Tanaiste calls on doctors to reduce their charges

tallaght01 · 18-10-2008 12:11AM #1

http://www.independent.ie/breaking-news/national-news/tanaiste-calls-on-doctors-to-reduce-their-charges-1502090.html

the irish times wrote:

The Tanaiste is putting pressure on doctors to reduce the amount of money they receive to provide healthcare for elderly medical card holders.

Mary Coughlan has indicated that if GPs were prepared to take less money, the Government could readdress the abolition of universal medical cards for the over 70s.

There has been uproar since the Government announced in the Budget on Tuesday that they would be scrapping the scheme, which automatically entitles every person over 70 to a medical card.

The Minister for Health issued modifications to scheme last night.

People on the State contributory pension will still qualify, and those over the threshold will receive either a GP-only card or a €400 annual payment, depending on their financial situation.

So, what do people reckon?

Should lawyers take less cash to prop up the crappy legal aid system?

Should junior doctors and nurses take less money so the government can improve the crappy hospital system?

Or is coughlan justified in what she's asking for?

My opnion: It's a crock of balls. She's paying private contracters. If you want to dictate how much private business people charge, then emply them.
Emply docs to work for the state, and provide free-at-the-point-of-entry care to the old, the less well-off and the very young via salaried public doctors.
Just my 2c though.

2Scoops · 18-10-2008 12:22AM

A completely transparent exercise in blame repositioning. If nothing else, it will be interesting to see how hard they push this and whether it will affect the equilibrium between public dislike of 'greedy politicians' versus 'rich doctors.'

Bison · 18-10-2008 08:41AM

It is very cynical for the government to try and renegotiate this GP agreement through the stress and emotion of old age pensioners worried about their health. They wouldn't have been "over a barrell" if they had actually put some thought into this first and hadn't used it as an election stunt just a few years ago.

I can't comment on whether the over 70's payment is an over/underpayment as I don't know the figures for average visits per year or GP workload for these patients, but the IMO should use this as opportunity to get the HSE to sit down to the overall GP contract negotiations they have been avoiding. They specifically need to address the lack of GP training places in my opinion.

Also, the IMO needs to show a bit of testicular fortitude in the face of these snide comments by politicians implying that if it wasn't for greedy doctors we would all be fine. Every time one is released they should have their own statement ready for the media, perhaps pointing out that if we didn't have such incompetents in senior positions we would all be fine.

asdasd · 18-10-2008 10:24AM

It's a crock of balls. She's paying private contracters. If you want to dictate how much private business people charge, then emply them.

consultancy is a cartel.

tallaght01 · 18-10-2008 10:38AM

asdasd wrote: »

consultancy is a cartel.

She's talking about GPs.

SomeDose · 18-10-2008 11:30AM

I don't think the HSE could possibly sink any lower in my estimations these days. Pulling at public heart-strings is a favourite spin tactic of theirs. This smacks of the same machinations that Jabba and her HSE cronies tried to pull with the pharmacists earlier this year. They suddenly decided that they didn't like the price they were paying for GMS medicines (which the HSE themselves negotiated with manufacturers) and figured they could unilaterally change their contractual payments to private contractors without consultation. Recent court decisions have rightly deemed this action illegal, so I'd imagine the HSE will be very hesitant to attempt anything similar with GPs.

tallaght01 · 18-10-2008 11:55AM

I just wrote a piece about it in the boards medics blog

RobFowl · 18-10-2008 12:03PM

just to give a bit of background. The IMO (GP's union) have been trying to renegotiate the whole GMS contract since early 2005 at least. The government has refused to meet to negotiate as it claims it cannot negotiate fees and charges with the IMO as a result of their comeptition act.
Interesting to she how quickly they change their stance whey political reality bites ! (ps am a GP and an IMO member so not totally unbiased, In my situation I would actually make more money if the present proposal goes through but I'm strongly against it, totally unfair to people who were promised free medical care and prescriptions by the same goverment who now claim thats its an unfair and inequitable system)

sam34 · 19-10-2008 11:46AM

this is another cynical cheap shot by the government. very easy to blame those big bad greedy doctors. tbh, i wish the imo were a bit more vocal and came out and defended their members. as a union, i feel theyre very low profile.

