# Total National Spend on Healthcare



## Purple (6 Jan 2011)

We spend an average of just under €4'000 per person on healthcare. That's a total figure, i.e. both public and private spending. Only the USA, Norway, Switzerland, Luxembourg, Canada, Netherlands and Austria spend more than us. I was under the impression that the Swiss spend less per capita than us but I was wrong. 
Incredibly countries with vastly superior healthcare systems such as France, Belgium, Germany, Sweden, Finland and Japan spend less per capita than us, some of them substantially less.
Only 6 countries spend more than us per capita on public health, with the USA and Norway spending substantially more than anyone else.

When will the national dialogue on the heath move from the nonsensical notion that it is underfunded to the reality that is it structurally defective and run for the benefit of those delivering the service rather than those receiving it?  


Source


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## DerKaiser (6 Jan 2011)

Hi Purple.

I brought up this issue a while back:



Approx 40% of tax revenues were going to fund the health service in 2009.

I see from here:

http://www.finance.gov.ie/documents/exchequerstatements/2010/Enddecstatement.pdf

That the budget has been slashed by 10% from 2009 levels in 2010 (Note 4: Health and Children). I'm assuming there was ample fat to minimise the pain caused by this reduction.

I would be genuinely surprised if there are still people out there who believe more funding is needed rather than a better use of the funding available.


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## Shawady (6 Jan 2011)

Purple said:


> Incredibly countries with vastly superior healthcare systems such as France, Belgium, Germany, Sweden, Finland and Japan spend less per capita than us, some of them substantially less.
> 
> Source


 
Anyone know what health insurance costs are and how it works in a country with a well run health system?

I spend €2,500 a year in health insurance for my family which seems high. I don't mind paying it for a good service but I know at one stage we wanted an appointment for a speech therapist for one of my children and we were given a 22 month waiting list. Totally unacceptable.


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## Purple (6 Jan 2011)

Shawady said:


> Anyone know what health insurance costs are and how it works in a country with a well run health system?


In countries with a national health insurance scheme anyone who can’t afford their own insurance has it paid for by the state but from the healthcare providers perspective everyone is a private patient; no two tier healthcare system.
Looking at the graph it seems that private healthcare spending accounts for around 20% of our total healthcare spending. In other words private citizens are subsidising the public health system to the tune of €800 for every person in the state. This does seem very high.



Shawady said:


> I spend €2,500 a year in health insurance for my family which seems high.


In effect you are subsidising the state by paying for a service again that you already pay for through your taxes.


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## thedaras (6 Jan 2011)

So the public system bills the private healthcare enormous amounts for the services they use..correct? 
If so where is all this money going?


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## Purple (6 Jan 2011)

thedaras said:


> So the public system bills the private healthcare enormous amounts for the services they use..correct?
> If so where is all this money going?



Wages and other costs plus a margin which in effect is a subsidy from the private health sector the rest of the public health sector.

Please note that this is not a rant against the public sector. The problems in the Irish healthcare system are not confined to the public section. The problem lies with the funding structures, not the funding sources.


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## thedaras (6 Jan 2011)

Ok, so what happens if a huge amount of people pull out of the VHI?
How will the public system manage if this huge amount of money is withdrawn?


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## Shawady (6 Jan 2011)

Our healthcare plan covers us for semi-private care.
What has happened to us a couple of times is that we have needed to see a specialist/consultant for one of the children and the waiting time for semi-private has been so long that we have just paid to go private anyway.


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## Westie123 (6 Jan 2011)

Shawady said:


> Anyone know what health insurance costs are and how it works in a country with a well run health system?
> 
> *I spend €2,500 a year in health insurance for my family which seems high*. I don't mind paying it for a good service but I know at one stage we wanted an appointment for a speech therapist for one of my children and we were given a 22 month waiting list. Totally unacceptable.



If you are with VHI you will be paying a lot more now.


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## DerKaiser (6 Jan 2011)

thedaras said:


> Ok, so what happens if a huge amount of people pull out of the VHI?
> How will the public system manage if this huge amount of money is withdrawn?


 
The people who pull out of private health care benefit from the extra money in their pockets but lose out in terms of what they can expect to get in hospital (waiting times, private rooms, etc).

The state inevitably will pick up some of the tab that had been paid by private patients so it is worse off.

Hospitals will inevitably suffer from reduced funding.

Those with no private health care will be at less of a disadvantge than before i.e. more equality between patients, but worse off in absolute terms as the hospitals have less money.


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## Purple (6 Jan 2011)

DerKaiser said:


> Those with no private health care will be at less of a disadvantge than before i.e. more equality between patients, but worse off in absolute terms as the hospitals have less money.



