# More HSE waste of Taxpayers money - Should the health service be privatised?



## z104 (28 Oct 2009)

Health staff on paid leave involved in disciplinary proceedings

What kind of Banana republic are we living in. 

Should we just privatise the health service. It would at the very least cut out this type of waste.


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## z107 (28 Oct 2009)

Would you buy Health Service shares?


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## z104 (28 Oct 2009)

umop3p!sdn said:


> Would you buy Health Service shares?


 
If it was run correctly with service level agreements e.t.c. where patients were treated as customers then yes.


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## Complainer (28 Oct 2009)

Niallers said:


> Should we just privatise the health service. It would at the very least cut out this type of waste.



Are you sure? The last research I saw from the US indicated that private healthcare facilities were generally much more expensive than public facilities. When the doc knows that the more he treats you, the more he makes, he suddenly find lots of reasons for expensive tests/treatment/drugs etc.

The other problem with privatisation is that it will push basic healthcare out of reach of the 50% of the population that don't have private insurance.

I'm not condoning HSE waste, but the answer is not privatisation.


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## csirl (28 Oct 2009)

Yes, Yes, Yes - should be privatised.



> When the doc knows that the more he treats you, the more he makes, he suddenly find lots of reasons for expensive tests/treatment/drugs etc.


 
Health insurers usually put a check on excessive spending.

Shouldnt the question on this thread be changed to "Should the health service be liberalised?" People forget that we already have privatised delivery of public health services, just that it is done by a monopoly cartel (religious organisations) with no tendering and no competition.


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## Complainer (28 Oct 2009)

csirl said:


> Health insurers usually put a check on excessive spending.
> 
> .


How's that worked out for us here in the last 10 years?


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## S.L.F (28 Oct 2009)

Niallers said:


> where patients were treated as customers then yes.


 
Walked into a shop recently and asked for and got a sandwich, at the till realised I didn't have any money on me, they wouldn't let me keep the sandwich!

You want this to be expended to health care.

No thanks!


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## Mpsox (29 Oct 2009)

From reading the article, what the HSE are doing in many respects is not that dissimiler from what many large private companies do. Staff get sick, that's a fact, and on occassions, staff have long terms sick issues and given the size of the HSE, the numbers involved may not be excessive. It would be quite common for companies to pay sick pay for 6 months and then half pay for another 6 months (every major company I've worked for over the last 20 years has had similer policies)

However, it is after the 12 months that the HSE seem to be slipping up. Many large companies at this stage would have a private medical insurance scheme which would kick in and would pay a proportion of the employees wages, in the case of my current employer, they pay 66% of the wages after 12 months, employer pays nothing. Under the terms of the scheme, that can continue indefinately (assuming there is no change in the underlying condition). 

Even where companies do not have such a scheme, my understanding has always been that an employer has no obligation to hold a job open indefinately for someone who cannot physically do it. Therefore, and depending on the circumstance, either resignation or redundancy would kick it

To me this has nothing to do with the merits or demerits of privitisation of the health sector. It's just crap HR management and policies by the HSE. That happens in plenty of private sector companies as well, but if the willingness is there to fix it, it's not a difficult thing to do


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## Caveat (29 Oct 2009)

mpsox said:


> to me this has nothing to do with the merits or demerits of privitisation of the health sector. It's just crap hr management and policies by the hse. That happens in plenty of private sector companies as well, but if the willingness is there to fix it, it's not a difficult thing to do


 
+1


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## emaol (29 Oct 2009)

Mpsox said:


> To me this has nothing to do with the merits or demerits of privitisation of the health sector. It's just crap HR management and policies by the HSE. That happens in plenty of private sector companies as well, but if the willingness is there to fix it, it's not a difficult thing to do



How do you get the willingness? Should it come from Taoiseach? Minister? Head of HSE? We need a hero!


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## Purple (29 Oct 2009)

We need a system where the money follows the patient. It should be funded through health insurance, those that can't pay their own should have access to a state system but access to services should be equal. After that private and public hospitals can compete. The important thing is good regulation and auditing.


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## johnd (29 Oct 2009)

Peope join VHI and other private insurance because they know that it the only way they can get prompt treatment. If all had equal access then VHI and others would go to the wall.


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## Leo (29 Oct 2009)

Mpsox said:


> However, it is after the 12 months that the HSE seem to be slipping up. Many large companies at this stage would have a private medical insurance scheme which would kick in and would pay a proportion of the employees wages, in the case of my current employer, they pay 66% of the wages after 12 months, employer pays nothing.


 
Thing is, the government self-insure.


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## Complainer (29 Oct 2009)

johnd said:


> Peope join VHI and other private insurance because they know that it the only way they can get prompt treatment. If all had equal access then VHI and others would go to the wall.


Not true. If all had equal access to prompt treatment, we would end up like the UK, where a small minority (10-15%) buy private insurance, because they want the nice room and the fancy biccies.

Surely you're not suggesting that we need to maintain the serious inequalities that exist in our healthcare system just to keep VHI/Quinn/Hibernian in a job? People with no insurance are dying on waiting lists.


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## Purple (29 Oct 2009)

johnd said:


> Peope join VHI and other private insurance because they know that it the only way they can get prompt treatment. If all had equal access then VHI and others would go to the wall.