Heinrich · 19-10-2008 11:55AM

sam34 wrote: »

this is another cynical cheap shot by the government. very easy to blame those big bad greedy doctors. tbh, i wish the imo were a bit more vocal and came out and defended their members. as a union, i feel theyre very low profile.

If I may use a typical Dail buzzword "I won't take lessons" from overpaid, inept and cynical politicians...

asdasd · 19-10-2008 12:55PM

They suddenly decided that they didn't like the price they were paying for GMS medicines (which the HSE themselves negotiated with manufacturers) and figured they could unilaterally change their contractual payments to private contractors without consultation.

good for them. That has been a mainstay of the democratic party's agenda in the US for years - force the manufacturers to renegotiate on price.

The major cost of running the health service is Wages. The second major cost is drugs. Where did the 300% increase in costs go to?

tallaght01 · 19-10-2008 06:05PM

asdasd wrote: »

The major cost of running the health service is Wages. The second major cost is drugs.

But that is ENTIRELY different to saying either are poor value for money, or should be reduced.

If the main cost to airlines was safety, we wouldn't be asking them to skimp on it when times are tough.

metrovelvet · 19-10-2008 06:07PM

The doctors should call on the tanaiste and tds to reduce their charges and take a pay cut.

DrIndy · 20-10-2008 04:58PM

What the OP is proposing is a universal primary care system like in the UK - this would in fact cost much more of government funding that our semi-private GP service we are all used to here as the government would need to stump it all up rather than sting middle income taxpayers with PAYE and then medical costs.

To also radically change the system would mean a few years of chaos and a massive capital program to build primary care centres properly as in the UK.

Its cheaper to take cheap shots. (comment is directed at the government not the OP

)

asdasd · 20-10-2008 05:02PM

But that is ENTIRELY different to saying either are poor value for money, or should be reduced.

YOu are not proving that they are not either. the prices of drugs often reflects what government are willing to pay for.

Bison · 20-10-2008 05:28PM

asdasd wrote: »

good for them. That has been a mainstay of the democratic party's agenda in the US for years - force the manufacturers to renegotiate on price.

The major cost of running the health service is Wages. The second major cost is drugs. Where did the 300% increase in costs go to?

The government didn't try to renegotiate with the manufacturers, they unilaterally tore up the pharmacy contract. Then they got their ass kicked in the high court, so now they are after the GP's via the scared old people. Perhaps if they tried the same aggression with the manufacturers as they do with hard working professionals they could save a few Euro for us all.

tallaght01 · 20-10-2008 07:16PM

asdasd wrote: »

YOu are not proving that they are not either. the prices of drugs often reflects what government are willing to pay for.

Well, I was never quite sure what your point was in the first place.

I'm not sure if you're implying there's not more wages or drugs since Harney injected some poorly disseminated cash into the HSE.

asdasd · 21-10-2008 08:40AM

Well, I was never quite sure what your point was in the first place.

you didn't understand this!?

"The major cost of running the health service is Wages. The second major cost is drugs."

Why do we even have pharmacy as a "profession" anyway. get a prescription, and give it. How hard is that?

tallaght01 · 21-10-2008 10:04AM

asdasd wrote: »

you didn't understand this!?

"The major cost of running the health service is Wages. The second major cost is drugs."

Why do we even have pharmacy as a "profession" anyway. get a prescription, and give it. How hard is that?

Well, it was the point I had difficulty understanding, rather than the sentence.

But when you're aksing why we need pharmacists, then I think there's bigger gaps in your knowledge than what you've posted abve.

asdasd · 21-10-2008 10:58AM

But when you're aksing why we need pharmacists, then I think there's bigger gaps in your knowledge than what you've posted abve.

Feel free to explain. I would have thought pharmacy a mere medeival cartel, not dissimilar to the lawyer-solictor boondangle. Here is how things should work in this great internet age.

Doctor recommends medicine. medicine is there in hospital or Doctors surgery. Patient gets medicine.
or

Doctor recommends medicine. Not available yet, so types somthing into computer and gets medicine from source, or sends it to patients address.

People packaging medicine dont know what it is.

Why would this not work?

Tim Robbins · 21-10-2008 11:54AM

I think Doctors are over payed. The question is how much should they be paid?

In the private sector, it's supply and demand that determines price.
If there's low supply all government can do is increase college places so that there is no supply problem. Then the market can decide how much they should get paid like everything else in the private sector.

