Why can government consistently underfund hospitals?

shtpEdthePlum · 02-04-2021 5:34pm #1

https://www.echolive.ie/sponsored/arid-40253432.html

Why does CUH have to put out a public appeal and get charity donations so it can take care of elderly patients with dementia and delirium?

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

Meanwhile ten more private hospitals have appeared in Cork in recent years while the public health service is in shlt. You'd swear there was an agenda to get people to rely solely on the private health sector.

Why pay taxes (or even health insurance) at all when everyone except the ultra rich can expect extremely poor value for money no matter what service they opt to use?

Not a problem that impacts those in government, granted, but the rest of us plebs are all affected by this and there are way more of us than there are of them. This all seems very very wrong to me. Something something children's hospital.

rock22 · 02-04-2021 6:28pm

shtpEdthePlum wrote: »

https://www.echolive.ie/sponsored/arid-40253432.html

Why does CUH have to put out a public appeal and get charity donations
.......

Meanwhile ten more private hospitals have appeared in Cork in recent years
......

Not a problem that impacts those in government, ..

This all seems very very wrong to me. ..

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

Smee_Again · 02-04-2021 6:29pm

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

tommybrees · 02-04-2021 6:33pm

21 Billion budget for 4.5 million odd people

Del2005 · 02-04-2021 6:35pm

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?

LessOutragePlz · 02-04-2021 6:36pm

shtpEdthePlum wrote: »

https://www.echolive.ie/sponsored/arid-40253432.html

Why does CUH have to put out a public appeal and get charity donations so it can take care of elderly patients with dementia and delirium?

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

Meanwhile ten more private hospitals have appeared in Cork in recent years while the public health service is in shlt. You'd swear there was an agenda to get people to rely solely on the private health sector.

Why pay taxes (or even health insurance) at all when everyone except the ultra rich can expect extremely poor value for money no matter what service they opt to use?

Not a problem that impacts those in government, granted, but the rest of us plebs are all affected by this and there are way more of us than there are of them. This all seems very very wrong to me. Something something children's hospital.

I'd love to know where all the money goes myself.

The HSE had a budget of over €17bn in 2020.

https://www.hse.ie/eng/services/news/media/pressrel/hse-publishes-national-service-plan-2020.html

For that amount of funding you'd be expecting a decent service without ridiculously long waiting times.

Don't think it will be fixed anytime soon as no one takes responsibility for it or any of the errors made.

They'd rather fight every case in court before admitting any liability.

Bubbaclaus · 02-04-2021 6:38pm

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.

View · 02-04-2021 8:40pm

The “problem” is that you have practice medical treatment running in parallel to the public one and the same personnel operating in both. Hence there is an inherent conflict of interest in the system.

No one would pay for private medical care if the public health care provided the same level of care and attention and on an identical timescale. Why would you pay a premium for an identical level of care?

Hence, in order to “justify” you paying that premium for private care, the public health care provided by the personnel involved must be worse than the private health care they provide you with, even when they are provided in the same hospital. Bluntly, their private medical earnings are dependent on you hightailing it from the public system and seeing them as a private medical patient.

And, as that is what happens, our current medical system is in fact working well for the beneficiaries of it. Why should they change a system that suits them well?

[Deleted User] · 02-04-2021 8:48pm

The HSE is funded just as well as the NHS. Consider than when you hand over €50 quid to the doctor and another €40 to the chemist. Or when you're waiting 3 years to see a consultant.

tommybrees · 02-04-2021 8:52pm

[Deleted User] wrote: »

The HSE is funded just as well as the NHS. Consider than when you hand over €50 quid to the doctor and another €40 to the chemist. Or when you're waiting 3 years to see a consultant.

Working class getting screwed at every corner

shtpEdthePlum · 02-04-2021 8:58pm

I'm not working class, I pay for health insurance and I'm getting screwed as well. I seldom get sick as I'm young and relatively healthy but I wouldn't even get a private room in a private hospital even though I pay for the privilege.

