Health spending

Markjbloggs

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How does the level of employment in the Irish Health services copmare with other countries? Over 100,000 people are employed to care for a population of 4 million - that is one person for every 40 of the population. It is funded through income tax, health service levy & VHI/BUPA premiums and represents very poor value for money spent. And it is still one of the worst services in the developed world!

Surely this is overkill. What will happen when the (inevitable) downturn occurs - tax rates are going to have to increase just to keep this bloated monster afloat.
 
Don't forget all those in the private health care sector. I know they are not publically funded but they need to be added to the total. Does anyone know how many of them there are?
 
Health services are and have to be labour intensive. We cannot farm out the feeding and turning of our incapacitated elderly, or care of prematurely born infants, to Asia.
As medical science improves, people can live longer with more disabilities; we can keep people alive for longer in ITU etc of conditions they would have died of before. It's going to get costlier into the future (or should I say going forward? :).

Health Statistics from the OECD:
([broken link removed])

OECD Health Data 2006: Statistics and Indicators for 30 Countries

Total health spending accounted for 7.1% of GDP in Ireland in 2004, some way below the latest available
average of 8.9% across OECD countries. The United States is, by far, the country that spends the most on
health as a share of its economy, with 15.3% of its GDP allocated to health in 2004. Switzerland and
Germany followed with, respectively, 11.6% and 10.9% of their GDP spent on health. Several EU
countries - France, Belgium, Greece and Portugal – also devoted 10% or more of GDP to health in 2004.

In terms of health spending per capita, Ireland ranks just above the OECD average, with spending of 2596
USD in 2004 (adjusted for purchasing power parity) compared with an OECD average of about 2550 USD.
However, this is dwarfed in comparison with the United States (which spent 6102 USD per capita in 2004),
and significantly lower than some other big spenders, such as Luxembourg, Switzerland and Norway (with
spending from 4000 to 5000 USD)
Resources in the health sector (human, physical, technological)

Despite increasing numbers of doctors in recent years, Ireland continues to see a lower physician density
per capita than in many other OECD countries. In 2004, Ireland reported 2.8 physicians per 1 000
population. This figure is higher than in countries such as the United States, Canada, the United Kingdom
and Australia, but falls short of the OECD average of 3.0 and well behind some other European countries
such as France, Germany, Spain and Portugal, who all record 3.4 physicians per 1 000 population.

On the other hand, Ireland records a very high density of practising nurses, with 15 nurses per 1 000
population in 2004 (noting though that the comparability with other countries is more limited due to the
inclusion of different classes of nurses, mid-wives, etc.).

The number of acute care hospital beds in Ireland in 2004 was 2.9 per 1 000 population, below the OECD
average of 4.1 beds per 1 000 population. In most OECD countries including Ireland, the number of
hospital beds per capita has fallen over recent decades.
 
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Good post Gordanus.
I agree with your general point but it is worth noting that we have a very young population in relation to most of western Europe and the USA. This should mean that we have lower health spending per head.
It should also be noted that the exit of religious orders from the health service has increased the resources that the state has to fund. I do not remember the source but I do remember reading that their input in the 1970's and 1980's translates to about two billion a year in today's money.
It is also worth noting that much of the very high cost spending in on a small minority of patients who have the chance of a relatively normal life as a result of that spending. Doctors have to make difficult decisions on how to spend limited resources that can result in emotive and heart breaking cases. I do not envy them their task.
The fact does remain that staff numbers have increased from 60'000 to 100'000 in the last 10 years without any real structural reform and without much discernable improvement in day to day services. The fact that it is the workers within the health sector that resist change, be they nurses or consultants, is a worrying problem and belies the vocational murmurings that the INTO and the consultant and non consultant bodies come out with on a regular basis.
 
the vocational murmurings that the INTO

I think nurses got REALLY sick and tired of being underpaid because it was looked on as a vocation, and so there has been a bit of a backlash. When I used to be a nurse long ago and far away (ok it was in the NHS) we weren't allowed strike so we were going to work with emergency cover only...........Only to find out when the sums were done, that 'emergency cover' required a HIGHER rate of staffing than we had on a day to day basis!
I can't speak for the consultants, most of whom do a good job and who are well paid for it.
 
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Still trying to find number for different countries. Not making much progress, can anyone else find the statistics for the amount of people employed in different countries Health Services?

Here a bit from the BMJ though:

Number of frontline NHS staff has fallen

The number of NHS frontline staff in England has dropped sharply since the 1991 reforms, according to figures in a Department of Health bulletin, despite official attempts to disguise the drop. Although two out of three staff are engaged in direct patient care, the number has fallen by more than 30 000 since 1990.
The statistics are from a census of the NHS in September 1995 using a new classification based on occupations rather than pay scales as previously. Of the total 764 210 staff employed in the hospital and community health services, 93% were non-medical. Two thirds were staff engaged in direct patient care and 34% were management and support staff. The direct care staff comprised medical, dental, nursing, midwifery, and health visiting staff; health care assistants; and scientific, therapeutic, and technical staff.

