Private vs. public healthcare

[csirl]

Quote:
Originally Posted by Brianne http://www.askaboutmoney.com/showthread.php?p=649260#post649260
Health care is an endless demand curve and all this talk about the private system being efficient is just that.........talk.
The private system doesn't deal with major accidents, old people with dementia and multi disease who are waiting on suitable nursing homes. The private system doesn't have the orthopaedic lists f.......d up for the next two days because joy riders or drunken drivers or plain road traffic victims need urgent operations and automatically jump the list.The private system can pick and choose, the public system can't.
They operate on you in the private system but if things go really wrong, where do you end up.......back in casualty at 3 am being looked after by the public system.

Agreed


Quote:

I dont know about this one. There is no reason why A&E couldnt be put out to tender on the basis that whoever wins the tender has to deal with whatever injuries present themselves on a given day. There is an element of risk in this given that there will be quiet times and peaks, but, there is a lot of data on the accident rates available and so a company can price the extra costs associated with the demand risk. This is not an impossible service for a private sector organisation to provide - remember that most of the public health service A&E departments in Dublin are privately owned (Beaumont, Mater, St James, St Vincents) and are already doing this job in the context of the aforemention "Railtrack UK" monopoly situation. These hospitals are already coping with whatever is thrown at them. I dare say that if there was competition and the business was tendered, we would probably get a more efficient service at cheaper cost.

The argument is always made that private A&E would cut corners to save costs. I dont believe this as people would die thus pushing their mortality rate above norms. If too many people die, they'd lose the contract, so it is more profitable in the long run for them to provide a high level of care in order to keep the lucrative contract. Using my "hospitals must do procedures to make a profit argument" earlier in this thread, if A&Es were paid on a volume related basis rather than a lump sum basis, it would be in their interests to give better care as it would earn them more money. In terms of medical costs, the main difference between A&E and any other type of medicine is the demand risk - you cant schedule A&E whereas you can schedule other injuries. And demand risk CAN be priced.

 

[television]

How would competition in this respect work. Lets see, there is a really serious car accident. I can picture the scene 3 competing ambulences attend to the scene who ever gets there first wins the "unit". Or if I break my leg I decide to go to the most efficent Aand E based on published mortality rates for a and es. Crazy. Trying to blindly fit what works as competition in the private sector does not take into account the complexity of providing quality free health care for people.

 

[Complainer]

I dont know about this one. There is no reason why A&E couldnt be put out to tender on the basis that whoever wins the tender has to deal with whatever injuries present themselves on a given day. There is an element of risk in this given that there will be quiet times and peaks, but, there is a lot of data on the accident rates available and so a company can price the extra costs associated with the demand risk. This is not an impossible service for a private sector organisation to provide - remember that most of the public health service A&E departments in Dublin are privately owned (Beaumont, Mater, St James, St Vincents) and are already doing this job in the context of the aforemention "Railtrack UK" monopoly situation. These hospitals are already coping with whatever is thrown at them. I dare say that if there was competition and the business was tendered, we would probably get a more efficient service at cheaper cost.

The argument is always made that private A&E would cut corners to save costs. I dont believe this as people would die thus pushing their mortality rate above norms. If too many people die, they'd lose the contract, so it is more profitable in the long run for them to provide a high level of care in order to keep the lucrative contract. Using my "hospitals must do procedures to make a profit argument" earlier in this thread, if A&Es were paid on a volume related basis rather than a lump sum basis, it would be in their interests to give better care as it would earn them more money. In terms of medical costs, the main difference between A&E and any other type of medicine is the demand risk - you cant schedule A&E whereas you can schedule other injuries. And demand risk CAN be priced.

So is mortality rate the sole metric you'd use to measure success on the contract?

 

[room305]

How would competition in this respect work. Lets see, there is a really serious car accident. I can picture the scene 3 competing ambulances attend to the scene who ever gets there first wins the "unit". Or if I break my leg I decide to go to the most efficient Aand E based on published mortality rates for a and es. Crazy. Trying to blindly fit what works as competition in the private sector does not take into account the complexity of providing quality free health care for people.

There is no "free" health care, somebody has to pay for it at some point. The word you are looking for is "socialised". As has been pointed out numerous times to you on this thread to little avail, you can have a socialised medical system provided by the private sector (e.g. France or Sweden).

