Savings that aren't savings

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Purple

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When the government says that it is saving X amount by reducing medical card availability, decreasing the tax allowance on medical insurance etc it is not being truthful. What they are really doing is transferring the cost directly onto the tax payer/ service consumer. This is not a saving.
Saving money involves not providing a service or providing the same service more efficiently. In the cases above the same services will be provided by the same people and consumed by the same people. The only difference is that the consumers will be paying for them directly even though they are paying the same taxes.
 
Hi Purple

It is clearly understood that the Minister is referring to savings in public expenditure.

If they stop providing medical cards to some people, he will be making savings in public expenditure.

By the way, he will be making genuine savings as well, as people who have to pay for their visits to doctors make far fewer visits to the doctor.

Brendan
 
Hi Bronte

That is what doctors have told me. Although it is anecdotal, it stands to reason. When people get something for free they tend to consume a lot more of it.

Part of the argument for retaining medical cards is that people will make fewer visits if they can't afford them and therefore their health will suffer.

I am not sure if there are any statistics on it.

Brendan
 
Brendan Burgess said:
Hi Bronte

That is what doctors have told me. Although it is anecdotal, it stands to reason. When people get something for free they tend to consume a lot more of it.


Brendan
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I agree with this. When my father got the free medical card when they were issued to the over 70's a few years ago I'd say he went to the doctor 3 times a week. He had hypochondria to a certain extent and was obsessed with high blood pressure so he would call in to have it checked anytime he was going past the surgery. And he would tell us how he met half the road in there as well - all his age group and again people who would never have had a medical card before. He was very well off but would balk at paying to see the gp so prior to getting the card he would have gone once a month at most...
 
Brendan Burgess said:
Hi Purple

It is clearly understood that the Minister is referring to savings in public expenditure.

If they stop providing medical cards to some people, he will be making savings in public expenditure.

By the way, he will be making genuine savings as well, as people who have to pay for their visits to doctors make far fewer visits to the doctor.

Brendan
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He won't make any savings if GP waiting rooms are clogged up with every under 5 in the country with a runny nose.
 
Purple said:
He won't make any savings if GP waiting rooms are clogged up with every under 5 in the country with a runny nose.
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Agree fully.

But the key point is that limiting medical cards is a real saving for the exchequer and for everyone.

Extending them is an increase in expenditure for the exchequer and an overall increase for Society.
 
Brendan Burgess said:
But the key point is that limiting medical cards is a real saving for the exchequer and for everyone.

Extending them is an increase in expenditure for the exchequer and an overall increase for Society.
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So how come he's extended them to all 5 year olds and under, and seemingly taken them off those who really need them?
 
Bronte said:
So how come he's extended them to all 5 year olds and under, and seemingly taken them off those who really need them?
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Taking medical cards from well off over 70's is a good idea. Giving them to all under 5's is a really bad idea.
 
Purple said:
Taking medical cards from well off over 70's is a good idea. Giving them to all under 5's is a really bad idea.
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I agree. But it still makes no sense to me. Particularly the bit about taking it off people who need it, not the wealthy over 70's though. There was a horrific case in the Sunday Independant yesterday by Brendan O' Connor.

How many under 5's are there in the country. How many over 70's will lose their cards?
 
Bronte said:
I agree. But it still makes no sense to me. Particularly the bit about taking it off people who need it, not the wealthy over 70's though. There was a horrific case in the Sunday Independant yesterday by Brendan O' Connor.

How many under 5's are there in the country. How many over 70's will lose their cards?
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I agree, and to add to that; how is the Medical Card section of the HSE or Department of Health going to process 120'000 applications for under 5's as well as all the letters from over 70's and discretionary card holders that are now losing their cards?
What will that cost?
Why has a universal benefit been introduced before all those with chronic illnesses have been looked after or even properly assessed?
 
Brendan Burgess said:
Agree fully.

But the key point is that limiting medical cards is a real saving for the exchequer and for everyone.

Extending them is an increase in expenditure for the exchequer and an overall increase for Society.
Click to expand...

That argument not as straightforward as it seems. I understand there's plenty of evidence to say that if people delay getting medical attention (which they will do if they feel they can't afford to), when they eventually do get round to it, the cost of treatment is a lot higher. Early diagnosis and treatment is generally a lot cheaper.