The problem is that medical care is not like a normal private industry. It is an essential service. I agree with the OP, I'd like to more public contracts for GPs and then be paid a yearly salary. As for how much that should be, inline with what it is in other European countries. I can't see the IMO doing that though.

jaycen · 21-10-2008 11:57AM

Fair play to her but I don't think it will have any effect on the moneygrabbing doctors;
€50 for a GP visit that probably lasts 15 mins, there should be a law against rates like that, in any other profession price fixing like that wouldn't be tolerated.

ceegee · 21-10-2008 12:31PM

asdasd wrote: »

Feel free to explain. I would have thought pharmacy a mere medeival cartel, not dissimilar to the lawyer-solictor boondangle. Here is how things should work in this great internet age.

Doctor recommends medicine. medicine is there in hospital or Doctors surgery. Patient gets medicine.
or

Doctor recommends medicine. Not available yet, so types somthing into computer and gets medicine from source, or sends it to patients address.

People packaging medicine dont know what it is.

Why would this not work?

Such a system would be wide open to abuse: financially it rewards doctor for prescribing + then dispensing the more expensive option of drugs - not to mention enabling the next Harold Shipman to go about his business without any other health professional knowing what he has given to patients

Even more seriously the number of patients dying due to incorrect doses, inappropriate medicines, interactions etc. would skyrocket without pharmacists checking prescriptions.

Doctors are trained to be doctors. They dont have the appropriate training to do a pharmacists job.

tallaght01 · 21-10-2008 12:34PM

asdasd wrote: »

Feel free to explain. I would have thought pharmacy a mere medeival cartel, not dissimilar to the lawyer-solictor boondangle. Here is how things should work in this great internet age.

Doctor recommends medicine. medicine is there in hospital or Doctors surgery. Patient gets medicine.
or

Doctor recommends medicine. Not available yet, so types somthing into computer and gets medicine from source, or sends it to patients address.

People packaging medicine dont know what it is.

Why would this not work?

Pharmacists are some of the most important people in a health service.

Some of their vital roles:

They check patient prescription charts every day for drug interactions, dosage errors etc. It makes much more sense to have a person do this every day, who has expertise in the field. They have time to specifically go through the chart and check it in detail.... they are very good at this, and have much more time to do it than the exhausted intern.
My last 2 pharmacist interaction were:

1) pharmacist had calculated a patient's creatinine clearance for a drug my SHO had written up for a patient. It was a bit high, so she suggested another drug. I agreed. It was well spotted.

2) I wanted to give someone growth hormone. He was having counselling for extreme needle phobia. I rang up our pharmacists for ideas on the best way to deliver the drug. He suggested transdermal patches. Happy days. He sorted them out.

Pharmacists answer patients questions about their drugs, when to take them, what to take them with, how to take them. A lot of dispensing can be done by dispensing assistants.

But pharmacists are very often your last safety net. Getting rid of them would be a disaster for patient care.

tallaght01 · 21-10-2008 12:38PM

Tim Robbins wrote: »

I think Doctors are over payed..

Out of curiousity, how much would you expect to be paid for doing a 72 hour shift, making life or death decision, with maybe an hour of sleep?

jaycen wrote: »

Fair play to her but I don't think it will have any effect on the moneygrabbing doctors;
€50 for a GP visit that probably lasts 15 mins, there should be a law against rates like that, in any other profession price fixing like that wouldn't be tolerated.

I paid my lawyer 80 euro to notarise my medical degree before coming to Oz. Took maybe 1 minute in total.

I paid my driving instructor a better hourly rate than I was earning.
I currently pay my drum teacher a better hourly rate than I get.

inforfun · 21-10-2008 12:50PM

tallaght01 wrote: »

Out of curiousity, how much would you expect to be paid for doing a 72 hour shift, making life or death decision, with maybe an hour of sleep?

To be perfectly honest, i wouldnt like anyone who is up for 70 hours to make a life/death decision on me.

50 or 60 euro is an awfull lot to see a doctor for 10 minutes in order to walk out with a recipe for yet another antibiotics cure.

I live in ireland for 7 years now but i have seen more people on antibiotics in those 7 years than in 30+ years in my own country (the Netherlands).
What is up with that?

asdasd · 21-10-2008 12:57PM

I live in ireland for 7 years now but i have seen more people on antibiotics in those 7 years than in 30+ years in my own country (the Netherlands).

