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.
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?Be careful Purple - you are beginning to sound like one of those pompous, arrogant hospital consultants you all know.
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”.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.
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.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.
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
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.
What have you got against it being run like a business?Health isn't a business - it is a public services. .
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.
What have you got against it being run like a business?
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.
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.
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?
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.
They are privately owned but for all intents and purposes they are publically run (He who pays the piper calls the tune).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?
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.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?
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.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.
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.
They are privately owned but for all intents and purposes they are publically run (He who pays the piper calls the tune).
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.
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.
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.
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