Yes and how crazy would you have to be to want to be treated in the hospital in which you are least likely to die.

So is mortality rate the sole metric you'd use to measure success on the contract?

Being facetious adds little to the thread. The poster was illustrating his point by way of example, not writing a contract. Many factors could be included - wait time for treatment/bed/doctor/transfer, satisfaction with service, mortality rates, infection rates all as measured against the expected averages in other industrialised nations.

Done transparently and competently, the privatisation of healthcare could lead to a better and more accountable service than that currently provided by the HSE for the same cost.

 

[television]

Done transparently and competently, the privatisation of healthcare could lead to a better and more accountable service than that currently provided by the HSE for the same cost.

Why do you see transparency competence and accountability as something exclusive to the private sector. Plenty of examples from the private sector where there is anything but, by the way.

 

[csirl]

How would competition in this respect work. Lets see, there is a really serious car accident. I can picture the scene 3 competing ambulences attend to the scene who ever gets there first wins the "unit". Or if I break my leg I decide to go to the most efficent Aand E based on published mortality rates for a and es. Crazy. Trying to blindly fit what works as competition in the private sector does not take into account the complexity of providing quality free health care for people.

This is not how the system works.

You would have 1 A&E service in each area (as you have now) and the operation of the A&E could be tender e.g. every 5 years. If an operater is not up to scratch, then they will have no hope of getting the contract renewed. This model actually works quite well in a lot of public service sectors around the world. People always use the German train service as an example as an efficient public service. In most German cities, the public trains are operated by a single private company (much in the same way as the Luas is operated by a private company, but on a much bigger scale) who tender for the business periodically e.g. Munich underground. Company isnt up to scratch, they lose the business to a competitor.

This mulitple ambulance argument is always used as a scaremongering tactic by socialists. They misinterpret competition as being on an indivudual e.g. road traffic basis and say it will cause confusion. They fail to see that the competition is to get the contract in the first place - when the contract is being placed.

 

[television]

.
This mulitple ambulance argument is always used as a scaremongering tactic by socialists.

Anything that goes against the blind religious zeal of nieve application of competition is seen as socialist scaremongering.


And its not just competition to get the contract in the first place its also competition over patients as as you said earlier under your systemits also about volume.

This model actually works quite well in a lot of public service sectors around the world

You do not really understand the complexity of this situation if you are seriously trying to equate the provision of a transport to the provision of health care.

 

[room305]

Why do you see transparency competence and accountability as something exclusive to the private sector. Plenty of examples from the private sector where there is anything but, by the way.

You have misinterpreted my comment. I said that if the privatisation process is performed transparently and competently (e.g. public tender process, properly specified terms and conditions, penalties for default, unambiguous contracts etc.) then an improvement upon the service provided by the HSE will result. This process will have to be carried out by the public sector.

Of course if you are unhappy with the service provided by the private sector you can always take your business to a competitor. An option always denied to you under the public sector monopoly you treasure so much.

 

[shnaek]

Why do you see transparency competence and accountability as something exclusive to the private sector. Plenty of examples from the private sector where there is anything but, by the way.

And there are close to zero examples of where it applies to the public sector - certainly wrt accountability and transparency!

 

[csirl]

You do not really understand the complexity of this situation if you are seriously trying to equate the provision of a transport to the provision of health care

People make out healthcare to be to complex and difficult to be run by the private sector. The reality is that a lot of the major public service hospitals in Ireland ARE private sector owned (Beaumont, St. Vincents, St James, Mater), so this statement has been disproven. Are you really trying to get us to believe that a private sector organisation can run a service better with a monopoly/cartel situation that it can without? Can you give any examples of where a private sector monopoly/cartel has given better service in any sector of business?

What particular aspects of healthcare delivery make it more difficult for a private sector organisation to deliver as opposed to a public sector organistion? Can you state them? Volume and demand is not the correct answer as the public sector also has to deal with them.

 

[television]

People make out healthcare to be to complex and difficult to be run by the private sector. The reality is that a lot of the major public service hospitals in Ireland ARE private sector owned (Beaumont, St. Vincents, St James, Mater), so this statement has been disproven.

And according to anyone who asks not very efficently.