Pharmacists not doing their essential job.

1) pharmacist had calculated a patient's creatinine clearance for a drug my SHO had written up for a patient. It was a bit high, so she suggested another drug. I agreed. It was well spotted.

2) I wanted to give someone growth hormone. He was having counselling for extreme needle phobia. I rang up our pharmacists for ideas on the best way to deliver the drug. He suggested transdermal patches. Happy days. He sorted them out.

No idea what a SHO is? Why could either of you not do this job? Do we need another prefessional to know that if you dont use needles you use patches? Why?

deepimpact · 21-10-2008 01:03PM

asdasd wrote: »

Pharmacists not doing their essential job.

And what job is that?
Seriously, give your own view on a pharmacist's job description.

I'm very interested, as a pharmacist.

asdasd · 21-10-2008 01:05PM

I'm very interested, as a pharmacist.

Surely you would know, then? The original poster said anti-biotics are over-perscribed. Why not intervene, or whats the point of you.

Am interested, as a citizen.

ceegee · 21-10-2008 01:52PM

asdasd wrote: »

Surely you would know, then? The original poster said anti-biotics are over-perscribed. Why not intervene, or whats the point of you.

Am interested, as a citizen.

As a pharmacist, there isnt generally enough information available to you when a patient presents an antibiotic prescription to justify you second guessing a doctors diagnosis. In these situations the role of the pharmacist is primarily to ascertain whether the medication is suitable for the patient (drug allergys, interactions with other medicines), whether it is a suitable dose, etc.

The onus for appropriate prescribing of antibiotics is primarily with the doctor, as they are the ones qualified to diagnose and who have access to test results to aid them in doing so.

Basically, it is the role of the doctor to decide if an antibiotic is required, and the role of the pharmacist to ensure the most suitable antibiotic is given in an appropriate manner

(I realise that this is a vast simplification of both roles but its quite hard to suimmarise these roles in a definite manner)

tallaght01 · 21-10-2008 01:57PM

inforfun wrote: »

To be perfectly honest, i wouldnt like anyone who is up for 70 hours to make a life/death decision on me.

50 or 60 euro is an awfull lot to see a doctor for 10 minutes in order to walk out with a recipe for yet another antibiotics cure.

I live in ireland for 7 years now but i have seen more people on antibiotics in those 7 years than in 30+ years in my own country (the Netherlands).
What is up with that?

Yea, we don't particularly like doing it either. But, one of the carrots at the end of the stick is a well paid position at the end of it.

Many many doctors do a 24 hour shift 1 day in every 3 or 4, and they do a 72 hour shift every 3rd or 4th weekend.

They might do this for 8 or more years. These are some of the most highly qualified people in the country, who work essentially slave labour for the best part of their lives (well I'd regard my 20s and early 30s as the potential fun years). So, you have to reward them.

I don't begrudge a GP earning 150k per year. They're highly qualified,a nd they've busted their balls for the health service.

The reason they give antibiotics is simple. 99% of GPs know they're useless. But you're paying. You should see the arguments people put up when they go to their doctors, and they don't get an antibiotic. I've heard my relatives complaining about ot getting an antibiotic, when their cold has "gone to my chest" or "started getting green phlegm". GP surgery waiting rooms are packed t the hilt in december/january every year. It's full of people with colds.

They're all their for one reason...an antibiotic.

I spoke to a GP friend of mine before, and asked him why he just doesn't refuse to prescribe antibiotics. He said he just didn't have the stomach for the fight anymore. He tried. But he was getting into arguments with 10-15 people each day.

He's only human, so he now prescribes amoxicillin for colds. He's a really good guy, and really really intelligent. He's worked in an infectious disease unit when he was a hospital doctor.

asdasd wrote: »

Surely you would know, then? The original poster said anti-biotics are over-perscribed. Why not intervene, or whats the point of you.

Am interested, as a citizen.

Pharmacists aren't there to query the diagnosis. Pharmacists aren't trained to diagnose. Therefore, they don't ring you up saying "I've had a look inside that kiddy's ear, and I think it's viral.".

If you prescribe an antibiotic, then the pharmacist has to take it at face value that you suspect a bacterial infection.

That is not their "essential role"

Tanaiste calls on doctors to reduce their charges

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