People would still have to pay the VHI etc since the government would only pay the insurance for those who cannot afford to pay their own. The important point is that the hospitals would get paid for what they do, not a blanket payment at the start of the year. That way the money follows the patient, i.e. each patient is a source of revenue, unlike the current system where private patients are a source of revenue and public patients are a drain on revenue.


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## johnd (29 Oct 2009)

Complainer, that is the point I'm making. I agree with you! If we all had access to equal treatment then only a small minority would be in private health insurance because they want the silver plated tea tray or whatever the reason would be. The private insurance companies would not make enough profit to keep going. In my opinion there should be no tax relief for private health insurance.


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## Purple (29 Oct 2009)

johnd said:


> In my opinion there should be no tax relief for private health insurance.



The state couldn't afford that. At the moment 2/3 of the population subsidise the public health system by buying private insurance. If they didn't do so all medical services would have to be delivered using the public system. It would collapse under the strain.


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## johnd (29 Oct 2009)

Purple - The state already provided everyone with free hospital treatment apart from a small fee for bed and board. The reason the VHI originally came into existance was because hospital treatment was subject to a means test and if you earned over that amount you were liable for fees.

If other countries can give their citizens a decent medical and hospital service why can we not? The reason the public service is so bad is because the middle classes do not have to avail of it. If they did it would have to improve because they would not stand for it.


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## Purple (29 Oct 2009)

johnd said:


> Purple - The state already provided everyone with free hospital treatment apart from a small fee for bed and board. The reason the VHI originally came into existance was because hospital treatment was subject to a means test and if you earned over that amount you were liable for fees.


 Are you suggesting that if every person who currently occupies a bed in a private hospital was in a bed in a public hospital (as well as those already there) it would not add any cost for the public service??  The state provides everyone with the option of a bed but knows that a large proportion of people will not avail of that option and budgets accordingly.



johnd said:


> If other countries can give their citizens a decent medical and hospital service why can we not? The reason the public service is so bad is because the middle classes do not have to avail of it. If they did it would have to improve because they would not stand for it.


Rubbish. It’s bad because there is a lack of competence at all levels of management, no accountability for front line staff, strong vested interest groups (unions) who stymie change and reform at every hands turn and pay levels that are far too high across the board. 
Add to that a stupid way of funding hospitals which encourages waste and inefficiency and you have our public health service.


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## Mpsox (29 Oct 2009)

Purple said:


> People would still have to pay the VHI etc since the government would only pay the insurance for those who cannot afford to pay their own. The important point is that the hospitals would get paid for what they do, not a blanket payment at the start of the year. That way the money follows the patient, i.e. each patient is a source of revenue, unlike the current system where private patients are a source of revenue and public patients are a drain on revenue.


 
Any competent manager sits down before the beginning of the year, forecasts the likely income/sales his business is likely to have in the next financial year and budgets accordingly.

Hospitals should be no different, a hospital manager should, be able to forecast the likely patient throughput in a year and then budget accordingly, (with suitable margin for errors). You could build safeguards into the system for epidemics etc but the key is, pay per patient and if you're busy, you get paid more and if things are quieter, management need to take the costs out

At the moment what seems to happen is that a hospital is given a pot of money, if they are busier then planned or the pot won't cover what they need, they struggle and there is no incentive to take on extra patients. If the pot is too much, the challenge is to spend it all because otherwise they won't get it next year.

This isn't rocket science, it's basic good business practises which seem beyond the HSE.


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## Purple (29 Oct 2009)

Mpsox said:


> Any competent manager sits down before the beginning of the year, forecasts the likely income/sales his business is likely to have in the next financial year and budgets accordingly.
> 
> Hospitals should be no different, a hospital manager should, be able to forecast the likely patient throughput in a year and then budget accordingly, (with suitable margin for errors). You could build safeguards into the system for epidemics etc but the key is, pay per patient and if you're busy, you get paid more and if things are quieter, management need to take the costs out
> 
> ...



I agree Mpsox but even if the manager does his or her job properly it is still in their interest to see as few patients as possible to minimise expenditure. What should happen is they get X money to cover admin etc (more or less fixed costs) at the start of the year and then get paid for each patient/procedure etc. This system works well in most of Europe. Belgium has exactly that set-up and has the best healthcare system in Europe. It is mostly publically funded and mostly privately delivered.


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## johnd (29 Oct 2009)

Be careful Purple - you are beginning to sound like one of those pompous, arrogant hospital consultants you all know. My point is that the health service in general and hospital service in particular is so bad is because the attitude of those working in it is that the public patient has no voice and is therefore of no importance.

The average public patient is so pathetically grateful if they are treated with even a sembance of civility that they are loath to complain. Somehow the notion has grown up that public patients deserve what they get - that if they wanted to be treated decently they should have private insurance. I accept all your points regarding the reasons why our health service is so rotten but not your solution.


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## Purple (29 Oct 2009)

johnd said:


> Be careful Purple - you are beginning to sound like one of those pompous, arrogant hospital consultants you all know.


 Why do you say that? Where have I defended those overpaid, underworked, self-serving, unaccountable, unsanctionable hypocrits who held the state to ransom for years over their bloated contracts all the while bleating about health cuts?


johnd said:


> My point is that the health service in general and hospital service in particular is so bad is because the attitude of those working in it is that the public patient has no voice and is therefore of no importance.