Yes, that's called the socialist model.


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## Protocol (6 Jan 2011)

Purple,

here is a link to some OECD health spending data:

[broken link removed]

Probably the same as your source, but I always like to use the primary data.


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## Protocol (6 Jan 2011)

More OECD data on health in Ireland:

[broken link removed]


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## Petermack (7 Jan 2011)

I nearly fell off my chair last night when I read this article in the evening herald. At the end of the day is health insurance of any real benefit in a situation like this. 

http://www.herald.ie/entertainment/...d-to-go-into-labour-on-a-trolley-2486442.html


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## Vanilla (7 Jan 2011)

Had a similar experience on my first child, discharged myself early against medical advice as I could not take being in a public ward any more without any sleep, the constant noise and heat.

Had paid for a private consultant who was on holidays when I went into labour. Had paid (and continue to pay) all my working life for private health care. Ended up in the same position as everyone else in the public health care system. Hospitals are the great levellers.


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## truthseeker (7 Jan 2011)

Vanilla said:


> Had paid for a private consultant who was on holidays when I went into labour.


 
I dont understand how the private consultant can keep the entire fee if they are not available for the birth? OK - you see him/her for appointments during the pregnancy, but surely the birth is the most important time youd want the consultant there?


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## shnaek (7 Jan 2011)

I agree completely with Purple. 
I wrote an article about 4 years ago advocating that everyone with private health care stops paying for it. The reasons for my argument were numerous. But the main thrust of the argument was that it would end the two tier system, and force the government to do something about our appalling health system which is unfit for a developed country. 
Now it looks like economic factors will bring about mass withdrawal from private health care, so how will the department of health respond? 
The chance to do something with our dreadful health system was blown when the HSE was introduced, so I have to say I'd have no great faith in our leaders ability to get things right now.


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## Firefly (7 Jan 2011)

shnaek said:


> I agree completely with Purple.
> I wrote an article about 4 years ago advocating that everyone with private health care stops paying for it.



I've also advocated here that private medical insurance should be banned. This would force everyone from the top down through the public system. I would imagine that the great and the good at the top (including TDs, ministers etc) would kick up enough to ensure radical reform in the HSE overnight.


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## Barney Magoo (7 Jan 2011)

It amazes me that so much is allocated to the Healthcare budget in a country where as much as 50% of the population is supposedly covered by Private Health Insurance. 
It can only lead to further strains and reductions in service provided when an increasing number fall back on the public system through inability to pay the spiraling costs of private health insurance.


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## terrontress (7 Jan 2011)

Isn't semi-private a bit of an oxymoron anyway? You are either in a private room or else you have to share with other people.

The Irish healthcare system is a shambles. From having to pay for GP visits and A&E to trolley waits and waiting lists. 

A nation should be judged on how it treats its most vulnerable.


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## orka (7 Jan 2011)

Vanilla said:


> Had a similar experience on my first child, discharged myself early against medical advice as I could not take being in a public ward any more without any sleep, the constant noise and heat.
> 
> Had paid for a private consultant who was on holidays when I went into labour. Had paid (and continue to pay) all my working life for private health care. Ended up in the same position as everyone else in the public health care system. Hospitals are the great levellers.


That was very poor service from your consultant.  No consultant will guarantee to be there for your delivery but they should arrange cover from another consultant so you are getting what you paid for.  You might not actually need the consultant as the midwives do a great job but it's nice to know your consultant or a replacement are there if needed.



terrontress said:


> Isn't semi-private a bit of an oxymoron anyway? You are either in a private room or else you have to share with other people.


There's a BIG difference between being in a fully public ward with possibly 20+ beds in it and a room with 4-6 people in it who have paid for private health insurance.


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## DerKaiser (7 Jan 2011)

Firefly said:


> I've also advocated here that private medical insurance should be banned. This would force everyone from the top down through the public system. I would imagine that the great and the good at the top (including TDs, ministers etc) would kick up enough to ensure radical reform in the HSE overnight.


 
Not sure that's what Purple had in mind.  

I think his point was that everybody should pay medical insurance with a very large subsidy from the state for those who can't afford it.

Maybe if everyone feels they are paying for it they might demand better services and accountability as regards the wages of medical staff.

If half the patients are effectively getting it for free you get the attitude from consultants that they should be grateful for anything and the incorrect belief from patients that they have no real right to complain.