The estimated total number of direct care staff in 1995 was 500 800 (65.5% of all staff). The 1990 figure was 533 450 (66.9%). This is a fall of 6%. A Department of Health press release reporting an "increase in frontline staff" quoted an estimate of only 60% of staff engaged in direct patient care 12 years ago. The earliest figure in the statistical bulletin for 1985 puts the share at 63.8%, or 518 490, which is 4% higher than in 1995.

Since 1990 the number of managers in the NHS has risen by 133% to 22 530, accounting for 3% of the workforce. By September 1995, 4280 qualified nurses were managers. Administrative and clerical staff have increased by 15% to 138 440 since 1990. Managerial and administrative staff make up 20% of the workforce.

http://www.bmj.com/cgi/content/full/313/7057/575/a
 
The main problem the Health Service has here , in common with the rest of the civil service and Public service is chronically poor and inefficient management - period.

The arguements to the whys and wherefores of what percentage of GDP is spent on Healthcare is not really the point here. I would question whether 7 or so % given to Ireland includes the private health sector and also the many direct charges made when you need to use the health service here. The USA is much further ahead in that - a) their healthservice is so much more expensive for the user , is almost totally private and Americans go for elective surgery and healthcare on a much greater scale than Europeans . Actually , from what I have been reading in the US media over the last year or so - there is a major debate on as to how efficient the US health sector is, and how they can spend so much and still leave over 40 million people without access to the most basic forms in Health care - they are looking at the scandavians countries for ideas and dont be surprised if this becomes a major issue for the incoming Democratic congress.

Getting back to here - it would appear to me that the Health Service here has been putting on layer upon layer of bureaucracy to supervise all this extra spending in the last 10 years - really becoming a self defeating action in the end - very little seems to be seeping down to where it is needed and it would seem any little change that would appear to be needed gets wrapped up in bureaucratic and union infighting.

I , thank God , and touch wood , have had little need to use the health service in recent years , bar my GP and Dentist , but on the few occasions when I have been in hospitals , normally visiting friends or relatives or picking up my now-ex girlfriend who is a nurse , I was really struck by the lack of organisation and also the lack of care for equipment and the facilities. Purple has brought it up here already - but as my mum put it - once the religious orders left the Health care system standards started to fall rapidly - its true - the whole MRSA scandal is indicitive of this - I see no difference in the standard and state of facilities from 10-15 years ago when the health services had been starved of money and now - where the hell is the extra 8 billion a year going?

I believe it is badly run and managed. You can have the most brilliant technicians, doctors , specialists and nurses - but they might as well be running around in circles if the system is wrong. The ethos of an organisation is formed from the Top down - if the managment isn't up to it , then dont expect the Frontline fighters to be able to cover it up or more particularly to actually give a damn.

A few examples of this.

My ex - who is a top class nurse and like so many of them - really dedicated to their profession and their patients - could tell me some horror stories about the crazy way the service is managed - from the lunatic rostering hours ,the fact that temps got paid far more than a staff nurse who has paid for her own education - crazy - the difficulties in getting equipment moved from faculty where they would be little used to where they were really needed without bringing the entire service out on strike. Also , The woman was a walking pharamacy! - She would take drugs for her entire extended family and friends - there was no control over this - I remember questioning her about this and I got the typical "ah sure its only now and again and nobody will miss it" - The Purchasing officer in me though ,well, what if every nurse and health technician has the same attitude - This post will be deleted if not edited immediately we could talking millions walking out the door.

which bring me on to next example - a few years ago I did a course in warehousing and inventory managment by night and one evening we were talking about inventory variances after stock takes (ie What you should have minus or plus what you really have!) The students were divided roughly 50/50 Public and Private Sector and there were a couple of guys from one of Large Dublin Hospitals on the course and the lecturer went around the room asking what the usual variances would be and what the attitude taken would be to these .
Well It came around to the guys and they said that on average there would be a discrepancy of 35-40% minus and they said it was no big deal and that the buyer would purchase 130% of their requirements so they would never run out. 35-40% folks - thats nearly half your stock gone walkies or not accounted for! - HOLY GOD - Those of us in the private sector sat in stunned silence with our jaws on the floor contempating the reaction of our own superiors if we posted such a figure (Personally I rather do an all inclusive deal to Guantanamo Bay than have to stand in front of my financial directors and relay such a report!) . But the guys were pretty nonplussed by the whole thing and said it was no biggie and pretty much par for course . Unbelievable

I could go on - The main issue is that the Health service is in need of massive surgery and restructuring - We all know this - you could walk from here to the moon and back on all the reports that have been written - all saying essentially the same thing. But the Goverment is caught in a pincer movement between the nurses unions, the other staff unions and The IMA and doctors groups all fighting for their own interests thus preventing any movement on anything - none of them seeing or wanting to see the big picture . Its time for some hard brave and tough decisions to be made - more money wont solve anything and unless there is a reform you are just throwing good money after bad - and general public will have to learn that you cant have your cake and eat it too and you do not have a divine right to a hospital with all service in your own backyard if you cant afford it (Maybe a bit of decentralisation and local democracy might be a good idea here - if you want a hospital in your region - well then your region pays for it - an arguement for another day maybe)
 
(Maybe a bit of decentralisation and local democracy might be a good idea here - if you want a hospital in your region - well then your region pays for it - an arguement for another day maybe)

Please, don't mention local democracy in the same sentence as health service. For how many years were the health boards around the country local fiefdoms stacked with political appointments? Local management of the health service has been shown to be a failure in Ireland, centralisation is the only way.

