Why can government consistently underfund hospitals?

They’re not underfunded, the system is poorly managed.

rock22 wrote: »

I think you have answered your own question.
( My views comes from a lifetime working in the public health system )

You missed the important bit. The HSE is well funded but there's too many admin/management people. We merged 8 health boards to form the HSE yet had zero redundancies, so at least 6 people have no jobs to do while still getting paid and getting incremental pay rises for doing nothing.

shtpEdthePlum wrote: »

Surely that's what our bloated HSE should be funding?

Smee_Again wrote: »

They’re not underfunded, the system is poorly managed.

This. I'm pretty sure our health budget per capita is the highest in the EU, or certainly there abouts. HSE needs major overhaul.

We overspend on healthcare, relative to the age profile of the population.

This is well known.

Have a read of this:


https://twitter.com/seamuscoffey/status/1376932341751418889

Atlantic Dawn wrote: »

And then when you try to even make an appointment with a doctor who is oversubscribbed with medical card patients you can't even get an appointment for a week plus. Last time I wanted to make an appointment I had to ring near 10 practices to make an appointment, what I found most frightening is not a single one of them actually asked me what was wrong with me, shocking.

Funny thing is if you have a medical card ya ain't treated much different. Ya get prescribed shoddy medication too.

While it is probably true that the health service is well funded and probably overstaffed it's problem is that is structurally inefficient and those who control it want to keep it that way.
We don't have a private and a piblic health system, we have a two tier system. That means that those better off can access the service as needed via health insurance while pushing poorer but more needy patients to the end of the queue. And all done under the cover of a 'single system'

Some poster complained about the fees to GPs and Pharmacists. But that money never finds it way to the HSe, unlike any fees collected by the NHS. Many workers in the public hospitals find themselves providing service for the private hospitals with no say oin the matter, because the consultants they answer to in the public service also work, and in some cases own, the private hospitals.

The last great review of the service was by Michael Martin who spent an absolute fortune on reviews and reports 9 including glossy books to every staff member in the health boards (about 120000) and then implemented nothing. He was followed by Mary Harney who's only interest was in privatisation of the health service. The results of her decisions to outsource to cheaper and less well regulated laboratories in the US and Mexico ultimately caused the Cervical screening catastrophe.

Unbelievably , Michael Martin was rewarded for his incompetence by being elected leader of FF and is no Taoiseach .

I am sure Paul reid would love to get rid of a lot of excess baggage from the HSE but he has not that power, it rests with the government and this government will not be making any such decision. In fact, for all the government with access to private health service they are ppresumably quite happy with the current system.

Deleted User wrote: »

The HSE's funding covers what exactly? Some of the care for maybe 25% of the population. Get brought in by an ambulance? That'll cost you.

The taxes used to finance the HSE cover all public healthcare..

There are four fees that some people pay

(1) A&E fee = 100
(2) Overnight fee in hosp = 80
(3) GP fees
(4) Pharma up to 114 pm

Deleted User wrote: »

And 3 year waits to see consultants.
On top of that, half of people have health insurance.
The NHS meanwhile covers all that, with shorter waiting lists. It also covers all dentistry and optical.
It's really incredible the difference in what the two systems can achieve.

NHS GP and dentistry services are in tatters - and were before COVID - in many areas.

Significant number of UK residents have private health insurance due to waiting lists.

I worked in the HSE for a number of years - I can tell you it is populated by the most inept clowns I have ever come across in 25years of my career. Some of the ineptitude and tail chasing is sickening.

Secondly, there is a deference to "consultants" like they are gods, meaning they are given undue reverence when answering questions they are not equipped to answer ( and medical consultants have the ego to always think they have the answer ) - the same people also have 0 interest in fixing the system as they are best positioned to benefit from the current quagmire

3rd - literally 0 people in the HSE are there to look after the publics health, EVERYONE there are only interested in the publics health if it helps further an agenda that suits them ( normally their own status or power ). Status also can mean number of staff - which means duplication of positions and a tolerance for people doing absolutely 0 as long as they are a bum on a seat.

