HSE waiting lists

realitykeeper · 09-05-2014 6:19am #1

Hospital consultants are paid per hour. Perhaps it would be better to pay them per surgical procedure. Rwanda uses this system and they can run a good health service for eleven million people for a fraction of what is costs here. This is also the way the doctors have the incentive to do more and this will eventually clear the waiting lists. It would be like the private sector were running the hospitals, - all nice and efficient with no waste.

Either that or just privatize the hospitals. Health is too important to be left to the state. The nation would starve if it relied on them for food.

_Brian · 09-05-2014 6:34am

Really.
Your suggesting we base our healthcare on the systems in Rwanda ?

So you pay per procedure, and people will rush procedures, rushing procedures would be disastrous.

I know when I'm under the knife I want the lad to take his time and not be thinking that if he hurries up he could squeeze in a few more procedures before lunch.

Black Swan · 09-05-2014 7:21am

realitykeeper wrote: »

Rwanda uses this system and they can run a good health service for eleven million people for a fraction of what is costs here.

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.

realitykeeper · 09-05-2014 11:19am

_Brian wrote: »

So you pay per procedure, and people will rush procedures, rushing procedures would be disastrous.

So you are saying surgeons would rush their work to get more money thereby abandoning their Hippocratic oath? I don`t think so. Certainly they would be motivated to do more but that is far better than not being motivated to do anything. At present they just sit back, get paid and squeeze in the odd surgical procedure between rounds of golf. Surgeons who work more accumulate more experience and competence just like Ryanair pilots. Ryanair has never had a plane crash unlike Air Lingus which is a far smaller airline. So hard work would be good for the surgeons, the patients as well as the taxpayer. Granted some Irish consultants may be afraid of hard work but they could apply for jobs in some other country.

realitykeeper · 09-05-2014 11:35am

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.

chopper6 · 09-05-2014 11:47am

I for one am all for a Rwandan-style healthcare system

We could learn a lot from the country generally :rolleyes: :rolleyes:

sarumite · 09-05-2014 2:44pm

realitykeeper wrote: »

So you are saying surgeons would rush their work to get more money thereby abandoning their Hippocratic oath? I don`t think so. Certainly they would be motivated to do more but that is far better than not being motivated to do anything. At present they just sit back, get paid and squeeze in the odd surgical procedure between rounds of golf. Surgeons who work more accumulate more experience and competence just like Ryanair pilots. Ryanair has never had a plane crash unlike Air Lingus which is a far smaller airline. So hard work would be good for the surgeons, the patients as well as the taxpayer. Granted some Irish consultants may be afraid of hard work but they could apply for jobs in some other country.

The last time Air Lingus had a crash (1986) Ryanair was less than 6 months in operation. I don't necessarily want my surgeons working hard, I want him/her working smart.

robp · 09-05-2014 3:01pm

chopper6 wrote: »

We could learn a lot from the country generally :rolleyes: :rolleyes:

Such a blind insular attitude is crippling.

mariaalice · 09-05-2014 3:07pm

The health system is more that surgical procedure, how do you propose to pay other doctor and health care workers who don't do actual procedures in there work.

chopper6 · 09-05-2014 3:12pm

robp wrote: »

Such a blind insular attitude is crippling.

Correct...but not as blinding as being struck across the face with a machete because of where you're from.

robp · 09-05-2014 3:24pm

mariaalice wrote: »

The health system is more that surgical procedure, how do you propose to pay other doctor and health care workers who don't do actual procedures in there work.

Reasonable point. I guess it would only work with consultants but currently consultants are one of the major bottle necks.

chopper6 wrote: »

Correct...but not as blinding as being struck across the face with a machete because of where you're from.

There is many things we can learn and borrow from developing countries especially those in Africa.

chopper6 · 09-05-2014 4:00pm

robp wrote: »

There is many things we can learn and borrow from developing countries especially those in Africa.

Do tell...

Black Swan · 09-05-2014 4:55pm

realitykeeper wrote: »

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.

