An "Irish NHS" - what needs to change?

dulpit · 25-04-2021 12:17pm #1

Hey,

I saw that there was a BBC spotlight set of polls carried out last week for voters in the North and Republic. One of the questions asked was "in a United Ireland, should there be an Irish NHS?". Here are the results:

https://twitter.com/NextIrishGE/status/1385360191097614339

https://twitter.com/NextIrishGE/status/1385361279762767872

It got me thinking, what is the difference between the HSE as it exists and a true NHS? Or is the HSE that already?

I was chatting with a buddy of mine who's recently moved home from Scotland, he mentioned that dentists, GPs and medicines were covered by the NHS, whereas here you pay for most things (unless you have medical card).

I get that the HSE management is a bit all over the place, but apart from that, what sorts of services would an "Irish NHS" offer that the HSE doesn't?

Economics101 · 25-04-2021 12:30pm

The UK NHS has a lot in common with the Irish GMS as operated by the HSE. Biggest differences are coverage for GP services, Drugs costs, and dental treatment.

What is not realised is how much else the HSE and the NHS have in common: they are both basically free or heavily subsidised at the point of usage and are both almost entirely financed directly through taxation. They both seem to have a propensity to generate long delays and queues for treatment. Sometimes the HSE is worse (for hospital treatment and consultant services) and sometime the NHS is worse (apparently to get a GP appointment).

The big contrast is with many systems in continental Europe, which tend to be more insurance-based. This does not necessarily mean a State insurance scheme, but it does mean a very high degree of regulation. Often there are relatively modest co-payments to deter frivolous usage. The main result is that providers have an incentive to get people treated so they can get paid. Also the providers are not necessarily State-owned. As long as they meet all the regulatory requirements that's what matters.

People in the UK tend to think they have the world's best health service. They don't. For some reason (mainly Irish Times journalism, in my opinion) many Irish people also suffer from NHS delusion.

Kermit.de.frog · 25-04-2021 12:38pm

People not paying for stuff would strike me as a massive problem in this country as it is.

I'm not sure the answer is trying to provide more 'free' stuff that workers in the state will again pay for one way or another.

And something as proposed in the OP would be a bottomless money pit we simply can't afford because of other choices we make as a country. Like the basic concept of rates in the UK for example.

People here won't even pay for water ffs. They think clean drinking water magically arrives from the reservoir to their taps courtesy of nature.

So I would be against these initiatives because it will bankrupt us quicker and does not deal with the underlying disease in Irish society of not wanting to pay for anything.

Also agree on the UK NHS. It's far from what it's cracked up to be.

km991148 · 25-04-2021 2:04pm

UK NHS has lost its way over the last 10/15 years. Coincidentally during one of the most privatisation-heavy conservative governments.

It tricks people into thinking it's still the same as it once was because it's free at the point of entry, but more and more of the services are given by private companies. I don't necessarily think it's bad to have private firms involved, but there has to be sufficient motivation to provide good quality healthcare and not just hoover up lucrative contracts with healthcare secondary concern.

I think Irish healthcare (from my experience) is really poor. Long waiting times and having to pay for a lot. It's no better than the NHS, far worse it seems in many aspects (especially in preventative measures.. happy to treat things but not as proactive at preventing or detecting illness). The NHS seems to be declining towards the Irish type of healthcare.

This I can only see as opening the back door to American style private health. If you have the money, you will be seen quicker.

Other EU countries seem to have different models that promote overall better healthcare for the masses.

So do we need an 'Irish NHS' - yes, but based on what the NHS should be, not what it is currently evolving into.

slipperyox · 25-04-2021 2:10pm

if you look@:
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29

Ireland is clouded, as private contributions (laya, vhi etc)account for a lot too.

So, is the government going to pay this?

No

jimmycrackcorm · 25-04-2021 2:24pm

Kermit.de.frog wrote:

People here won't even pay for water ffs. They think clean drinking water magically arrives from the reservoir to their taps courtesy of nature.

I'm not surprised that so many in a poll want an NHS style system here. If you asked if pubs should give out beer for free then you'd get the same results.

jimmycrackcorm · 25-04-2021 2:27pm

km991148 wrote:

This I can only see as opening the back door to American style private health. If you have the money, you will be seen quicker.

The American system is terrible. Money might buy you access but it's poor value. Even well off middle class people can get crippled financially if they have a serious long term illness. If you have cover through your work but contract cancer as an example, where you can't continue working then tough luck.