The HSE is simply a layer of management smeared across a number of disparate specialties and services run as fifedoms and which are totally independent ( bar funding from HSE ) and despise the HSE's very existence. This means each service goes away and does its own thing independently of the greater good of the HSE - for example, they buy their own IT systems which often are capable but extremely expensive to integrate with other specialties IT systems. ( not entirely true, but clever companies take advantage )

Another issue is there is a legacy of strong groups of vested interests, employee unions, hospital groups, GP groups, religious orders etc that make getting anything done difficult, even for a competent management team - which the HSE dont have.

clustefluck

Good loser wrote: »

More than once I've heard that cataract surgeon (Ml O'Keefe?) say that he worked/works in private and public health and that in the private sector he can get twice as much work done in half the time. If true that means private sector productivity is four times greater.

I think the reason for that is not as simple as it may seem. There absolutely is an element of private hospitals being more efficient. There's also a lack of investment in critical infrastructure that is often a bottleneck to progressing patient care (Notably MRI/CT scans). Also at play though is that private hospitals take bog-standard cases with minimal chance of complications while off-loading complex care to the HSE. I'm a doctor who has worked in both public and private hospitals, and more often than not if a complication arises that is in any way significant or would result in a prolonged admission, the patient is transferred to a public hospital for their care.

The HSE is over-funded for what we get. Management needs to be cut, hospital administration amalgamated, more doctors/nurses/AHPs recruited and capital funds rolled into key infrastructure like scans & homecare packages/nursing homes/hospital at home. That would sort many of the blockages in patient flow

Deleted User wrote: »

There are no fees collected by the NHS.
My point wasn't that we fund the HSE through everything, it was that the direct funding from government is higher for the HSE than the NHS.
Under the NHS you get everything, everything covered. Even dentistry. Even cosmetic stuff, completely free, that if you got in the South you can't even claim tax back on.
The NHS's funding covers eyesight, dentistry, GPs, consultants, prescriptions all completely free at the point of use.
The HSE's funding covers what exactly? Some of the care for maybe 25% of the population. Get brought in by an ambulance? That'll cost you.

There are absolutely fees in the NHS(here are some of them)

I agree however wit hprvious posters that eh HSE is grossly overstaffed in administration . That was a decision of our politicians, few redundancies were sought or achieved in amalgamating the 11 health boards.
What is more, there has been an expansion of the administrative staffing at a time when basic nursing roles were being reduced.
But having to provide services for private health and private hospitals is a hidden cost and is directly caused by our two tier system

Basically the private medical sector leech off the public system and make a lot of money

The State tried to take over healthcare from the church and were stopped, its only very slowly been released. They are still stopping any real moves to take over education.

Banana Republic 1 wrote: »

When they say stopped...
How did Hugo Chavez overnight take control of the countries oil industry. He just did it.

That’s a bad example but when the state wants to do something in a hurry it’s done remember the bank bailout. The problem here is spineless politicians.

Being decried by the bishops was sufficient to ensure you weren't re-elected back then (outside of a few city seats); hence pushing ahead was not an option.

seamus wrote: »

Well yes and no.

When you compare us to gold-standard countries for medical care, our per-capita public health spending is lower. In the EU area we're about average, but that just puts us above poorer countries and behind comparably wealthy countries.

In terms of health spending as a % of GDP we're quite far behind.

We are using our resources very inefficiently. But we're also not spending enough.

We overspend on healthcare, relative to the age profile of our population.

We spend too much, as the prices are too high.

Our high spending does not deliver high volumes.

https://read.oecd-ilibrary.org/social-issues-migration-health/ireland-country-health-profile-2019_2393fd0a-en#page9



Seamus Coffey UCC has a nice series of charts on this topic:

https://twitter.com/seamuscoffey/status/1376932341751418889

The bottom line is that any serious reform of the HSE, in order to turn it into a more efficient organisation, would involve a lot of redundancies at the administrative level. That appears to be an impossibility (not sure if that's from a legal point of view or purely a political one). Taking that off the table makes an already difficult situation practically impossible.

Good loser wrote: »

When it comes to 'insiders' being pinned down on what's wrong with the HSE i.e. why is it so expensive and still people are unhappy with the service the answer is 'vested interests'. Nobody seems willing to specify in detail what these are.

More than once I've heard that cataract surgeon (Ml O'Keefe?) say that he worked/works in private and public health and that in the private sector he can get twice as much work done in half the time. If true that means private sector productivity is four times greater.

The problem is these surgeons working privately & publically in the same facility.