Given that the health care infrastructure had collapsed for all practical purposes during the Rwanda 1994 genocide (approximately 800,000 Tutsi and Hutu deaths), starting from almost zero to present should show substantial improvements with the implementation of universal health insurance in that nation.

realitykeeper wrote: »

Also, I would be inclined to take WHO statistics with a (very small) pinch of salt.

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.

medicine12345 · 09-05-2014 7:45pm

realitykeeper wrote: »

So you are saying surgeons would rush their work to get more money thereby abandoning their Hippocratic oath? I don`t think so. Certainly they would be motivated to do more but that is far better than not being motivated to do anything. At present they just sit back, get paid and squeeze in the odd surgical procedure between rounds of golf. Surgeons who work more accumulate more experience and competence just like Ryanair pilots. Ryanair has never had a plane crash unlike Air Lingus which is a far smaller airline. So hard work would be good for the surgeons, the patients as well as the taxpayer. Granted some Irish consultants may be afraid of hard work but they could apply for jobs in some other country.

What are you talking about? I'm afraid you are misinformed.
''They just sit back, get paid'' ''afraid of hard work'' GET REAL!!
You have no idea how hard surgeons work, these are the people working the 100+ hour weeks for 15+ years in order to qualify as surgeons and then working long hours with unreal pressure after that. Trust me, if someone is 'afraid of hard work', surgery is the last thing in the world they would do.

And your idea is ridiculous, obviously some operations take longer than others - some take 15 mins some take 6 hours, some are more complex, some take several people, etc. Plus a large part of a surgeons work is in clinics, meeting patients and assessing if they're suitable for surgery, following up, etc.

realitykeeper · 10-05-2014 1:20am

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).

realitykeeper · 10-05-2014 1:41am

medicine12345 wrote: »

You have no idea how hard surgeons work, these are the people working the 100+ hour weeks ...

some operations take longer than others - some take 15 mins some take 6 hours, some are more complex, some take several people, etc. Plus a large part of a surgeons work is in clinics, meeting patients and assessing if they're suitable for surgery, following up, etc.

Junior doctors work ridiculous hours but that is a different matter. This thread pertains to surgical consultants. I`m not sure what point you are making when you say some procedures take longer than others. MacDonalds have a price for a big Mac and another price for a chicken MacNugget ... pricing a product is not rocket science.

Your final point about surgeons meeting patients etc - I know all about that. Last week I took a day off from work to keep an appointment and I was told the purpose of the appointment was to appoint a date for the next appointment. That was the inspiration behind this thread. Paying by procedure performed will cut out all the nonsense.

medicine12345 · 10-05-2014 2:50pm

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...

medicine12345 · 10-05-2014 2:55pm

And the majority of routine surgerys are done by the 'junior doctors' in combination with the 'consultant surgeon' or under his/her observation, so it is not a separate issue. .

lyda · 10-05-2014 10:46pm

realitykeeper wrote: »

Hospital consultants are paid per hour. Perhaps it would be better to pay them per surgical procedure. Rwanda uses this system and they can run a good health service for eleven million people for a fraction of what is costs here. This is also the way the doctors have the incentive to do more and this will eventually clear the waiting lists. It would be like the private sector were running the hospitals, - all nice and efficient with no waste.

Either that or just privatize the hospitals. Health is too important to be left to the state. The nation would starve if it relied on them for food.

Private health systems are less efficient. The US spends much more per person and gets worse outcomes.

realitykeeper · 11-05-2014 2:45am

lyda wrote: »

Private health systems are less efficient. The US spends much more per person and gets worse outcomes.

If you are referring to pre Obama-care you are wrong on both counts. The US government spent very little on health care because it was mostly private and the hospitals and care were fantastic. It is probably still very good because Obama care has not been around long enough to destroy it.

realitykeeper · 11-05-2014 3:52am

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.

dissed doc · 11-05-2014 11:04am

There is already pay per surgery, in the private sector. If you want it, go and use it. Consultants in the public sector don´t get paid by the hour, they are salaried.