 I agree completely. The health service is run primarily for the benefit of those who work in it, not those who have to avail of its “services”.



johnd said:


> The average public patient is so pathetically grateful if they are treated with even a sembance of civility that they are loath to complain. Somehow the notion has grown up that public patients deserve what they get - that if they wanted to be treated decently they should have private insurance. I accept all your points regarding the reasons why our health service is so rotten but not your solution.


 My point is that if everyone had insurance (some provided by the state but just like a private health insurance company at the point of consumption) then everyone would be the same as far as the hospital was concerned.  Hey presto; no more two-tier healthcare system.


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## johnd (29 Oct 2009)

*My point is that if everyone had insurance (some provided by the state but just like a private health insurance company at the point of consumption) then everyone would be the same as far as the hospital was concerned. Hey presto; no more two-tier healthcare system*

I agree!


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## daithi (29 Oct 2009)

one of the major problems with the Health service in this country is that it can be very difficult to forecast future health expenditure-Im sure  no country on this planet had forecast the emergence of Swine flu, for example-The annual spike of seasonal flu and winter vomiting bug has yet to happen and  both events are not easily quantifiable..
on a different note, if there is a recruitment embargo within the HSE, why do we need all the HR staff???


daithi


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## Mpsox (30 Oct 2009)

daithi said:


> one of the major problems with the Health service in this country is that it can be very difficult to forecast future health expenditure-Im sure no country on this planet had forecast the emergence of Swine flu, for example-The annual spike of seasonal flu and winter vomiting bug has yet to happen and both events are not easily quantifiable..
> 
> 
> daithi


 
You can forecast the most of the requirements reasonably accurately, for example, it's not likely that there will be a spike next year in peeople wanting their appendix out, or their tonsils removed or breaking their legs. The liklihood is those figures stay reasonably static. Likewise seasonal illness such as flu in winter is also reasonably quantifiable. You can set aside an emergency fund for things such as natural disasters or unplanned epidemics


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## Complainer (30 Oct 2009)

Mpsox said:


> Any competent manager sits down before the beginning of the year, forecasts the likely income/sales his business is likely to have in the next financial year and budgets accordingly.
> 
> Hospitals should be no different, a hospital manager should, be able to forecast the likely patient throughput in a year and then budget accordingly, (with suitable margin for errors). You could build safeguards into the system for epidemics etc but the key is, pay per patient and if you're busy, you get paid more and if things are quieter, management need to take the costs out
> 
> ...



Health isn't a business - it is a public services. Blind application of business practices don't work. Budgeting is all nice and dandy, but patients have this awful habit of not getting sick in line with the budget.

Bar stool experts won't solve the many problems that exist in the HSE.


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## Latrade (30 Oct 2009)

Complainer said:


> Health isn't a business - it is a public services. Blind application of business practices don't work. Budgeting is all nice and dandy, but patients have this awful habit of not getting sick in line with the budget.
> 
> Bar stool experts won't solve the many problems that exist in the HSE.


 
+1. 

Somethings just are and the Health Service is not condusive to being a completely private enterprise. I think it is more than possible to run an efficient and good service through the public sector it just needs political will to make it so.


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## Bronte (30 Oct 2009)

Complainer said:


> Health isn't a business - it is a public services. .


  What have you got against it being run like a business?


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## Sunny (30 Oct 2009)

The health service is not a public service for the vast numbers of people who hold private health insurance in this Country. The problem with the health service is that it is neither public nor private and is not been run as either. 
There is no doubt that the results seen from the vast amounts of resources poured into the system over the past few years have been very poor. Not all the fault lies with the HSE. Look at the opposition they face when they try to implement projects like the cancer programme and the merger of the the Childrens hospital.


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## csirl (30 Oct 2009)

Complainer said:


> Health isn't a business - it is a public services. Blind application of business practices don't work. Budgeting is all nice and dandy, but patients have this awful habit of not getting sick in line with the budget.
> 
> Bar stool experts won't solve the many problems that exist in the HSE.


 
You know the HSE advocates have lost the argument when they start trotting out the "we're special" argument.


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## Latrade (30 Oct 2009)

Bronte said:


> What have you got against it being run like a business?


 
I know you asked Complainer the question, but for me (as a strong supporter of business and free trade) I have everything against a health service run like a business. It's a service, not a business. 

The point is that a fit and healthy population (i'd add in educated too) is in everyone's interests including employer's. In order to achieve this you cannot have a system that operates on two tiers, those who can pay and those who can't. And I could afford any nice posh insurance to cover me too so I'd be grand, just like I would prefer to fly with Aer Lingus over Ryanair and don't mind paying the extra. But when it comes to health over personal travel arrangements everyone should have access to good level of health care. 

I'm not saying do away with any private health care though.

But look at how insurance can operate with all the clauses and excesses for when you have tip in the car or your house is burgled. It is not in the interests of the insurance companies to pay out money. I don't want either myself or any other citizen to have that potential denial of essential treatment because of failure to tick the right box on a form.


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## csirl (30 Oct 2009)

> But look at how insurance can operate with all the clauses and excesses for when you have tip in the car or your house is burgled. It is not in the interests of the insurance companies to pay out money. I don't want either myself or any other citizen to have that potential denial of essential treatment because of failure to tick the right box on a form.