Harry Palmr · 02-04-2021 9:03pm

Literally thousands of well paid and unneeded positions are siphoning off hundredsof millions every year. The entire system is being run by people not talented enough for private enterprise while using a mixed bag of Windows NT era software. No two aspects of the health service can communicate without intensive manual inputs. PPARS may have grabbed the headlines back in the early 00s but many more examples litter the HSE, some what which have almost certainly cost lives.

How do you fix Angola?

Geuze · 03-04-2021 1:11am

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 · 03-04-2021 1:37am

Deleted User wrote: »

The HSE is funded just as well as the NHS. Consider than when you hand over €50 quid to the doctor and another €40 to the chemist. Or when you're waiting 3 years to see a consultant.

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.

Mr. teddywinkles · 03-04-2021 1:45am

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.

Atlantic Dawn · 03-04-2021 1:49am

Mr. teddywinkles wrote: »

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

But with a medical card you could decide to go 100 times in a year for paper cuts, bruises etc and clog up the entire system, someone having to pay €60 a visit might risk avoiding going until they pass out or cancer spreads througout their body and they have to go. Neither system works.

rock22 · 03-04-2021 8:25am

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] · 03-04-2021 12:00pm

rock22 wrote: »

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.

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.

Geuze · 03-04-2021 11:57pm

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

Geuze · 04-04-2021 12:00am

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.

If I stay four nights in hosp, I pay 320, way below the true costs.

Taxes cover the balance.

All out-patients is tax-financed, no fees.

All maternity is tax-financed, no fees.

Good loser · 04-04-2021 1:46am

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.

Del2005 · 04-04-2021 10:51am

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.

They use taxis to transfer files FFS. If they can't transfer data efficiently, how inefficient are they on the difficult stuff?

[Deleted User] · 04-04-2021 4:53pm

Geuze wrote: »

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

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.

Fred Cryton · 04-04-2021 5:18pm

View wrote: »

The “problem” is that you have practice medical treatment running in parallel to the public one and the same personnel operating in both. Hence there is an inherent conflict of interest in the system.

No one would pay for private medical care if the public health care provided the same level of care and attention and on an identical timescale. Why would you pay a premium for an identical level of care?

Hence, in order to “justify” you paying that premium for private care, the public health care provided by the personnel involved must be worse than the private health care they provide you with, even when they are provided in the same hospital. Bluntly, their private medical earnings are dependent on you hightailing it from the public system and seeing them as a private medical patient.

And, as that is what happens, our current medical system is in fact working well for the beneficiaries of it. Why should they change a system that suits them well?

You pay a premium to get a better level of care than you would in the public sector. What about that do you not understand.

Are you seriously suggesting that there's some deliberate intention from doctors in the public sector to deliver a bad service, in order to justify the premium for the better private sector care?

Riiighhht....there's a new level of paranoia right there.

L1011 · 04-04-2021 7:06pm

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.

rock22 · 04-04-2021 7:16pm

Fred Cryton wrote: »

You pay a premium to get a better level of care than you would in the public sector. What about that do you not understand.

...

Riiighhht....there's a new level of paranoia right there.

I don't understand any of that, having worked in health care all my life.
Can you explain how the care is 'premium' if you pay more?

RobAMerc · 04-04-2021 7:53pm

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

[Deleted User] · 04-04-2021 9:13pm

L1011 wrote: »

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

And free.
What is the idea of "in tatters" over there? Because I've heard of 6 month waiting lists being disastrous, if that's their bar then their "in tatters" may compare fairly well to here.

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

Would be interested what kind of proportion. Apparently we're at 2.2/4.9million.

Anita Blow · 04-04-2021 9:47pm

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

Lumen · 05-04-2021 12:08am

Del2005 wrote: »

They use taxis to transfer files FFS. If they can't transfer data efficiently, how inefficient are they on the difficult stuff?

This is also done in the UK, or at least was a couple of years ago when I sat in a taxi whose driver regularly transported individual files whilst the patient travelled separately.

rock22 · 05-04-2021 8:14am

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

Why can government consistently underfund hospitals?

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