See the following, for example:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742317/
 
I think this has more to do with assessment and administrative costs than medical need.

Individualised assessment is extremely costly. Which is simpler - seeking proof of age or carrying out a full assessment of medical need and another of income?

Somebody somewhere will have worked out the proportion of successful claims for medical cards under or over a certain age and weighed this against assessment, administration and average health costs.

For example, let’s say the proportion of successful claims within a certain age group was 80%, the logic would probably be to save administration and take a hit on the remaining 20%.

This is only my opinion, and I am certainly not condoning it, but I cannot see any other logical reason for universality based on age. It is just a blunt instrument.

The Minister seems to be tinkering around with universality. Replace one age group with another, and don’t think beyond that. When questioned, waffle and spin your way out of it.
 
Brendan Burgess said:
By the way, he will be making genuine savings as well, as people who have to pay for their visits to doctors make far fewer visits to the doctor.

Brendan
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That is true

[broken link removed]

If people are feeling unwell and delay going to the doctor because of cost, they may be putting themselves at risk as the early signs of cancers or other more serious diseases may be missed and then the patient would be subjected to much more intensive hospital treatments.
 
ang1170 said:
That argument not as straightforward as it seems. I understand there's plenty of evidence to say that if people delay getting medical attention (which they will do if they feel they can't afford to), when they eventually do get round to it, the cost of treatment is a lot higher. Early diagnosis and treatment is generally a lot cheaper.

See the following, for example:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742317/
Click to expand...

The solution to that is to make the cost of accessing medical care cheaper. The solution is not to pay for it through taxation.
The cost of medical care in Ireland is vastly higher than the cost in the UK. Even taking into account that doctors and nurses in Ireland are very well paid (by OECD standards) the cost is still much higher than it is there.
Why is the solution to inefficiency to spend more money rather than look at root causes?
 
cashier said:
That is true

[broken link removed]
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And so they should. But that does not mean their medical needs are not been treated. Patients with minor ailments should go initially to their pharmacist who can easily dispense treatment for minor ailments. For example, I can choose to pay €60 euro at my doctors for the winter flu jab or I can get it from my local pharmacy for €15. Of course if you have a medical card all things being equal you will to to the docs because it’s free. So doctors’ surgeries get filled up with patients who can be treated less expensively elsewhere but won’t as the treatment is delivered at no cost to them. Rather than having medical treatment free at point of delivery the government should charge all medical card patients say €30 a visit to the doctors. This would separate out those with non minor ailments who would pay the €30 and those with minor ailments who would go the the pharmacy as first point of call and those without any medical problems but who just visit the doctor for a chat/ re-assurance etc. because the visit is free. €30 a visit isn’t too much to ask seeing as we have some of the highest rates of social welfare and old age pensions in Europe and you could set the amount depending on the elasticity of demand for doctors’ services. You don’t need to get into a big debate on who should or should not have medical cards, and the associated administrative costs of policing this, but just introduce pricing structures that force those who abuse or misuse the system to contribute to the costs they are imposing on others.
 
The main issue here is the the whole health system in Ireland is dysfunctional. What is happening currently is that various attempts are being made to patch up a system that needs "major surgery". various Ministers of health have tried and failed to implement reform to the HSE and the health system. The result of the patches are that many genuinly really ill people are being affected by the application of Political solutions to a system that is no longer effective for purpose. There is little point in complaining only about the proposed amendments when the whole system is broken. It would appear that no Party or Minister has the capacity to implement the changes required to get this system working. This is no Country for "ill men" or "ill women"!!
 
Dysfunctional is a tame word to describe what goes on. I won’t go into the details, but last week I had to accompany my elderly father on an odyssey into the health service. He was referred to a hospital to get some tests, that could easily be provided by GPs, but they are very badly equipped to do this. Hence, he joins dozens of people trying to access expensive hospital based services. We ended up in one of the private hospitals, where he was seen (once he’d paid of course). They were somewhat surprised he didn’t check in for the night: it turns out the VHI pay fully for overnight stays, but very little for attendance at the emergency department. They all but encouraged him to do this, despite it not being medically required. And people wonder why health insurance premiums are so high?

Meanwhile, people in real need are faced with cutbacks, because the cash has run out.

To be fair to the current minister, he has started more structural reform by building primary care centres and services, but I suspect it’s somewhat a Sisyphean task he’s faced with….
 
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