 
The solution to this is that every insurance company is required to offer a minimum level of cover with all policies.


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## Latrade (30 Oct 2009)

csirl said:


> The solution to this is that every insurance company is required to offer a minimum level of cover with all policies.


 
It's not. The answer is that no private business should have a role, influence or decision in appropriate medical care. It should be down to health professionals without any concern over budgets, targets, costs to decide what is the best interest of the patient. 

Look, you're right in that the main justification for a health service as opposed to a business is one of belief/opinion and probably not one of logic.

On a purely logical sense then there's no reason why education, Gardai, the Army, Tax collection, road maintenance, couldn't be run better by the private sector. I'm sure there are numerous valid arguments to show how a private police force would not only lower crime, but increase detection rates and speed up the whole process.

But sometimes it just isn't about that, sometimes it is simply that the certain tasks are the function of the state for the people. To me health is one of those.


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## csirl (30 Oct 2009)

> The answer is that no private business should have a role, influence or decision in appropriate medical care. It should be down to health professionals without any concern over budgets, targets, costs to decide what is the best interest of the patient.


 
Then how come the majority of public health services in Ireland are delivered by the private sector e.g. major hospitals owned and run by private religious organisations/trusts?



> It should be down to health professionals without any concern over budgets, targets, costs to decide what is the best interest of the patient.


 
This is a very utopian view. We do not have unlimited budgets for health care. The HSE has to operate within the limits put on it by D/Health and D/Finance. Ultimately, all costs are billed to the taxpayer. Even in our current public health system, decisions, including life and death decisions, are made with reference to budgets, targets, costs etc. I would argue that as our public health funding system discourages efficiencies (lump sum budgets to private organisations rather than paying for work done), it is more likely that someone will miss out on important treatment due to lack of money than in an alternative system.

We call all make theoretical arguments etc etc., but look at the evidence.

In Ireland, public health care is very expensive, yet very *inefficient.* 

Private health care is very expensive and very *efficient*.

The proof of the pudding is in the eating and its clear to see which system works in Ireland and which system doesnt.


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## Latrade (30 Oct 2009)

csirl said:


> Then how come the majority of public health services in Ireland are delivered by the private sector e.g. major hospitals owned and run by private religious organisations/trusts?


 
Does this not contradict your statement then on privatisation being better? If the majority are currently privately run then doesn't this mean that private enterprise has failed? 



csirl said:


> This is a very utopian view. We do not have unlimited budgets for health care. The HSE has to operate within the limits put on it by D/Health and D/Finance. Ultimately, all costs are billed to the taxpayer. Even in our current public health system, decisions, including life and death decisions, are made with reference to budgets, targets, costs etc. I would argue that as our public health funding system discourages efficiencies (lump sum budgets to private organisations rather than paying for work done), it is more likely that someone will miss out on important treatment due to lack of money than in an alternative system.


 
Of course it is utopian, I've already stated that I'm not arguing from a position of pure logic here it's just a system I firmly believe is for the greater good. But like my other examples, why is it only health that gets hit with the privatisation tag? Why not argue for a private army or a private police force? 

You're right, the system does have many, many faults and does appear to encourage inefficiency, but that's not an argument to intorduce the etch-a-sketch approach to reform and just abandon the whole thing altogether. It's an argument to fix the inefficiency. A failure of the current management to implement a system and carry through policy effectively doesn't mean the original concept was wrong.

And the rest is just assumption that it's more likely that some will miss out on treatement, the same as I assume there will be more business based decisions that health based decisions. It's a stalemate.




csirl said:


> We call all make theoretical arguments etc etc., but look at the evidence.
> 
> In Ireland, public health care is very expensive, yet very *inefficient.*
> 
> ...


 
I refer back to my first point in that you state Ireland's health service is private. However, you're right the proof is in the pudding but you've not given any proof, just a couple of statements. That's not proof I'm afraid, it's supposition.


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## Purple (30 Oct 2009)

Latrade said:


> Does this not contradict your statement then on privatisation being better? If the majority are currently privately run then doesn't this mean that private enterprise has failed?


They are privately owned but for all intents and purposes they are publically run (He who pays the piper calls the tune).



Latrade said:


> Of course it is utopian, I've already stated that I'm not arguing from a position of pure logic here it's just a system I firmly believe is for the greater good. But like my other examples, why is it only health that gets hit with the privatisation tag? Why not argue for a private army or a private police force?


 If over the last 10 years the budget for the police force had quadrupled and the staffing levels had tripled but there had been no substantive increase in detection levels or drops in crime rates it would be reasonable to look at other countries who were much better at policing to see how they did things. 




Latrade said:


> You're right, the system does have many, many faults and does appear to encourage inefficiency, but that's not an argument to intorduce the etch-a-sketch approach to reform and just abandon the whole thing altogether. It's an argument to fix the inefficiency. A failure of the current management to implement a system and carry through policy effectively doesn't mean the original concept was wrong.


 It’s a cop-out to say it’s all down to management (and a bigger one to say it’s all down to politicians). The current system can never work properly. It’s very design ensures this.

Decisions are made based on budgets every day at the moment. Medical staff are very inefficient in how they carry out their work, a bigger budget just gives them more money to waste.


