HSE waiting lists

Black Swan wrote: »

If I were sick, I would much rather be treated in Ireland than Rwanda. The World Health Organisation ranks the world's health systems from 1 (best) to 190 (worst) by nations. Ireland ranks 19, the USA 37, and Rwanda ranks 172 (18th from the bottom of the list).

If I were being born, I would much rather be in Ireland than Rwanda. The World Fact Book ranks nations by deaths per 1000 live births from 1 (highest deaths) to 224 (lowest deaths). Ireland ranks 202 with only 3.74 deaths, USA ranks 169 with 6.17 deaths, and Rwanda ranks 23 with 59.59 deaths. Rwanda is only 23rd from the highest deaths per 1000, and roughly 16 times more deaths per live births than Ireland.

If I were giving birth to a child, I would much rather do so in Ireland than Rwanda. For 2013 WHO reported the proportion of deaths among women of reproductive age that were due to maternal causes as only 0.9% for Ireland, 1.5% for USA, but 13.6% for Rwanda. Maternal mortality in Rwanda was roughly 15 times higher than in Ireland.

All this may be true but if you watch the trend in these statistics over the coming years you will probably find that Rwanda will improve. Ireland will not dis-improve until economic reality makes the present system unsustainable, that will likely be within five years. The plan for compulsory health insurance will not necessarily bring efficiency. It will punish people who look after their health while rewarding the smoker, the drinker and the couch potato. The unhealthy will be effectively subsided by healthy people who are forced to pay health insurance whether they want to or not. One wonders if Minister Reilly were a healthy weight would he be doing this to the non obese.

Also, I would be inclined to take WHO statistics with a (very small) pinch of salt. Like the rating agencies which gave Ireland a AAA rating just before the crash, the WHO may be somewhat influenced by historical variants which is understandable but can be misleading.

As a developing country, Rwanda has more home births. Fuel and transport costs are very high and infrastructure is similar to the Ireland of the 1920s so it is not always possible for women to avail of a hospital for giving birth. The idea of paying consultants per procedure is not the reason behind the WHO ratings and it is a good idea in and of itself.

Black Swan wrote: »

Caution should also be exercised when reviewing Rwanda's health care claims when criticism of the ruling Paul Kagame regime have been reported to have severe consequences for journalists and dissidents.

To understand where these reports come from and the motivation behind them, I recommend a book called A Thousand Hills by Steven Kinzer. (It is also worth reading Dead Aid by Dambisa Moya).

medicine12345 wrote: »

Humans are not machines and no two patients are the same. The same operation can take very different times depending on the health status of the patient, comorbidities, etc.
As for your second point, would you prefer patients to get unnecessary operations to cut down on other appointments as they only get paid for ops?
the surgeons squeeze as much operations as they can into the time available. It is not the doctors that need fixing, its the system thats broken. Why should it be up to the doctors to organise the waiting lists when they're doing as much as they can. There are 1.3 nonhealthcare workers per health care worker in the hse. Surely it must be one of these peoples jobs to organise the resources better...

Despite the fact that humans are not machines and patients/operations differ from case to case - a fixed price should nonetheless be set per procedure. Think of it this way, suppose I paid someone to mow the lawn and I agreed to pay them per hour - the job might never get done if they spent enough time scratching their behinds instead of cutting the lawn. Meanwhile the clock is ticking and it is costing me money every hour. Alternatively, we could agree a price to be paid after the lawn has been cut. No doubt the lawn mower could break or lightening could strike but that is the chance you take if you want the job.

Assuming Hannibal Lechter is not in the surgery I see no reason why a patient would get an unnecessary operation. A surgeon could make a million appointments with every patient if he wants to but he should only get paid per operation. As for squeezing a lot of operations into an allotted time - such practice would be unlikely as the surgeon risks his career if he makes a mistake and besides such malpractice can easily be contained by simple rules. In any case, there are cancer patients on waiting lists - perhaps it wouldn`t be so terrible if consultants were motivated to do more operations thereby shortening the time people have to wait.

The way to fix the system is to pay surgeons per procedure. This will free them to do less if they choose while providing an incentive for them to do more, so everyone is a winner

I said nothing about "organizing" waiting lists so that addresses that concern. Besides, the waiting lists will be eliminated as the surgeons will have the motivation they need to carry out more procedures. Then the surgeons can compete for patients and what could be better for the patients than a little competition.

If junior doctors assist in operations then they do so irrespective of whether their senior counterparts are paid per procedure or per hour, so no changes there.

I understand why consultants cherish their hourly pay but they should also understand that the taxpayers cherish the money they are forced to pay to prop up the HSE.

Geuze wrote: »

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The US is by far and away the highest spender on hc in the world.

It's approaching 17% of GDP there, about double the UK spending.

The US get very bad value for money for such huge health expenditure.

17% is not that high relative to some other countries. I may be completely wrong but I think at one point Ireland was spending something like 40 billion per year which was over 50%. As I say I am probably wrong about that but while 17% is too much it is a lot lower than the proportion of GDP some other countries spend.