Sadler Peak · 25-04-2021 2:31pm

Has any other country copied the British NHS model ?

Inviere · 25-04-2021 2:31pm

Economics101 wrote: »

What is not realised is how much else the HSE and the NHS have in common: they are both basically free or heavily subsidised at the point of usage and are both almost entirely financed directly through taxation. They both seem to have a propensity to generate long delays and queues for treatment. Sometimes the HSE is worse (for hospital treatment and consultant services) and sometime the NHS is worse (apparently to get a GP appointment).

That's not inherent to the model of providing care as such, more so to do with the craggy island/cute hoor approach to it. The funds generated could be put to a LOT better use than they are currently, without raising taxation levels.

suicide_circus · 25-04-2021 2:32pm

Kermit.de.frog wrote: »

People not paying for stuff would strike me as a massive problem in this country as it is.

This. In Austria for example everyone pays social (health) insurance, even people on the dole. There is no level of income that is free of income tax. There is no free public transport, everyone pays something, everyone contributes. It's no accident the have top class services and infrastructure.

Kermit.de.frog · 25-04-2021 2:37pm

suicide_circus wrote: »

This. In Austria for example everyone pays social (health) insurance, even people on the dole. There is no level of income that is free of income tax. There is no free public transport, everyone pays something, everyone contributes. It's no accident the have top class services and infrastructure.

It's funny because I do genuinely think sometimes who is paying all the taxes to keep the show on the road given the sheer numbers out of the tax brackets completely, all the loopholes, all the reliefs out there?

I fear we are heading for a serious crisis and that we have a gaping hole in our finances because the net is not as wide as it should be that won't take much to expose.

km991148 · 25-04-2021 2:38pm

jimmycrackcorm wrote: »

The American system is terrible. Money might buy you access but it's poor value. Even well off middle class people can get crippled financially if they have a serious long term illness. If you have cover through your work but contract cancer as an example, where you can't continue working then tough luck.

This is what I mean, the worst of all worlds. Pay a fortune, mediocre at best (for most).

UK is headed this way. More private providers or tax money squandered while the quality of care decreases year on year.

dulpit · 25-04-2021 3:20pm

I've definitely seen some reports that suggest that the younger cohort of voters would actually support higher taxes (or at the very least no tax reduction) if there was a tangible and clear improvement in public services.

It would need a strong political will though, most parties would look at the short term gain of reducing taxes..

EddieN75 · 25-04-2021 3:25pm

dulpit wrote: »

I've definitely seen some reports that suggest that the younger cohort of voters would actually support higher taxes (or at the very least no tax reduction) if there was a tangible and clear improvement in public services.

It would need a strong political will though, most parties would look at the short term gain of reducing taxes..

Nothing as intelligent as throwing good money after bad.

More than enough money is given to the hse. Changing the name but keeping the same people and culture won't make a difference

Hamsterchops · 25-04-2021 3:41pm

dulpit wrote: »

An "Irish NHS" - what needs to change?

What needs to change?

Well firstly we need to be part of a much bigger population of about 65 million people. The reason the NHS is better than the HSE (relatively speaking), is because of the sheer size of the NHS and the costs are spread far and wide, the NHS is moulded on a regional basis, NHS England being the largest, then you also have the NHS in Scotland, Northern Ireland & Wales.

Actually there might be an argument for the NHS being extended down here (from NI) in the event if a United Ireland. Understandably the North would not want to let it go, so maybe as a bargaining chip the NHS is extended into the ROI, obviously with us paying our share.

Now there's a nice thought.

Probably not a runner though, but it would be one way of us actually getting the NHS down here. Free GP visits for all like they have up North.

The NHS works because it's spread across such a large population.

I see sheep · 25-04-2021 3:50pm

Economics101 wrote: »

The UK NHS has a lot in common with the Irish GMS as operated by the HSE. Biggest differences are coverage for GP services, Drugs costs, and dental treatment.

What is not realised is how much else the HSE and the NHS have in common: they are both basically free or heavily subsidised at the point of usage and are both almost entirely financed directly through taxation. They both seem to have a propensity to generate long delays and queues for treatment. Sometimes the HSE is worse (for hospital treatment and consultant services) and sometime the NHS is worse (apparently to get a GP appointment).