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## csirl (30 Oct 2009)

> Does this not contradict your statement then on privatisation being better? If the majority are currently privately run then doesn't this mean that private enterprise has failed?


 
It is competition and consequences for doing a good/bad job which are the key features missing from our health system. This is where we have problems. Its no use having private delivery of health services if the organisations doing the delivery are a monopoly/cartel who will be paid regardless of whether or not they do a good job. 

A competitive private system where the organisations have to tender and are paid for work actually done is the best system. I would agree with you that the monopoly/cartel private operators we have is the worst case scenario (ala Railtrack in UK) - even maginally worse that a fully public system.


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## Purple (30 Oct 2009)

csirl said:


> it is competition and consequences for doing a good/bad job which are the key features missing from our health system. This is where we have problems. Its no use having private delivery of health services if the organisations doing the delivery are a monopoly/cartel who will be paid regardless of whether or not they do a good job.
> 
> A competitive private system where the organisations have to tender and are paid for work actually done is the best system. I would agree with you that the monopoly/cartel private operators we have is the worst case scenario (ala railtrack in uk) - even maginally worse that a fully public system.



+1


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## Latrade (30 Oct 2009)

Purple said:


> They are privately owned but for all intents and purposes they are publically run (He who pays the piper calls the tune).


 
This is my point though, we're passing judgement on a public service that isn't actually fully public. 

All we can say is the current model just doesn't work, however that doesn't automatically mean a private system is the best.



Purple said:


> If over the last 10 years the budget for the police force had quadrupled and the staffing levels had tripled but there had been no substantive increase in detection levels or drops in crime rates it would be reasonable to look at other countries who were much better at policing to see how they did things.


 
Pretty much my point though. Gardai, Defence, even the Fire Service, what's their efficiency and why aren't there calls for these to be privatised? In all cases there is the exact same argument to call for them to be run by the private sector.



Purple said:


> It’s a cop-out to say it’s all down to management (and a bigger one to say it’s all down to politicians). The current system can never work properly. It’s very design ensures this.
> 
> Decisions are made based on budgets every day at the moment. Medical staff are very inefficient in how they carry out their work, a bigger budget just gives them more money to waste.


 
100% agree, I just disagree that the conclusion to these points is that a Public Health Service can never work and only the Private Sector can save us. 

This model, for a variety of reasons went wrong. You have to say that is down to mismanagement. Me saying that isn't down to fixing the blame, I'm more interested in fixing the problem. But to use the apt examples of the private sector: the banks. Their failures are deeper and more complex that the CEO or Board failed, but in judging these businesses ultimately it is a failure of management. It's the same here. 

Ultimately it's a matter of belief. Personally, I feel it is better for society to contribute a bit each month on the off chance you may get ill and in the knowledge that it contributes to a pool that will help your neighbour if they're ill, their children, and the rest of society, than gambling and having a huge bill if I'm ill and not making any contribution to the health and welfare of society.




csirl said:


> It is competition and consequences for doing a good/bad job which are the key features missing from our health system. This is where we have problems. Its no use having private delivery of health services if the organisations doing the delivery are a monopoly/cartel who will be paid regardless of whether or not they do a good job.
> 
> A competitive private system where the organisations have to tender and are paid for work actually done is the best system. I would agree with you that the monopoly/cartel private operators we have is the worst case scenario (ala Railtrack in UK) - even maginally worse that a fully public system.


 
This is where we have to realise what problems we would generate with a private system. We remove all control from the government because once it is private it's under the control of competition rules. So we couldn't impose conditions, we couldn't impose limits, we'd be restricting trade. Everything would be down to the Board who answer to no one but shareholders. 

And what if we get a Dell situation with a major hospital? What if they just decide they can't afford to operate any more and shut up shop? Will another company step in? Will we bailed out or will we be left with a huge gap in health care, even for a short time? And then if there's competition what happens to those receiving treatment when one goes bust? Will other hopsitals accept their care? If you buy a television from a shop that goes bust can I go to its competitor to if it breaks or needs repair? 

Alright, there's a fair amount of hyperbole behind those statements, because getting health care isn't like buying a tv. Mainly in that when you need it most you don't have the luxury of shopping around for your health. You can't post on here with a thread, "Hi I need cancer treatment, just wondering what people's views are on MegaCorp Health care in Cork or GlobalGiants in Sligo". 

And then we do look at where there are examples of privatisation, such as the UK and its public transport. Now the stats look impressive, but what actually happened is the private companies pumped resources into the busy routes and abandoned the lesser used routes. 

So who's going to build and run a hospital to care for the huge rural community when first, there's less money there than in the biger cities and towns and less useage.

Then who runs the ambulance service or paramedics? Do you have to have different phone lines for different providers? Is it going to be like the taxi listings in the Golden Pages?

And if it does go wrong, if it is unfair, if people are refused treatment, what can we do about it? Where do we go? Once we've sold our soul what do we do then? 

The American system works only for those who can afford it (and even then it's a fight with the insurance companies). I'm not prepared to sell out the health of the other 4 million people here on the basis that first, I'm ok and can afford it and second that the current system needs an overhaul, but not abandoning.


