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

[z104]

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.

 

[Purple]

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.
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.

That's it!

 

[csirl]

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.

 

[Purple]

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.

 

[Latrade]

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?

 

[csirl]

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.

 

[Brianne]

[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.

 

[Purple]

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.

 

[Complainer]

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?

 

[Purple]

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.

 

[S.L.F]

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.

 

[Purple]

She was not an Irish nurse.

 

[S.L.F]

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.

 

[annet]

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.

 

[Complainer]

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.

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.

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.

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.

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.

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?

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".

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?

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.

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.

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.

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.

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.

 

[annet]

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.