - and earned about double the money I would have in the public sector while enjoying a much easier professional life.

Nursing staff etc were also less burdened and used to do it for quality of life reasons too. Of course there’s a downside to being in the private sector and having a boss but while they might be tough on nurses and MDT members they really needed me more than I ever needed them as there’s such a shortage of consultants so they didn’t f**k with me. They tried it slightly a few times and I shut them down so they learned not to go there.

I moved into the public sector for a combination of personal reasons and the fact that I actually think a public service mandate is the way to go. It is better for society as a whole. That’s my personal philosophy on it and not a political point.

Private is good, public is bad or public is good, private is and is simplistic and unhelpful. In a utopia it’s be all public and be wonderfully funded and meet every need. In the real world both systems side by side have their place.

ironcage

Anyone know what average waiting lists are for a venesection or phlebotomy?

[Deleted User]

salonfire wrote: »

Aren't you lucky you can put ideology to the forefront of your concerns regarding healthcare.

Maybe if you were dragging one leg after you with a bad hip, you would be less concerned about ideology and more concerned about access and quality, and not whether someone makes a profit or not.

It's telling then that private hospitals can do the procedure and make a profit on top yet public hospitals can barely do the procedure.

Congratulations on your amazing ability to diagnose my medical status via a few online posts. Maybe you should be offering your services to the HSE? Sure you'd be much cheaper than all those expensive doctors and consultants, with their strange habits of actually seeing the patient to be able to diagnose something.

Graces7

JohnnyFlash wrote: »

You complain about the health service yet insisted on being housed on an island. Spare me the pity.

A complete non sequitur. Please explain? Thank you.

Graces7

Rodin wrote: »

Whose taxes?
And if my taxes are being used for the health service don't I have a right to say people need to do their bit to not be a burden on the system?

Noooo you don't have any say. That is up to who you elected, Oh you can " say".... lol

Graces7

Graces7 wrote: »

A complete non sequitur. Please explain? Thank you.

On second thoughts? Nah!