I think if there was one change to be made it would be to stop the medical card scheme as cost-free blank cheque for medical card holders. In Germany there is a charge of €10 on going to see the doctor but the payment has to be made only once in a quarter. This small charge acts as a deterrent so people won't go as frequently as if it was completely free.
 
I think if there was one change to be made it would be to stop the medical card scheme as cost-free blank cheque for medical card holders. In Germany there is a charge of €10 on going to see the doctor but the payment has to be made only once in a quarter.

More importantly we need a deterrent that would stop people going to A&E for minor ailments when they should of course be going to a local GP.
 
More importantly we need a deterrent that would stop people going to A&E for minor ailments when they should of course be going to a local GP.
How about no fee for medical card holders presenting at A&E with a GP letter but €30 without letter. The doctor can sign a waver if s/he thinks it is a real emergency.
 
where will you find a gp at the weekend or on sundays. Mrs Cu took ill a few weeks ago on a sunday and we couldnt find a gp. her own gp had an answering machine with a phone number, which wasn't answered in the morning. I took her to the ( no doctor on call in dundalk) alternative to doctor on call centre located in the louth hospital and there was nobody there. turned out when the original number finally answered it was ...................... centre at the louth hospital. afaik there's two operating threatres in the louth hospital, and they are now adding two new ones. but IMO they dont need additional ones, just use the ones they have after 6pm - which is the cut off point for operations in the louth. unreal.
 
Cuchulainn, sorry about your wife and hope she's ok again.
Could it be that the problem is that the GP service isn't part of a Primary Care Strategy, and so where they locate and the hours they work and whether they have out-of-hours cover is up to each individual GP? The HSE attempt to run a GP Health Centre was a total fiasco - we all know about the €million centre built in Ballymun and never opened or used. And I was reading in the Irish Times yesterday that there is a shortage of GPs on Dublin's Northside.
 
thanks Gordanus. Pleurisy, short of breath etc. ok now. the doctors in dundalk run their own 'cover' and ( I assuse pay rent on) a room attached to the Louth Hospital at the rear ( near the Mortuary, would you believe?) and when I enquired off a local chemist on the Sunday morning she informed me where it was and that she would remain open untip 1pm to dispense any prescription. had a looksee and it was closed. then mrs cu rang her gp and got the answering machine directing her to ...... this surgery. when she tried again around 2pm she got an answer and he informed her that he would be there until 3 or something like that. anyway all's well but I wouldn't like to be really sick.
 
It must be a uniquely Irish system where people (well PAYE) are forced to pay 2% of their earnings into a public health system but said system is so patchy that it is practically a must that the same people pay private health insurance. Then the private health insurance companies buy up beds in public hospitals, and, because there aren't enough beds left in the public system for public patents the NTPF then uses tax payers money to buy up beds in private hospitals for those public patients. The whole thing is a bit of a fubar.
 
My ex - who is a top class nurse and like so many of them - really dedicated to their profession and their patients - could tell me some horror stories about the crazy way the service is managed - from the lunatic rostering hours ,the fact that temps got paid far more than a staff nurse who has paid for her own education - crazy -
Nothing unusual about short-term contract staff getting higher pay than permanent staff, to compensate them for the lack of security, sick-pay, holiday pay etc. This is common in many professions and businesses.
 
Nothing unusual about short-term contract staff getting higher pay than permanent staff, to compensate them for the lack of security, sick-pay, holiday pay etc. This is common in many professions and businesses.
And the hospitals are effectively paying a premium to those who are willing to work in a more flexible labour market. The unions guard the job for life system that they love so the employer (in this case the hospital) has to pay a premium to allow it to plan for fluctuations in demand. As we all know labour market inflexibility is a major contributor to inefficiency. I’m not saying it is any better in any other country; I’m saying it should be better here.
 
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are forced to pay 2% of their earnings into a public health system

Not true - Firtstly, the real cost is much higher and, secondly, the 2% Health levy has nothing to do with health - the money goes into the state's tax coffers, just like income tax
 
And the hospitals are effectively paying a premium to those who are willing to work in a more flexible labour market. The unions guard the job for life system that they love so the employer (in this case the hospital) has to pay a premium to allow it to plan for fluctuations in demand. As we all know labour market inflexibility is a major contributor to inefficiency. I’m not saying it is any better in any other country; I’m saying it should be better here.

It's nothing to do with unions or flexibility. The same basic principles (i.e. the shorter the contract, the higher the daily rate) is endemic in the non-unionised IT business.
 
The health service consists of much more than just the Hospitals

For example there are several legions employed in Care in The Community.

If it were not for them there would be much greater demand on hospital and nursing home beds.
 
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