Are you really trying to get us to believe that a private sector organisation can run a service better with a monopoly/cartel situation that it can without? Can you give any examples of where a private sector monopoly/cartel has given better service in any sector of business?

You see the proviision of health as a market place where the rules of profit and loss etc applies. If you dont then your not really talking about privatision in the sence I unnderstand it. In a privatised system, privately owned health care providers will charge insurance companies for services and insurance companies will levy the cost of this onto consumer in terms of policies.

This would mean that those who cannot afford to pay the cost on health insurance will be left behind. Now if you are saying that in some way the government could pay private health care providers for the health needs of poor people who cannot afford it then this may solve the equity problem. But this is not pure privatisation as the government would be paying for certain people.

I aggree with you that monolopies are bad for consumers. However you do not see that monolopies do not have to exist within the public sector. there can be competition between hospitals in the public sector. Along much of the saME CRITERIA that you are suggesting. the difference being that the ultimate motivation is making patients better not making profit.

What particular aspects of healthcare delivery make it more difficult for a private sector organisation to deliver as opposed to a public sector organistion? Can you state them? Volume and demand is not the correct answer as the public (did you mean private)sector also has to deal with them.

I was making this comment in relation to you trying to compare running a health service with running a bus company.

 

[television]

Just to clarify one thing csgirl. do you believe the state should pay for the health care of those who cannot afford to pay?

 

[csirl]

do you believe the state should pay for the health care of those who cannot afford to pay?

Depends on the reason they cannot afford to pay.

If someone has a genuine disability, then the State should pay, but I do not believe that the State should pay for people who are capable and able to work, but choose not to. People have to take a certain amount of personal responsibility for their circumstances. In most cases when you talk about paying for health care, you are really asking the question as to whether or not health insurance should be paid for. Its easy to state that very few people could pay for a complex operation costing €100,000's, its less easy to argue that very few people could pay a few hundred euro per annum for the insurance policy that would pay for such an operation.

Quote:
Originally Posted by csirl http://www.askaboutmoney.com/showthread.php?p=651004#post651004
People make out healthcare to be to complex and difficult to be run by the private sector. The reality is that a lot of the major public service hospitals in Ireland ARE private sector owned (Beaumont, St. Vincents, St James, Mater), so this statement has been disproven.

And according to anyone who asks not very efficently.

Precisely - due to having a monopoly/cartel. Do you not think that these hospitals would up their game if they faced the prospect of losing their public sector contracts to a competitor if they did not improve?

You see the proviision of health as a market place where the rules of profit and loss etc applies. If you dont then your not really talking about privatision in the sence I unnderstand it. In a privatised system, privately owned health care providers will charge insurance companies for services and insurance companies will levy the cost of this onto consumer in terms of policies.

2 points:

1. There are many forms of privatisation, some of which may be more suitable and efficient than the one you describe.
2. It may surprise you, but whether public or privately funded, economics do apply to healthcare. You argue that a private sector organisation may determine that it is not worth offering a particular service because it costs too much. A public sector organisation e.g. HSE, Dept of Finance, may also make the same decision and seem to be doing so with increasing frequency as the economy slows down. Public health is not immune from being shut down for budgetary reasons as the 1980s would prove. The public service always has to balance the additional charge to be passed onto the taxpayer in the form of higher taxes against the benefit of providing the service.

However you do not see that monolopies do not have to exist within the public sector. there can be competition between hospitals in the public sector. Along much of the saME CRITERIA that you are suggesting. the difference being that the ultimate motivation is making patients better not making profit.

If you were going to get the same pay regardless of how hard you worked and you could never lose your job, what motivation do you have to work harder? Answer: None. This is just ideological claptrap - it goes entirely against human nature to suggest that people would go out of their way to work harder for no reward.

The only way you can have genuine competition between hospitals delivering public services is if those who are not up to scratch lose their jobs - this can only be achieved by competition with real benefits for those who perform well i.e. increased profits, and real penalties for those who dont i.e. no profits, job losses etc.

 

[television]

Depends on the reason they cannot afford to pay.

If someone has a genuine disability, then the State should pay, but I do not believe that the State should pay for people who are capable and able to work, but choose not to. People have to take a certain amount of personal responsibility for their circumstances. In most cases when you talk about paying for health care, you are really asking the question as to whether or not health insurance should be paid for. Its easy to state that very few people could pay for a complex operation costing €100,000's, its less easy to argue that very few people could pay a few hundred euro per annum for the insurance policy that would pay for such an operation.

