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

[Purple]

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.

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.

 

[johnd]

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.

 

[Purple]

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?

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”.

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.

 

[johnd]

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!

 

[daithi]

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

 

[Mpsox]

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

 

[Complainer]

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.

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.

 

[Latrade]

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.

 

[Bronte]

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

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

 

[Sunny]

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.

 

[csirl]

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.

 

[Latrade]

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.

 

[csirl]

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.

 

[Latrade]

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.

 

[csirl]

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.

 

[Latrade]

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?

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.

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.

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.

 

[Purple]

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).

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.

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.

 

[csirl]

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.

 

[Purple]

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

 

[Latrade]

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.

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.

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.

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.