As you will realise, the cost increases a lot when it is pay per surgery. Also, 95% of healthcare is not surgery. Most healthcare is in primary care.

Geuze · 11-05-2014 10:23pm

realitykeeper wrote: »

If you are referring to pre Obama-care you are wrong on both counts. The US government spent very little on health care because it was mostly private and the hospitals and care were fantastic. It is probably still very good because Obama care has not been around long enough to destroy it.

.

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.

realitykeeper · 11-05-2014 10:27pm

dissed doc wrote: »

There is already pay per surgery, in the private sector. If you want it, go and use it. Consultants in the public sector don´t get paid by the hour, they are salaried.

As you will realise, the cost increases a lot when it is pay per surgery. Also, 95% of healthcare is not surgery. Most healthcare is in primary care.

What I want is to not be ripped off on my taxes by supporting a great white elephant. You say costs increase a lot when when it is pay by surgery and yet the private hospitals still manage to make a profit. It is strange that these profit orientated enterprises would choose the costlier of the two options. I wonder why.

If I sound skeptical it`s because I am. Have you ever listened to politicians trying to justify expenditure? If so you may have heard them say something like "I didn`t use this money, I used that money." Of course tax revenue is collected, pooled and decanted all from the same trough so they evidently think the public are stupid and perhaps with some justification.

I am also impressed by the number a red herrings in the mix. First junior doctors, now primary care. This thread pertains to hospital consultants and again I say they should be paid per procedure. If that costs more then I`m sure they`ll have no objection.

realitykeeper · 11-05-2014 10:42pm

Geuze wrote: »

.

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.

chopper6 · 11-05-2014 10:44pm

I wonder will this marvelous system apply when the regions are granted autonomy.

zl1whqvjs75cdy · 11-05-2014 10:52pm

realitykeeper wrote: »

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.

The most cursory of Google searches tell me it's 11% currently. Tell me did you bother to actually investigate or research any of your figures before you started this thread?

realitykeeper · 11-05-2014 11:18pm

donkeyoaty0099 wrote: »

The most cursory of Google searches tell me it's 11% currently. Tell me did you bother to actually investigate or research any of your figures before you started this thread?

The thread proposed an idea. Now don`t you feel foolish?

The ERSI recommend the use of GNP in Ireland`s case so that blows your 11% out of the water and into the stratosphere.

chopper6 · 11-05-2014 11:43pm

realitykeeper wrote: »

The thread proposed an idea. Now don`t you feel foolish?

The ERSI recommend the use of GNP in Ireland`s case so that blows your 11% out of the water and into the stratosphere.

He said he did a very quick google search.

You seem to be having some sort of seizure.

medicine12345 · 11-05-2014 11:49pm

realitykeeper wrote: »

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.

do you not think that surgeons don't already try to do as many surgerys as they can in the time available, shur if they were to put off doing one this week, its just an extra one to do next week. Do you think they like telling patients that need operations that they will have to wait a few months??? Its really frustrating!!
As another poster pointed out they get paid an annual salary so its not as if they are dragging out each day, they have nothing to gain by having these lists.
If this provided greater motivation to do more operations and the lists were reduced, where would the money come to pay them, the system is already in massive debt obviously...

medicine12345 · 11-05-2014 11:53pm

realitykeeper wrote: »

What I want is to not be ripped off on my taxes by supporting a great white elephant. You say costs increase a lot when when it is pay by surgery and yet the private hospitals still manage to make a profit. It is strange that these profit orientated enterprises would choose the costlier of the two options. I wonder why.

Of course private hospitals make a profit, the whole point is that people are willing to pay big money (or pay high insurance) in order to 'skip the queues'. And anyway aren't surgeons their own boss in these hospitals, just operating out of them so they can operate on who they like and charge what they want??

chopper6 · 12-05-2014 12:13am

medicine12345 wrote: »

Of course private hospitals make a profit, the whole point is that people are willing to pay big money (or pay high insurance) in order to 'skip the queues'. And anyway aren't surgeons their own boss in these hospitals, just operating out of them so they can operate on who they like and charge what they want??