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## z104 (30 Oct 2009)

Hospitals should compete for business and the money should follow the patient.
The best hospitals will attract more patients and therefore will have more money.

The poorer performing hospitals will need to up their service levels in order to attract more patients.
MRSA Stats should be published. A&E turnaround time e.t.c. should all be made available.

I think you would find that patients would not be on trolleys if the hospital thought they would not be paid. A bed would be found quickly.
I have my suspicions that patients being left on trolleys is coordinated by nursing unions in order to flex their muscle to advance their objectives.

So privatise all hospitals and let the money whether it be from Insurance or the medical card follow the patient. The patients will then have the power to decide where they go for their medical care based on the service from a particular hospital.


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## Purple (30 Oct 2009)

Niallers said:


> Hospitals should comptete for business and the money should follow the patient.
> The best hospitals will attract more patients and therefore will have more money.
> 
> The poorer performing hospitals will need to up their service levels in order to attract more patients.
> ...



That's it!


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## csirl (30 Oct 2009)

There seems to be an assumption that a privatised medical system would mean a free for all. What you are actually describing is an unregulated medical system. There are other ways of running a fully privatised medical system.

One possible model is one whereby the State constructs the asset - in this case a hospital - and private medical companies have to tender to run the hospital for a set number of years. If they do a bad job, they'll be out of work when the service is retendered.

Another possible model is having a framework agreement in place in each region of the country whereby the State can draw down various services/jobs on a volume related basis. With this model there will be competition to get included in the framework and competition between those in the framework for the various individual job items. 

A third possible solution is compelling all employers to provide mandatory health insurance for all employees (can be paid for by a set deduction from employees salary which will probably be less than the tax saving they'd get from taking HSE costs out of the budget). This will probably result in each employer having a commercial agreement with a health insurance company and/or private hospital chains. Self employed can have an individual contract and the State could provide a fully refundable credit to all those who have no earnings or simply tender for those who have no earnings.

I'm sure there are other ways of doing it, possibly better than those above which I've come up with off the top of my head, but they are all better than what we currently have.


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## Purple (30 Oct 2009)

csirl said:


> There seems to be an assumption that a privatised medical system would mean a free for all. What you are actually describing is an unregulated medical system.



Nobody is describing an unregulated system. The government regulates and funds where it has to fund (but it funds by buying the care, not running the hospital), the private and public sector compete to deliver the service.
It’s not a new idea; they do it all over the world.


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## Latrade (30 Oct 2009)

Purple said:


> Nobody is describing an unregulated system. The government regulates and funds where it has to fund (but it funds by buying the care, not running the hospital), the private and public sector compete to deliver the service.
> It’s not a new idea; they do it all over the world.


 
In fairness, I was. 

Look, I honestly hear what you're saying (csirl and Purple). We agree the current system is poor, I think we just disagree on whether this means an abandonment of the public system or looking at a public system that could work. 

I don't believe that there is no scope at all within a public system to produce an efficient, fair and good service. I also don't believe that the private sector has the monopoly on providing efficiency or good services.

However, in other areas of privatisation, there has been greater emphasis on the greater profit making side of things and a drain away from areas of less margin. There is a cherry picking from the private companies of all the nice chocolates and the state gets left with the coffee creams that no one likes. 

It's all well and good having the tender process and rating performance when it's a rail service or a bus service, but not a health service. How bad does it get before they lose the contract? Then the lawyers get involved and it gets dragged out. Most similar situations have meant you've had to wait until the end of the contract period to award it to another provder. At that point we could have a major problem. Do we want to take that gamble with health care?


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## csirl (30 Oct 2009)

> However, in other areas of privatisation, there has been greater emphasis on the greater profit making side of things and a drain away from areas of less margin. There is a cherry picking from the private companies of all the nice chocolates and the state gets left with the coffee creams that no one likes.


 
There's a price at which it is profitable to treat any patient for any condition. Even for the coffee creams, its possible for a tendering company to work out the cost then add a risk premium and a small profit margin. 



> It's all well and good having the tender process and rating performance when it's a rail service or a bus service, but not a health service. How bad does it get before they lose the contract?


 
Doesnt have to be paying a lump sum for the entire service provided and getting rid a few years later. With a pay as you go system, they dont get paid for any bad work they do. In such system, no private provider would expect to be paid 100% of the time as even the best will make occasional errors. Those with a high error rate would go to the wall very quickly.


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## Brianne (30 Oct 2009)

[quote=Niallers;952583
I have my suspicions that patients being left on trolleys is coordinated by nursing unions in order to flex their muscle to advance their objectives.

Niallers, I take grave exception to that comment. It is a complete insult to all nurses and it shows your own lack of knowledge. Nurses neither admit or discharge patients. That is done by doctors and to be fair to doctors, they make their decisions on admission on clinical need not on whether patients are rich are poor. Having worked as a nurse for many years, I have never, ever seen what you suggest and such an action would be construed as unethical .
 Incidentally An Bord Altranais had given very clear guidelines to nurses as to their behaviour in relation to any industrial action and how the patient is always to be the primary focus of the nursing profession and nurses are disciplined regularly and struck off for unethical behaviour.
So to voice comments like this is insulting to an entire profession.


