Why can government consistently underfund hospitals?

RobAMerc wrote: »

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

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.

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.

Brussels Sprout wrote: »

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.

awec wrote: »

I've always wondered about this.

Is the reason this is allowed that they believe if they force medical professionals to pick public or private that too many would just pick private since that's where the major earnings are?

Good loser wrote: »

I kind of remember there were 3 or 4 simple procedures union rules wouldn't let nurses carry out. Then a negotiation allowed the actions. And two years later they were still not being done. Maybe putting in cathaters for the first time, preparing injections/charging?
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coylemj wrote: »

It's fashionable in political circles to whinge about the 'two tier' system but there are benefits on both sides when consultants can do a mix of public and private work.

For the consultant, the public job which occupies part of the working week gives them a steady income with a pension. And a lot of them get to deal with people who came in via A&E, which means they get a more varied workload and experience than if they were exclusively doing elective procedures in a private clinic.

For the public hospital, letting the consultant do some private work means they hang on to some people who would otherwise abandon the public system. And medical insurance companies can be sent hefty bills for the beds occupied by their private patients.

While there are a lot of dedicated and excellent consultants who are prepared to work exclusively in the public system, forcing all consultants to elect for public or private with no overlap would result in public hospitals losing skills some of them could ill afford to lose. Then you really would have a two tier system.