In your opinion do you think there are A)more competant surgeons in the public sector and

that they could earn more money privtely?

medicine12345 · 12-05-2014 12:18am

chopper6 wrote: »

In your opinion do you think there are A)more competant surgeons in the public sector and that they could earn more money privtely?

I thought they tend to do a combination of both public and private?? So the same doctors are doing both??

chopper6 · 12-05-2014 12:24am

medicine12345 wrote: »

I thought they tend to do a combination of both public and private?? So the same doctors are doing both??

Yup...it's all about referrals..there might be one surgeon/specialist qualified in a procedure with the principal diffrence being he will get paid far more in the private pratice than in the salary-orientated public sector.

realitykeeper · 12-05-2014 1:20am

chopper6 wrote: »

You seem to be having some sort of seizure.

Temper, temper.

realitykeeper · 12-05-2014 2:12am

medicine12345 wrote: »

As another poster pointed out they get paid an annual salary so its not as if they are dragging out each day, they have nothing to gain by having these lists.
If this provided greater motivation to do more operations and the lists were reduced, where would the money come to pay them, the system is already in massive debt obviously...

A year is a unit of time. Paying per unit of time guarantees nothing. Paying per operation guarantees a link between what is paid and what is received in return. When the waiting lists are reduced to very low numbers, what you would find is that there would not be enough patients in need of operations to keep up with the surgeons demand for business. The excess supply of surgeons would then leave for greener pastures thus rendering the HSE more efficient with fewer wage bills to pay.
If the surgeons were to demand more pay in the short term for performing more operations they would first have to explain how they were suddenly able to perform so many more operations. Without an adequate explanation, all kinds of theories and related consequences could present themselves and that would not be in the interests of the surgeons.

medicine12345 wrote: »

Of course private hospitals make a profit, the whole point is that people are willing to pay big money (or pay high insurance) in order to 'skip the queues'. And anyway aren't surgeons their own boss in these hospitals, just operating out of them so they can operate on who they like and charge what they want??

Yes but there would be no queues to skip if the HSE paid surgeons per operation. Why should public patients have to wait when they pay good money through their taxes. When you think about it, if a public patient is ultimately going to be operated on then the delay serves no purpose in and of itself. If the patient dies while waiting then ultimately the surgeon doesn`t have to do that operation which is good for the surgeon who still gets paid but bad for the patient who is dead. Paying surgeons per operation would mean it is no longer in the surgeons interests if a patient dies while on a waiting list.

I`m not saying there is no place for private health care but the difference should be in the decor, the gourmet food and the movie channels - it should not be about waiting until your cancer is terminal before you get treatment.

Permabear · 12-05-2014 5:47am

This post has been deleted.

dissed doc · 12-05-2014 7:07pm

realitykeeper wrote: »

A year is a unit of time. Paying per unit of time guarantees nothing.

Well it guarantees a certain amount of work done for the amount of time the consultants are contracted for. That is the purpose of a salary position and providing incentives like job security, money for further training, holidays, pension, etc., . The alternative is fee for service which becomes very expensive for state-driven services to afford.

At the moment the state pays 100k/year salary for a consultant surgeon. If he was fee for service, it would like cost a lot more (basing it off what it costs in the private sector). As surgery accounts for a tiny amount of overall healthcare expenditure, it would make little difference overall to how much tax you pay. Which, comparing to other countries european countries in terms of tax burden, is very little.

Paying per operation guarantees a link between what is paid and what is received in return. When the waiting lists are reduced to very low numbers, what you would find is that there would not be enough patients in need of operations to keep up with the surgeons demand for business. The excess supply of surgeons would then leave for greener pastures thus rendering the HSE more efficient with fewer wage bills to pay.