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## Purple (30 Oct 2009)

Brianne said:


> Niallers, I take grave exception to that comment. It is a complete insult to all nurses and it shows your own lack of knowledge. Nurses neither admit or discharge patients. That is done by doctors and to be fair to doctors, they make their decisions on admission on clinical need not on whether patients are rich are poor. Having worked as a nurse for many years, I have never, ever seen what you suggest and such an action would be construed as unethical .
> Incidentally An Bord Altranais had given very clear guidelines to nurses as to their behaviour in relation to any industrial action and how the patient is always to be the primary focus of the nursing profession and nurses are disciplined regularly and struck off for unethical behaviour.
> So to voice comments like this is insulting to an entire profession.


How many nurses are there in Ireland and how many were struck off over the last 10 years due to incompetence?
How many of the midwives in Lourdes Hospital were struck off for gross incompetence for saying/seeing nothing despite working with a man who was removing a hugely disproportionate number of patients’ wombs over many years?

If you want to be taken seriously as a “profession” by anyone other than yourselves and if you really are skilled healthcare workers then you have to stand up to the mark when the need arises.


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## Complainer (30 Oct 2009)

csirl said:


> There's a price at which it is profitable to treat any patient for any condition.


So how much would you quote to treat an adult for depression? Or anorexia?


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## Purple (30 Oct 2009)

Complainer said:


> So how much would you quote to treat an adult for depression? Or anorexia?



Is csirl a doctor, an accountant in a mental hospital?

There's a price for the overhaul of a jet engine. How much would you charge? What, you don't know... oh, well then it must be impossible to cost it. Whatever will the aviation industry do???!! 

You keep using that same childish point (non-point?) when anything about costs anywhere in the state sector comes up. It's stupid and illogical. Stop doing it.


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## S.L.F (30 Oct 2009)

Purple said:


> How many nurses are there in Ireland and how many were struck off over the last 10 years due to incompetence?
> How many of the midwives in Lourdes Hospital were struck off for gross incompetence for saying/seeing nothing despite working with a man who was removing a hugely disproportionate number of patients’ wombs over many years?
> 
> If you want to be taken seriously as a “profession” by anyone other than yourselves and if you really are skilled healthcare workers then you have to stand up to the mark when the need arises.


 
I think there is more to this than meets the eye.

My understanding on the issue was there were complaints made about a certain doctor but when the complaints were aired there was a whitewash and whistle blowers were gotten rid of.

Then after a time 2 midwives went to a solicitors office to make a statement which they did and they wished to remain anonymous (at first anyway) more questions were asked and finally action was taken.

From this





> It is right that whistleblowers should be protected, nowhere more so than in the health services. Brave people in these services have repeatedly exposed wrongdoing and neglect which has resulted in injury and sometimes loss of life. It was a courageous midwife who blew the whistle on the appalling scandal in the obstetrics and gynaecology department of Our Lady of Lourdes Hospital in Drogheda. Michael Neary’s professional peers protected him for years from the consequences of his brutal actions on dozens of women, and even tried to protect him after he had been exposed. Every protection should be offered to those who out of selfless motives act in the public interest. They should not be penalised. Too often it is the person who reports the wrongdoing who is punished while the culprit escapes censure.


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## Purple (30 Oct 2009)

She was not an Irish nurse.


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## S.L.F (30 Oct 2009)

Purple said:


> She was not an Irish nurse.


 
I wonder how many Irish nurses spoke out only to have their contracts terminated.

In the hospital environment the consultant is a god, who is feared by all those who work under him (or her) and protected by his peers.

If you have a good read of this document you will see midwives were trying to shout it from the roof tops but didn't get very far, even after the whole thing blew he was protected.

Transferred all his dosh to his kids and then still gets a full pension then to add insult to injury medical files go missing so a court can't proceed so when the women ask our govt to act what do they do they set up a redress board to access what the women should get.

If they had gone to the high court they could have sued and maybe won.

From this document

[broken link removed]



> 7.4 At the same time as the Matron was trying to express her misgivings to the consultants, Sr. F. a temporary midwifery tutor, also a Medical Missionary, had serious reservations relating to two caesarean hysterectomies carried out in late 1979 by Dr. Neary. It was not entirely clear whether her concerns were ethical concerns (about possible sterilisations), concerns for the patients, or a combination of both. She had been looking for interesting case histories to present to her midwifery students and had become aware that two young mothers who were patients in the postnatal ward had hysterectomies following caesarean section in and around the same time.


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## annet (31 Oct 2009)

The INO and the HSE both provide stats on number's of patients in A&E's waiting on trolley's... coincidently these two stats never tally due to the fact that the stats are calculated at different times of the day!  I am perplexed however, where An Bord Altranais and the Code of Professional Conduct 2000 comes into this?

To fully understand why there are people left on trolley's in our A&E Dept's I would suggest the Acute Hospital Bed Capacity Review 2002 be a good starting point.... its available on the DOHC's website.  There is yet another report done in 2008 called the PA Consulting Acute Hospital Bed Capacity Review.... yet again another report that was commissioned and is available on the HSE's website.  To sum it up, the situation of people who are waiting on trolleys in an A&E Department is symptomatic of the wider problems that exist in the acute hospital sector - it comes down to the mix of issues like medical vs. surgical beds, delayed discharges and lack of step-down facilities.

