Are income tax rates really too high in Ireland

[Carnmore]

More examples:

(1) A consultant stated that he gets four times as many procedures done in the private hosp compared to a public hosp. This quote was in the public domain.

Now, I suspect a certain amount of hyberbole, but I'm sure there is some truth to that.

Output per day is bound to be higher.

(2) I spoke to a HR manager in a large private hosp, tells me scans/MRI/imaging continues until 2am. I asked are there really patients going in after midnight for scans? Yes.

But not in the HSE hosp.


(3) Staff in Sligo endoscopy unit confirmed to me that they often have excess staff, as the number of staff isn't matched to the volume of patients on the list.


I accept that unions may not be involved in all these issues.

However, I contend that is all hosps were run on the basis of "money follows the patient" / UHI, I feel output would be higher.

Providing actual examples is preposterous and does not fit the public servant union-apologist narrative!

This inanely perpetual discussion might have nowhere else to go now.

 

[RetirementPlan]

It's not just individual failures, it's a pattern and why do they occur more often there. It's because of a lack of accountability.
What do you think would happen to the manager who tried to make those individuals accountable and tried to drive efficiency and flexibility over rigid separation of duties?

Maybe instead of speculating as to what might happen to the manager, we could look at actual facts, actual evidence - WRC cases, Labour Court cases, press reports of union negotiation, any other credible sources, instead of just making guesses?

 

[RetirementPlan]

However, I contend that is all hosps were run on the basis of "money follows the patient" / UHI, I feel output would be higher.

FG came into power in 2011 with UHI as their stated policy. When they went to actually implement it, they found that Ireland was too small a market for UHI to work, which is why we ended up with Slaintecare.

Higher output isn't the only criteria, or even the main one. Quality of output is more important than speed of output. It's easy for private hospitals to cherrypick the simpler procedures and simpler cases, and they won't hesitate to fall back on the public system, handing the more complex cases back to the public service when they can't squeeze any more insurance payments out of them.

 

[odyssey06]

Maybe instead of speculating as to what might happen to the manager, we could look at actual facts, actual evidence - WRC cases, Labour Court cases, press reports of union negotiation, any other credible sources, instead of just making guesses?

You don't bring a case you know you will lose. You don't even try.

 

[Purple]

FG came into power in 2011 with UHI as their stated policy. When they went to actually implement it, they found that Ireland was too small a market for UHI to work, which is why we ended up with Slaintecare.

I don't think that was the only reason. Resistance from players at all levels who have an interest in maintaining the current system was strident.

Higher output isn't the only criteria, or even the main one. Quality of output is more important than speed of output. It's easy for private hospitals to cherrypick the simpler procedures and simpler cases, and they won't hesitate to fall back on the public system, handing the more complex cases back to the public service

That's a valid point.

when they can't squeeze any more insurance payments out of them.

Can you provide evidence that this happens?

 

[RetirementPlan]

You don't bring a case you know you will lose. You don't even try.

I'm not 100% sure on your implication here.

One implication is that unions aren't really all that intransigent, so they don't challenge cases where they would be seen to be intransigent, so they effectively 'give in' to management on such cases.

Is that what you mean?

 

[Purple]

I'm not 100% sure on your implication here.

One implication is that unions aren't really all that intransigent, so they don't challenge cases where they would be seen to be intransigent, so they effectively 'give in' to management on such cases.

Is that what you mean?

Now you are being obtuse. Funny, but obtuse.

 

[RetirementPlan]

I don't think that was the only reason. Resistance from players at all levels who have an interest in maintaining the current system was strident.

That's a valid point.

Can you provide evidence that this happens?

Cherrypicking has been fairly widely reported over the years, at home and abroad;

Cherrypicking off the public sector

YES says Gerard Bury. Private medicine can not be compared withpublic healthcare

www.irishtimes.com

When Private Hospitals Cherry-Pick, Teaching Hospitals Pay the Price – The Health Care Blog

https://www.imo.ie/policy-international-affair/documents/imo-submissions-archive/IMO-Sub-on-Risk-Equalisation-2010-Final.PDF

Block on patient ‘cherry picking’ dropped

www.ft.com

I remember when herself was in Holles St, she met a bunch of mums of twins who had planned to deliver in Mt Carmel, but had been dumped back into the public system when their cases looked a bit risky.

 

[nest egg]

FG came into power in 2011 with UHI as their stated policy. When they went to actually implement it, they found that Ireland was too small a market for UHI to work, which is why we ended up with Slaintecare.

Do you have any sources for that? I'm genuinely curious. There's no perfect solution but UHI always struck me as the most pragmatic way to solve the two tier health system.

 

[Protocol]

I will try to post some data on healthcare costs.

 

[Purple]

I will try to post some data on healthcare costs.

It's worth noting that our GDP is grossly inflated. That's why the CSO came up with GNI* or Modified Gross national Income. For most countries *GNI and GDP will be the same or very close so it's good to use it instead of GDP for these comparisons. Our spending as a percentage of GNI is just over 11% of *GNI which would put us in the top 3 on your first chart.

 

[odyssey06]

I would also be curious to see the definition of health expenditure. Does it include private expenditure on health such as payments for GPs, physiotherapy, private health insurance, prescriptions, co-payments etc as this varies from country to country also.

 

[Purple]

I would also be curious to see the definition of health expenditure. Does it include private expenditure on health such as payments for GPs, physiotherapy, private health insurance, prescriptions, co-payments etc as this varies from country to country also.

Yes. It's all expenditure on health, both public and private.