I think you are under the assumption that there is a finite amount of surgery that has to be delivered and once it is done, that is it. Unlike the Economics 101 supply and demand theory which works for something that has a maximum market penetration (e.g., iPhones, how many can afford it, of that how many do buy it, and then eventually the market is saturated and you need a new product). Healthcare never reaches saturation point (except non-essential cosmetic-related healthcare). There is endless demand, limited supply (of doctors to provide the care) and limited resources from insurance or taxpayers. There will never be an excess of surgeons for the care being demanded and what can be provided.

If the surgeons were to demand more pay in the short term for performing more operations they would first have to explain how they were suddenly able to perform so many more operations. Without an adequate explanation, all kinds of theories and related consequences could present themselves and that would not be in the interests of the surgeons.

Why not? Treat it like Uber with your market model. Lots of people want care at 2am on a Friday night? Cost per surgery for stabbing should go up according to demand. In fact, that is the real solution. Pay per fee that dynamically adjusts to the level of demand. Hold out for the cheaper appendectomy maybe €5k in 12 hrs time, or go for it now but it costs €10k because there is only one surgeon and you are paying per fee.

But of course what you want basically is a highly trained doctor, of which there is limited supply, to be paid per procedure at a rate that you personally can afford and whenever you like. Failing to see that the supply of the doctor is the rate limiting step.

Yes but there would be no queues to skip if the HSE paid surgeons per operation. Why should public patients have to wait when they pay good money through their taxes. When you think about it, if a public patient is ultimately going to be operated on then the delay serves no purpose in and of itself. If the patient dies while waiting then ultimately the surgeon doesn`t have to do that operation which is good for the surgeon who still gets paid but bad for the patient who is dead. Paying surgeons per operation would mean it is no longer in the surgeons interests if a patient dies while on a waiting list.

Thankfully, being paid or not paid does not come into the decision making process for surgery. For example, some procedures have high mortality rates than others. Your idea would mean surgeons would pick ones with lower mortality. Or would you also force them to do procedures against there will? A conscripted workforce?

I`m not saying there is no place for private health care but the difference should be in the decor, the gourmet food and the movie channels - it should not be about waiting until your cancer is terminal before you get treatment.

I put it to you, that you already pay most likely very little for healthcare and resent having to pay it at all. Look at your paycheck and deduct 15%. That is around what you should be paying to get equivalent care that leads to quick appointments e.g., in Germany.

realitykeeper · 13-05-2014 3:59am

dissed doc wrote: »

... I think you are under the assumption that there is a finite amount of surgery that has to be delivered ...

Hospital consultants like to work in private hospitals on a pay per fee basis, in fact they don`t seem to want to do anything else. So all I am suggesting is the hospital consultants get paid per procedure in the public hospitals as well. No need for a salary then and won`t that make them feel happy?

You keep saying there are lots of other costs in the HSE but this is not about those other costs, this is about hospital consultants. You also say that there are no limits to to number of potential surgeries people could have and that some people might like a 2 AM breast augmentation with a side order of liposuction. I think most folks would be happy with a lesser service. The elimination of the existing waiting list which is for daytime surgery for hip replacement, heart bypass and such like.

dissed doc · 13-05-2014 7:52am

realitykeeper wrote: »

Hospital consultants like to work in private hospitals on a pay per fee basis, in fact they don`t seem to want to do anything else. So all I am suggesting is the hospital consultants get paid per procedure in the public hospitals as well. No need for a salary then and won`t that make them feel happy?

it is purely conjecture on your part that hospital consultants like to work in private hospitals and conjecture and supposition about what people may or may not like is not a solid basis for deciding how health care gets delivered.

There is also no finite amount of surgery that is done; that model of economics does not apply as demand is never satisfied and supply can never be fulfilled.

You keep saying there are lots of other costs in the HSE but this is not about those other costs, this is about hospital consultants.