The big contrast is with many systems in continental Europe, which tend to be more insurance-based. This does not necessarily mean a State insurance scheme, but it does mean a very high degree of regulation. Often there are relatively modest co-payments to deter frivolous usage. The main result is that providers have an incentive to get people treated so they can get paid. Also the providers are not necessarily State-owned. As long as they meet all the regulatory requirements that's what matters.

People in the UK tend to think they have the world's best health service. They don't. For some reason (mainly Irish Times journalism, in my opinion) many Irish people also suffer from NHS delusion.

The NHS is vastly superior to the Irish health service in every sense imo, having lived in both places.
The only problem is like people have said, the tories ars trying to privatise it.

dulpit · 25-04-2021 3:53pm

Hamsterchops wrote: »

What needs to change?

Well firstly we need to be part of a much bigger population of about 65 million people. The reason the NHS is better than the HSE (relatively speaking), is because of the sheer size of the NHS and the costs are spread far and wide, the NHS is moulded on a regional basis, NHS England being the largest, then you also have the NHS in Scotland, Northern Ireland & Wales.

Actually there might be an argument for the NHS being extended down here (from NI) in the event if a United Ireland. Understandably the North would not want to let it go, so maybe as a bargaining chip the NHS is extended into the ROI, obviously with us paying our share.

Now there's a nice thought.

Probably not a runner though, but it would be one way of us actually getting the NHS down here. Free GP visits for all like they have up North.

The NHS works because it's spread across such a large population.

But none of this explains (apart from the free gp) what is different between the NHS and the HSE? What do you get with the NHS that the HSE doesn't give us?

25-04-2021 4:02pm

dulpit wrote: »

I've definitely seen some reports that suggest that the younger cohort of voters would actually support higher taxes (or at the very least no tax reduction) if there was a tangible and clear improvement in public services.

It would need a strong political will though, most parties would look at the short term gain of reducing taxes..

We have a fairly high tax take already and high enough spend. Paying extra taxes shouldn’t be necessary.

25-04-2021 4:03pm

dulpit wrote: »

But none of this explains (apart from the free gp) what is different between the NHS and the HSE? What do you get with the NHS that the HSE doesn't give us?

Everything is free.

indioblack · 25-04-2021 4:09pm

km991148 wrote: »

UK NHS has lost its way over the last 10/15 years. Coincidentally during one of the most privatisation-heavy conservative governments.

It tricks people into thinking it's still the same as it once was because it's free at the point of entry, but more and more of the services are given by private companies. I don't necessarily think it's bad to have private firms involved, but there has to be sufficient motivation to provide good quality healthcare and not just hoover up lucrative contracts with healthcare secondary concern.

I think Irish healthcare (from my experience) is really poor. Long waiting times and having to pay for a lot. It's no better than the NHS, far worse it seems in many aspects (especially in preventative measures.. happy to treat things but not as proactive at preventing or detecting illness). The NHS seems to be declining towards the Irish type of healthcare.

This I can only see as opening the back door to American style private health. If you have the money, you will be seen quicker.

Other EU countries seem to have different models that promote overall better healthcare for the masses.

So do we need an 'Irish NHS' - yes, but based on what the NHS should be, not what it is currently evolving into.

I agree. I can only echo your sentiments. It's an excellent service - but not what it was. I had to make use of the NHS for some weeks this time last year - when things were bad here. The level of personal attention and care from nurses and others was impressive - considering what was happening in the country at the time. Some were retired nurses who had returned to help out. This was regular local healthcare that had to continue despite all that was happening in the country.
Your point about what the NHS may be evolving into is something I agree with.

RandomViewer · 25-04-2021 4:18pm

Kermit.de.frog wrote: »

People not paying for stuff would strike me as a massive problem in this country as it is.

I'm not sure the answer is trying to provide more 'free' stuff that workers in the state will again pay for one way or another.

And something as proposed in the OP would be a bottomless money pit we simply can't afford because of other choices we make as a country. Like the basic concept of rates in the UK for example.

People here won't even pay for water ffs. They think clean drinking water magically arrives from the reservoir to their taps courtesy of nature.

So I would be against these initiatives because it will bankrupt us quicker and does not deal with the underlying disease in Irish society of not wanting to pay for anything.

Also agree on the UK NHS. It's far from what it's cracked up to be.