Getting back to whether we should privatize health services - there are elements of privatization and market principles within current health policy.  Our system supports two tier access - with access not being based on medical need but on your ability to pay.  We have the NTPF who contracts from public and private hospitals services that have not been delivered under our public hospital system.  We have tax incentives for private hospitals - the most recent of which was co-location which by all reports has been scaled down to 4 sites.  

While there are inherent benefits to the private sector in healthcare - I would suggest that we as a society do need to reflect on the fundmental values that we wish to underpin our health services - do we want them to be based on univerality, equity, solidarity and access to good quality and comprehensive care and if so are these values and principles consistent or in conflict with an ideology where health is a commodity?  Other questions that I would raise is what would be the role of government in a privatized system -  will they still be providers of hospital and personal social services, will they continue to fund services, will they be providers of private health insurance and will they they also be charged with being regulators of services in the market?  Also, how will a privatized system be funded - through tax or private insurance?

A totally privatized system would require strong regulation to prevent cherry picking.  Another issue that I would have concern about is the tarrifs that insurance companies impose on members benefits and for certain conditions - and how comprehensive a fully privatized system could be in reality.     

While I do agree that the money should follow the patient - and that hospitals should be financed on performance - to be a devils advocate how exactly would we measure performance and success?   

There was only one whistleblower in relation to Neary - she was a foreign trained nurse.


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## Complainer (31 Oct 2009)

Bronte said:


> What have you got against it being run like a business?


The objective of a business is to make money. The objective of a public health service is to ensure the good health of the people of Ireland. Where you have some completely different objectives, the processes are not transferable.



Sunny said:


> The health service is not a public service for the vast numbers of people who hold private health insurance in this Country.


It's not that simple. The public health service subsidises private healthcare. The charges for private beds in public hospitals are nowhere near the full economic cost of those beds. The private patient in those beds use all the public services in those hospitals (labs, radiology, physio, OT etc). Don't draw any conclusions about the cost/value/profitability of private health care until it stands on its own two feet, i.e. no subsidised beds, no subsidised services, no tax relief etc.



Sunny said:


> Not all the fault lies with the HSE. Look at the opposition they face when they try to implement projects like the cancer programme and the merger of the the Childrens hospital.


Rightly so in relation to the Childrens hospital. To move this facility into Bertie's back yard with no parking and no transport links is a crazy decision.


csirl said:


> The solution to this is that every insurance company is required to offer a minimum level of cover with all policies.


That solution doesn't help those who can't afford insurance.


csirl said:


> Then how come the majority of public health services in Ireland are delivered by the private sector e.g. major hospitals owned and run by private religious organisations/trusts?


History. I don't like it any more than you do, but we are where we are.


csirl said:


> In Ireland, public health care is very expensive, yet very *inefficient.*
> 
> Private health care is very expensive and very *efficient*.


Source please - where on earth did you get this from?


Latrade said:


> Pretty much my point though. Gardai, Defence, even the Fire Service, what's their efficiency and why aren't there calls for these to be privatised? In all cases there is the exact same argument to call for them to be run by the private sector.
> 
> Alright, there's a fair amount of hyperbole behind those statements, because getting health care isn't like buying a tv. Mainly in that when you need it most you don't have the luxury of shopping around for your health. You can't post on here with a thread, "Hi I need cancer treatment, just wondering what people's views are on MegaCorp Health care in Cork or GlobalGiants in Sligo".
> 
> ...


Two points here - The US privatised model for fire-fighters means that when California burns in the summer, privatised fire-fighters will consult insurance records when deciding which houses are to be rescued. Is this really where we want to go?

Also, it doesn't need privatisation to bring about consumer choice in healthcare. See  I'm not sure this is a great idea, but regardless, it doesn't require privatisation.



annet said:


> We have the NTPF who contracts from public and private hospitals services that have not been delivered under our public hospital system.


Indeed, so we are incentivising consultants to keep their public waiting lists high, so they get paid on the double for treating the same patients, once through their standard public sector contract, and then again from the NTPF.


annet said:


> While I do agree that the money should follow the patient - and that hospitals should be financed on performance - to be a devils advocate how exactly would we measure performance and success?


This is a huge issue - very important point.



annet said:


> There was only one whistleblower in relation to Neary - she was a foreign trained nurse.


She was an Irish lady - right? She was on TV3's breakfast show during the week. 

It is quite obscene to see people trying to rewrite history by blaming nurses for Neary's actions. This is the guy who was reviewed by three eminent male Irish consultants who signed off on his assaults. We know who bears the real responsibility for Neary's actions, and it is not the nurses.


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## annet (31 Oct 2009)

The US is a prime example of privatization gone wrong.  In the insurance market access to life altering and often life saving treatments for certain conditions are not covered within the health market because of their high resource cost base.  Similarly, in the UK there are situations were your geographical location and street will heavily dictate whether you get access to certain treatments including drugs for cancer.  In the whole NTPF model we continue to apply a "sticky plaster" approach to problem solving in our public hospital sector by contracting out to private services providers.... and then we get public patients who are so eternally grateful for finally getting treated by their own public hospital consultant in this whole perverse system.

On the Neary issue, while one obviously cannot deflect from individual responsibility, there were "enablers" like the anaesthetists, junior doctors, theatre nurses, midwives and the pathologists who said and did nothing.


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