And the reason I mentioned the other costs is to put the original suggestion in perspective of both overall national healthcare costs and also individual cost. The overall impact would be negligible and individuals would pay more. You seem primarily hoping somehow that it also means consultants will get paid less but the reality is they would be paid a lot more.

You also say that there are no limits to to number of potential surgeries people could have and that some people might like a 2 AM breast augmentation with a side order of liposuction. I think most folks would be happy with a lesser service. The elimination of the existing waiting list which is for daytime surgery for hip replacement, heart bypass and such like.

I think you missed the point there. For some procedures there is a finite market, such as cosmetic procedures. For everything else the market is infinite; the time of the surgeon will always be rationed. It is completely impossible for everyone who needs surgery to have it when they want at any time because you would need a population of surgeons equal to the population of people requiring surgery. That is ludicrous. When robot doctors come in, the situation will change.

Why not write some numbers. See how many of a certain procedure are done every year and how many surgeons can do that procedure. No conjecture, just put down rough figures. You will see that the rate limiter is the lack of surgeons (worldwide). Hence cost goes up, and demand goes up always because it is not like buying a Samsung because the iPhone is not available, and this is why market economics don't work in healthcare.

LeBash · 13-05-2014 7:52am

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.

That'll learn ya!

realitykeeper · 13-05-2014 11:29pm

dissed doc wrote: »

it is purely conjecture on your part that hospital consultants like to work in private hospitals

Ok so, maybe they don`t like it in which case they`re only in it for the money. The point is they choose to work in private practice despite being employed full time by the HSE at enormous expense to the taxpayer. Where do they get their energy? Could it be that the reason they work in private practice is because they don`t really work for the HSE - they just pocket the HSE salary and spend all their time doing private practice. After all, it all happens in the same buildings. Its not as if they have a boss looking over their shoulder making sure they deliver for the HSE and the health ministers are invariably clueless as to what is going on because they can`t micromanage.

Surely, if they must have a bolshevic public sector then they should at the very least have Stalinist type polit bureaucrats to watch their every move and ensure they are doing their jobs, or better still - just pay the surgeons per operation so there`ll be no need for the polit bureaucrats.

dissed doc wrote: »

There is also no finite amount of surgery that is done; that model of economics does not apply as demand is never satisfied and supply can never be fulfilled.

And the reason I mentioned the other costs is to put the original suggestion in perspective of both overall national healthcare costs and also individual cost. The overall impact would be negligible and individuals would pay more. You seem primarily hoping somehow that it also means consultants will get paid less but the reality is they would be paid a lot more.

It is true our government is stupid enough to pay them more, but at the end of the day the private hospitals make a profit despite the existence of the public hospitals. Therefore, the public hospitals should operate on the same basis. The surgeons have more freedom on a pay per operation basis and that freedom essentially renders them self employed. They ensure themselves, them pay their own taxes etc and just like in private practice they can opt to invest in equipment or buy it from the HSE. I think you would be surprised how much the HSE could save by paying consultant per operation.

dissed doc wrote: »

I think you missed the point there. For some procedures there is a finite market, such as cosmetic procedures. For everything else the market is infinite; the time of the surgeon will always be rationed. It is completely impossible for everyone who needs surgery to have it when they want at any time because you would need a population of surgeons equal to the population of people requiring surgery. That is ludicrous. When robot doctors come in, the situation will change.

Everyone has to die of something. So on that basis, yes the demand is potentially infinite. However, only a quack would try to exploit that and laws against quackery would be a good deterrent. I`ve just had a vision of hell, a world crammed with billions off very old people all being kept alive forever. Realistically, nobody really wants to live forever.

If surgeons are opposed to pay per operation in the public system then it is definitely a good idea.

Carawaystick · 15-05-2014 4:53pm

realitykeeper wrote: »

Hospital Managers are paid per hour. Perhaps it would be better to pay them per surgical procedure.This is also the way the managers have the incentive to do more and this will eventually clear the waiting lists.

fyp

Maybe even for all senior hse administrators.

HSE waiting lists

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