Water wouldn't have been an issue if it had have been handled by ESB and added to utility bill instead FG decided to hand it to their criminal crony ,

Eric Cartman · 25-04-2021 4:22pm

I see sheep wrote: »

The NHS is vastly superior to the Irish health service in every sense imo, having lived in both places.
The only problem is like people have said, the tories ars trying to privatise it.

The NHS also has funding and queuing issues.

The only way to reform the HSE into an NHS like model is to lock out the unions and sack all the duplicate workers then take the saved money and invest it in actual services instead of management.

Graces7 · 25-04-2021 4:35pm

jimmycrackcorm wrote: »

The American system is terrible. Money might buy you access but it's poor value. Even well off middle class people can get crippled financially if they have a serious long term illness. If you have cover through your work but contract cancer as an example, where you can't continue working then tough luck.

NB Our friends in the US take out insurance for medical costs.

Eric Cartman · 25-04-2021 4:38pm

RandomViewer wrote: »

Water wouldn't have been an issue if it had have been handled by ESB and added to utility bill instead FG decided to hand it to their criminal crony ,

the objection to water charges was for the first time in a damn long time, everyone was expected to pay. Those used to living completely off the state went mad at the idea of having to pay any money for anything and got violent.

theteal · 25-04-2021 4:43pm

dulpit wrote: »

But none of this explains (apart from the free gp) what is different between the NHS and the HSE? What do you get with the NHS that the HSE doesn't give us?

I've "only" been here a decade but thanks to favourable health I'm not entirely sure how it works. From what I gather, there are 2 sides to NHS service. Like Ireland, if you're on benefits, everything is free - prescriptions and all.

Now for us working folk, some bits are free but mostly it's heavily subsidised. So your GP and hospital visits are free. When I go to collect a prescription they ask if I normally pay for them i.e. nice way of asking if you're on benefits. I do have to pay, it's like £7.50 (or thereabouts) - that's it, doesn't matter what I'm getting, that's the fee.

Dentist check ups are free. Scale and polish was £19 last time I had one. I did have root canal in the first year here. That clocked in at <£300 and that included the expensive white crown, the horrible metallic one would have been free.

I had a non-serious issue that needed a bit of surgery 2 years ago. GP visit to job done inside 3 months. No mention of money. That doesn't happen in Ireland without health insurance.

Now it's not all sunshine and lollipops. I waited 2 months for a MRI scan after destroying my knee playing football. I also hear a lot of local complaints about being unable to get through to the GP ont he phone to make an appointment. I find because it's free, they tend to go to GP for every little thing and on the flip side of that, missed appointments are a big unpunished problem.

RandomViewer · 25-04-2021 5:13pm

Eric Cartman wrote: »

the objection to water charges was for the first time in a damn long time, everyone was expected to pay. Those used to living completely off the state went mad at the idea of having to pay any money for anything and got violent.

Dobby was the reason for most of the objections, in a lot of cases people had already paid large fees for a water connection and development fees when they built the house, NCT came in without a hitch 12 years earlier, people saw blatant criminal corruption in Irish water and objected, as I said the ESB had an existing database and another levy on the bill would have gone unchallenged,

Duckworth_Luas · 25-04-2021 5:16pm

fvp4 wrote: »

Everything is free.

Nothing is free

tommybrees · 25-04-2021 5:45pm

Only way to fix the HSE in this country is start from a blank canvas and getting rid of unlimited medical card usage.

It would be political suicide for Any minister to get the HSE to function to its potential though.

Eric Cartman · 25-04-2021 6:18pm

tommybrees wrote: »

Only way to fix the HSE in this country is start from a blank canvas and getting rid of unlimited medical card usage.

It would be political suicide for Any minister to get the HSE to function to its potential though.

anything that could realistically fix the HSE would cause strikes or riots, pissing off the unemployed or the heavily unioned public service is not something any career politician would even consider.

suicide_circus · 25-04-2021 6:45pm

I honestly think the Israeli Palestinian conflict is easier to fix than the HSE

Graces7 · 25-04-2021 6:51pm

suicide_circus wrote: »

This. In Austria for example everyone pays social (health) insurance, even people on the dole. There is no level of income that is free of income tax. There is no free public transport, everyone pays something, everyone contributes. It's no accident the have top class services and infrastructure.

Logically then they will have to raise the amounts of eg dole so that folk can pay without losing what they need to live on. eg food and heating,

Benefit levels in the UK and here take eg free health care into account. You cannot get blood out of a stone

An "Irish NHS" - what needs to change?

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