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## Welfarite (8 Jan 2011)

So what are the actual physical benefits of private V public? Forget about jumping waiting lists, getting private rooms, etc. when considering this. 
Does one get better medical care and attention? Why do we actually opt for private cover at such huge cost?
Another issue I think is that the Medical Card. Doctor's waiting rooms are filled with people who do not really need to be there; they are there because they have  amedical card and it does not cost them a penny. If there was a nominal fee for seeing a doctor this would eliminate a lot of this hypocondric behaviour. I actually agree with the nominal 50c fee for prescriptions.


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## shnaek (10 Jan 2011)

Welfarite said:


> If there was a nominal fee for seeing a doctor this would eliminate a lot of this hypocondric behaviour. I actually agree with the nominal 50c fee for prescriptions.



I agree completely. People think services are free, but nothing is free - someone always pays. Like the water debate - we should PAY for water - we are already paying for water, just not directly. Drives me nuts when people talk about FREE services, when none of them are free.


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## Purple (10 Jan 2011)

+1 DerKaiser and +1 shnaek


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## Bronte (11 Jan 2011)

Shawady said:


> Anyone know what health insurance costs are and how it works in a country with a well run health system?
> 
> I spend €2,500 a year in health insurance for my family which seems high. .


 
I live in such a country, just paid the family cost of less than 200 ( but it also comes out in the PRSI is my understanding). For that we have a superb health system.


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## Firefly (11 Jan 2011)

removed


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## Chris (11 Jan 2011)

Purple said:


> I was under the impression that the Swiss spend less per capita than us but I was wrong.


Keep in mind that the mandatory part of the Swiss system is a lot lower than the mandatory part of the Irish system. Like in Ireland, the Swiss choose to pay for additional cover, the main difference being that in Switzerland the basic cover encompasses a lot more than in Ireland and there is not a two tier system of waiting lists.
Ireland: €14bn health budget divided by 4 million people is €3500 per man woman and child
Switzerland: mandatory private health insurance depends on the canton you live in, but for an adult it is between SF200 and SF300 per month. Taking the average that means SF3000 per year or €2400 at current exchange rates. Children cost about half as much.



Purple said:


> The problems in the Irish healthcare system are not confined to the public section. The problem lies with the funding structures, not the funding sources.



I agree 100% with this comment. Getting rid of a two tier system, through e.g. a private health insurance system like Germany or Switzerland, puts all patients on par, regardless of public or private hospital, which increases competition between individual hospitals as well as between public and private hospitals.


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## Purple (12 Jan 2011)

Ok Bronte, where do you live?


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## onq (16 Jan 2011)

The fact that so little seems to have been achieved in the health  service hugely devalues the MBA's that adminstrators are trading on.
It seems to expose the vested interest in maintaining the status quo that seems to permeate every level of the health service.

The general gist seems to be that we need hospital administrators, but  the consultants cannot stand the thought of hospitals being run by staff  nurses.
Yet these are arguably the most competent people to run a ward and - by  implication, with an MBA on top of their nursing degree and experience -  a hospital.

The myth of theoretically based MBA's alighting from on high to dispense  wisdom on running a health service surrounded by a warm glow of  wonderment has to be utterly dispelled.
The only people impressed by someone who has an MBA [but no experience]  is someone who runs a small pub or country solicitors practice - ulp -  that defines half the Dáil, doesn't it? 

Well there you go - quod erat demonstrandum.

If you leave the running of hospitals to adminstrators with no grounding  in the health service you'll see a growth in the bureaurocracy but  little improvement in the service.
Inexperienced MBA's trying to accommodate a hidebound hospital  beauracracy ring-fenced by Nurses and Consultants organisations all  trying to get a bigger slice of the bandage
We need a root and branch review of the health service, see who's  delivering value for money and see what services need to be pruned back.
Otherwsie we'll never close the public service pay gap.

Of course, reducing the health bill starts with people taking better care of themselves and others.
Is an impromvement likely in this drug-addled, binge-drinking, society that we live in?
In the middle of a Depression/Recession/Whaveter.

The simple answer is that it MUST happen.

ONQ.


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## horusd (28 Jan 2011)

I have mentioned in other posts that there are alternatives (non EU style)that we might consider. A program on the issue a few yrs back suggested the Singaporean system. Apparently average health costs are in the order of $1200 p.a.Far lower than our figure of $4,000. They combine private cover, employer contributions and pricing gov.t controls to deliver one of the best health systems in the world. 

http://en.wikipedia.org/wiki/Healthcare_in_Singapore


This thread is about what we might change, and healthcare must be a priority. But I believe that more fundementally we need to look at the principles that underly society and steer policy. There are many great ideas here about what should change, but they often lack an underlying principle. That's where we should start from. I'm opening a new thread asking this question.


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