 

[RetirementPlan]

Do you have any sources for that? I'm genuinely curious. There's no perfect solution but UHI always struck me as the most pragmatic way to solve the two tier health system.

From

2011 was the first year the Irish government made a commitment to universal single tier health system which was to be delivered through compulsory universal health insurance and universal primary care [13]. This commitment to universalism was restated in a 2014 White Paper on Universal Healthcare [14], however analysis of this period shows that despite the policy intent, there was less universalism in the health system in 2015 than there was in 2011 [5].

An independent assessment of the 2011 universal health insurance (UHI) proposals which planned to provide coverage through competing private insurers found that the model would be too costly, that the vast majority of care would remain tax funded and many charges would remain [15]. By 2016, no party was advocating reform through an insurance model [16].

 

[nest egg]

From

Therefore they believed it would be too expensive, based on certain assumptions taken, rather than Ireland's market size, if I've followed correctly. I had a quick look at the referenced report and the first thing which jumped out was "The authors are also grateful to the many officials of the Department of Health and HSE, who have assisted this research, including the staff of the newly established Healthcare Pricing Office".

Coming back to two-tier system, I honestly can't understand why it's tolerated, it's horrific that rich people, like me, can queue jump those less fortunate, based on an ability to pay. Cost control is obviously an important factor, but surely eliminating the two-tier model is the most humane reason to reform our healthcare system? UHI would solve that in one fell swoop, everyone on a level playing field.

 

[RetirementPlan]

Therefore they believed it would be too expensive, based on certain assumptions taken, rather than Ireland's market size, if I've followed correctly. I had a quick look at the referenced report and the first thing which jumped out was "The authors are also grateful to the many officials of the Department of Health and HSE, who have assisted this research, including the staff of the newly established Healthcare Pricing Office".

Coming back to two-tier system, I honestly can't understand why it's tolerated, it's horrific that rich people, like me, can queue jump those less fortunate, based on an ability to pay. Cost control is obviously an important factor, but surely eliminating the two-tier model is the most humane reason to reform our healthcare system? UHI would solve that in one fell swoop, everyone on a level playing field.

I have some previous experience on one aspect of UHI, and it is very, very complex. Things might look sensible in principle, but putting them into practice is another matter entirely. My understanding, as set out in that paper by a very respected academic in the area, is that all parties involved found that UHI was unworkable in the Irish market.

I'm not an expert, so I can't tell you anymore, but I'd be wary about broad assumptions from afar.

 

[ryaner]

Coming back to two-tier system, I honestly can't understand why it's tolerated, it's horrific that rich people, like me, can queue jump those less fortunate, based on an ability to pay.

It is even worst than a two-tier system. What really annoys me is the pricing differences. If you need some and decide to pay for it privately, you will pay double (or more) than what the private hospital would have charged the insurance company should you have been covered.

Sadly even if UHI just came in indirectly tomorrow, with say the gov just buying everyone the top tier of health insurance, you'd still get an uneven playing field with people who can just paying to get ahead of the new queues.

 

[Baby boomer]

It is even worst than a two-tier system. What really annoys me is the pricing differences. If you need some and decide to pay for it privately, you will pay double (or more) than what the private hospital would have charged the insurance company should you have been covered.

That actually shows the benefit to the consumer generated by the bulk purchasing power of the insurance company.

Sadly even if UHI just came in indirectly tomorrow, with say the gov just buying everyone the top tier of health insurance, you'd still get an uneven playing field with people who can just paying to get ahead of the new queues.

No. Initially, there would be queues. They would soon evaporate as the private system expanded it's capacity to cope. That's the way private business works. Just do it. No reports, commissions, study groups, or endless negotiation. We don't have waiting lists for food, clothing, holidays, furniture and the myriad other consumer products and services supplied by the private sector. Markets work. Output rises to meet demand.

 

[Purple]

I have some previous experience on one aspect of UHI, and it is very, very complex. Things might look sensible in principle, but putting them into practice is another matter entirely. My understanding, as set out in that paper by a very respected academic in the area, is that all parties involved found that UHI was unworkable in the Irish market.

I'm not an expert, so I can't tell you anymore, but I'd be wary about broad assumptions from afar.

The problem isn’t the funding structure, it’s the delivery structure. There’s no way UHI will work with our current structure and there’s too many interest groups that would lose our if it was fixed so it won’t be fixed. I do agree that it’s very complex and, to be fair, for the first time in my lifetime there’s a cross party plan to improve things. They just have to have the strength and fortitude to keep pushing against the monoliths.

 

[Sophrosyne]

There was an extensive thread circa 2012 about UHI on AAM, but it seems to be gone.

Then as now, there were considerable unfulfilled healthcare needs.

UHI involved a basket of healthcare products to be purchased from competing medical insurance providers. See this

Those who could not afford healthcare premiums would be subsidised.

Because of the high-cost, low-waged economy, almost 2m people - medical and GP visit card holders - would have required subsidization to the basic healthcare basket.

But there was a dearth of information on the products in the health basket and also on the private sector profit margins & costings.

A report published circa 2012/2013 which examined potential costs per capita, I just can’t find it, but from memory it did mention lack of data to facilitate proper analysis.

Sláintecare seems to be exhibiting the same lack of cost transparency.

According to the Fiscal Assessment Report, December 2021, under the heading Fiscal Stance, paragraph 4;

“On health commitments, there is currently no clearly identified budget to continue implementing Sláintecare reforms in health beyond next year and there are no up-to-date estimates of the costs of implementing remaining reforms”.