In your market driven eutopia there will always be a certain amount of unemployed people. That is an economic fact. Your solution is the complex responce of a famous tory "get on your bike" What about the children of those people who "choose not to work". What happens to them. But you do aggree that it is the governments responcibility to look after the health needs of certain sections of the community.

Precisely - due to having a monopoly/cartel. Do you not think that these hospitals would up their game if they faced the prospect of losing their public sector contracts to a competitor if they did not improve?.

Even in your own example above you say that their should only be one And E per area.


2 points:

1. There are many forms of privatisation, some of which may be more suitable and efficient than the one you describe.

. It may surprise you, but whether public or privately funded, economics do apply to healthcare.?.

Yes economics applies of cource but if there is a decision to be made between cost and making someone better then the community have a responcibility to ensure the former.

. You argue that a private sector organisation may determine that it is not worth offering a particular service because it costs too much. A public sector organisation e.g. HSE, Dept of Finance, may also make the same decision and seem to be doing so with increasing frequency as the economy slows down. Public health is not immune from being shut down for budgetary reasons as the 1980s would prove. The public service always has to balance the additional charge to be passed onto the taxpayer in the form of higher taxes against the benefit of providing the service.

Whether thr cutting of essential health services happens in the publlic or private sector still makes it immoral and absolutly wrong. See I believe the provision of health care is also essentially a moral issue and responcibiliy for the community.

 

[room305]

In your market driven eutopia there will always be a certain amount of unemployed people. That is an economic fact.

Yes but usually a lower percentage than in your socialist utopia.

Even in your own example above you say that their should only be one And E per area.

With contracts for running the A&E renewed every five years. Poor performance against the competition (i.e. other companies competing for contracts, possibly running other A&E units in other areas) will result in a loss of existing contract and consequent job losses.

Yes economics applies of cource but if there is a decision to be made between cost and making someone better then the community have a responcibility to ensure the former.

At any price? If that is the case why not assign every family in the country a live-in doctor?

Whether thr cutting of essential health services happens in the publlic or private sector still makes it immoral and absolutly wrong. See I believe the provision of health care is also essentially a moral issue and responcibiliy for the community.

Basic healthcare is something that every citizen of the state should be able to avail of. It should be within the means of the state to provide this to everybody who cannot afford it. At the moment despite massive funding the public sector cannot guarantee a basic level of care. You yourself have admitted that you consider it necessary to purchase private health insurance to provide a decent health care service for your family. What makes you so confident that additional funding to the public health care system will allow you to happily no longer avail of private health insurance? How much extra tax will this require? Who will pay the extra tax and just how much damage to our already faltering economy will this do? Remember we have already flirted with high taxation in this country and the result was grinding poverty, widescale tax evasion and mass emigration.

Why is it so hard to imagine a completely privatised health system? The huge advances in medical technology, surgical procedures, drugs and treatments available today are almost invariably provided by private companies pursuing a profit-driven agenda. How much harder then can it be to run the hospital that provides these services?

What is so fundamentally different about healthcare that people feel it cannot be left to the private sector? Is it any more complex than other services that people every day entrust their lives to the private sector to provide such as air travel? I cannot help but feel that much of this is propaganda driven by unions trying to defend work practices that are no longer prevalent in the rest of society.

 

[Purple]

csirl, Room305; I 'aint posting 'cause you're saying it all.
Keep banging away and they might see logic trumps ideology.

 

[television]

Yes but usually a lower percentage than in your socialist utopia. .

But your responce tothese unemployed peoples health care needs is to say "tough luck go get a job you lazy scrounger" (paraphrase) Great sound bite, but simplistic, and ignores the fact that unemployed people would loose out badly in a purely for profit health service. Your answer "get a job". Tell that too a lot of hard working people who have lost thier jobs over the last year or so. tell that to the 50 year old with 3 kids who has worked for30 years in the one company and now its closed down. you see all unemployement as the fauth of the unemployed. And you call my stance ideological? I call it moral.

With contracts for running the A&E renewed every five years. Poor performance against the competition (i.e. other companies competing for contracts, possibly running other A&E units in other areas) will result in a loss of existing contract and consequent job losses.

If the state is paying for private companies runnign these a A%E units this is far from the privatised Eutopia your calling for.

At any price? If that is the case why not assign every family in the country a live-in doctor? .

That comment is unbecoming of your decent argument so far in this discussion.

Basic healthcare is something that every citizen of the state should be able to avail of. It should be within the means of the state to provide this to everybody who cannot afford it. At the moment despite massive funding the public sector cannot guarantee a basic level of care. You yourself have admitted that you consider it necessary to purchase private health insurance to provide a decent health care service for your family. What makes you so confident that additional funding to the public health care system will allow you to happily no longer avail of private health insurance? How much extra tax will this require? Who will pay the extra tax and just how much damage to our already faltering economy will this do? Remember we have already flirted with high taxation in this country and the result was grinding poverty, widescale tax evasion and mass emigration.

The key word here is basic. Your admiting here that you see a difference between the health care people who can afford it should recieve and people who cannot should recieve. That is fine up to a point, but when it comes to services like cancer, alsimers care, you believe those who can afford to pay have a greater right to these services simply because they can afford it. If you think that is a good way for society to devlope and tolerate good luck to you. I want QUALITY health care not BASIC health care for all.

Why is it so hard to imagine a completely privatised health system? The huge advances in medical technology, surgical procedures, drugs and treatments available today are almost invariably provided by private companies pursuing a profit-driven agenda. How much harder then can it be to run the hospital that provides these services?.

Even you see state funding for privatly provided service as a means of movign forward. SO where does this fit with your completly privitised health system?

What is so fundamentally different about healthcare that people feel it cannot be left to the private sector? Is it any more complex than other services that people every day entrust their lives to the private sector to provide such as air travel? I cannot help but feel that much of this is propaganda driven by unions trying to defend work practices that are no longer prevalent in the rest of society.

I am not arguing that private sector cannot provide efficent health care. I am arguing that a purely privitised service cannot provide equitable care. If the only responce you can give this is the typical

propaganda driven by unions trying to defend work practices that are no longer prevalent in the rest of society

argument, I suggest this is you being idological not me. What am I arguing for?Good quality health care avalible to all citizens regardless of thier ability to pay taking into account the complexity of issues of ppoverty, and the need for social justice and equity. Is essentially a question of morality.

 

[television]

csirl, Room305; Keep banging away and they might see logic trumps ideology.

That line could have been written by Marx well done

 

[television]

As has been pointed out numerous times to you on this thread to little avail, you can have a socialised medical system provided by the private sector (e.g. France or Sweden)..

Are you saying you favour this system as opposed to a purely privatised system?

All NHI funds are legally private organizations responsible for the provision of a public service. In practice, they are quasipublic organizations supervised by the government ministry that oversees French social security.

Taken from http://www.ajph.org/cgi/reprint/93/1/31.pdf makes interesting reading in regards public funding of health care from equitable social insurance payments and takes into account 1. equity 2. quality.

ONe final quote from artical.

Smaller funds with older, higher-risk populations (e.g., farmers, agricultural workers, and miners) are subsidized by the CNAMTS, as well as by the state, on grounds of what is termed “demographic compensation.” Retirees and the unemployed are automatically covered by the funds corresponding to their occupational categories. In France, the commitment to universal coverage is accepted by the principal political parties and justified on grounds of solidarity—the notion that there should be mutual aid and cooperation between the sick and the well, the active and the inactive, and that health insurance should be financed on the basis of ability to pay, not actuarial risk.

Common sence i'd say.

Vive la France.

 

[room305]

Are you saying you favour this system as opposed to a purely privatised system?

No. If it were up to me we'd have a purely free market system with no social welfare and no state-funded education or healthcare. However, I am well aware that such a system would be unpalatable to many and that it probably appeals to the same tacit sense of perfectionism as Marxism.

So what I am saying is that if we must have a health system where the cost is socialised then it is better that it is run by the private sector than the public sector as it will deliver a better service for less of my taxes.

During much of this debate you appear to have had difficulty distinguishing between public/private healthcare provision and public/private healthcare funding leading to much confusion.

If I am following you correctly, you are now modifying your original argument somewhat and believe that private healthcare is fine so long as it is paid for out of public funds? Am I right? If not perhaps you could clarify matters.