Why does nobody disagree with the Fiscal Council's report?

[NoRegretsCoyote]

That chart only shows life expectancy and mortality from heart disease, outcomes of interaction with health services goes further than that.

@Purple made a specific claim that Irish health outcomes were worst in the OECD.

This is not true.

Even the value for money claim is not obvious. Ireland has a bigger alcohol abuse problem than most countries. There is very little that health spending can do to prevent it. It also works the other way by pushing up spending as people with chronic alcohol problems need a lot of expensive treatment.

 

[Leo]

@Purple made a specific claim that Irish health outcomes were worst in the OECD.

I wasn't responding to Purple's point, just your assertion that the chart somehow confirmed 'Ireland does not have the worst health outcomes in the OECD'.

 

[NoRegretsCoyote]

I wasn't responding to Purple's point, just your assertion that the chart somehow confirmed 'Ireland does not have the worst health outcomes in the OECD'.

Would you like to point to other consistent, international measures of health outcomes that would better make your case?

 

[odyssey06]

Would you like to point to other consistent, international measures of health outcomes that would better make your case?

Ireland has the worst hospital waiting lists in Europe, according to a damning new index.
Ireland scores high for giving people subsidies for drugs, and it is among the best countries now for low rates of MRSA, as well as good infant vaccination rates.
Overall, the healthcare system here ranks 22nd out of 35 countries.
The European Health Consumer Index 2018 also puts Ireland bottom of the league for "bang for your buck", which measures value for money invested in the service.

Waiting lists here are the 'worst in all of Europe'

Ireland has the worst hospital waiting lists in Europe, according to a damning new index.

www.independent.ie

 

[Purple]

We really should be running a 3-5bn annual fiscal surplus, given GDP and employment levels / growth rates.

Yet no politician calls for this, do they?

No, politics is about bribing people with their own money (or their neighbours money).
There is no serious attempt at organisational excellence and value for money in the vast majority of the State funded sector, just the usual populist nonsense. The best example of this is when a hospital runs out of money it doesn't attempt to cut costs, it just cuts services to the public. Pathetic.
When a new drug that costs tens of thousands a week comes on the market all it takes is the usual emotive populist fluff piece that passes for news on RTE for the Minister for Health or some other gombeen to insist that it is provided. The conversation should be "we will need to cut X, Y or Z in order to provide this. Is that what people want?"

 

[Leo]

Would you like to point to other consistent, international measures of health outcomes that would better make your case?

My case that the table doesn't support your case? I'm not sure that's monitored internationally.

To measure the outcome of health spending, you need to gather data on those the health service has interacted with and the effectiveness of treatments provided. Longevity is more influenced by wealth, and so is a poor indicator of the value for money in health spending.

 

[NoRegretsCoyote]

To measure the outcome of health spending, you need to gather data on those the health service has interacted with and the effectiveness of treatments provided. Longevity is more influenced by wealth, and so is a poor indicator of the value for money in health spending.

Of course.

Your previous point seemed to confuse measures of efficiency (ratio of outputs to inputs) to outcomes.

The chain of causality runs both ways of course. As people get richer they demand more expensive treatments too.



Ireland may well have a very inefficient health service in the OECD when you look at the outputs given the inputs. But it does not have the worst health outcomes by any means.

 

[Purple]

Ireland may well have a very inefficient health service in the OECD when you look at the outputs given the inputs.

Thanks, that's the point I was making. This thread is about the Fiscal Council Report and why everyone agrees with it but no government spending is framed with the report in mind.
The usual nonsense that we need to increase taxes to provide better or more services (meaning increase marginal taxes on high earners) is trotted out by well meaning but economically illiterate commentators like Fergus Finlay but the reality is that if we just hit average OECD figures for value for money we would not have people dying on trolleys in Hospitals.
The reason children with special needs and sick old people don't get the services they need is mainly the fault of the people working within the organisations providing the services.

 

[WolfeTone]

The reason children with special needs and sick old people don't get the services they need is mainly the fault of the people working within the organisations providing the services.

I don't doubt that there is wide scope for improved efficiencies, but where does this fit with reducing national debt?
It is possible to improve efficiencies without necessarily saving money. All that may happen is that waiting lists are reduced - which is a good thing, but that does not necessarily transfer into cost savings. It just means we get bang for our buck.

 

[Purple]

I don't doubt that there is wide scope for improved efficiencies, but where does this fit with reducing national debt?
It is possible to improve efficiencies without necessarily saving money. All that may happen is that waiting lists are reduced - which is a good thing, but that does not necessarily transfer into cost savings. It just means we get bang for our buck.

There is massive pressure on the exchequer every year to keep pumping money into the leaky bucket that is our Public Services. The potential savings run into the billions. The money saved, or the future not spent, could be used to reduce our debt.

 

[WolfeTone]

There is massive pressure on the exchequer every year to keep pumping money into the leaky bucket that is our Public Services. The potential savings run into the billions. The money saved, or the future not spent, could be used to reduce our debt.

Yes, but where do you make those savings? Do you cut jobs? - its possible, but in an inefficient system, that wont make a difference to waiting lists, people on trolleys, or child healthcare. Invariably it will add to the inefficiencies, increase waiting lists, etc
Will it reduce national debt? Maybe, maybe not.
So the question is, how do you reduce national debt, as distinct from getting more and better services out of what is already paid?

 

[Leo]

Your previous point seemed to confuse measures of efficiency (ratio of outputs to inputs) to outcomes.

Which post are you referring to there?

In health spending terms, what ratio of outputs to inputs do you mean? A ratio is the relationship between two numbers.

 

[NoRegretsCoyote]

Which post are you referring to there?

This one.

In health spending terms, what ratio of outputs to inputs do you mean? A ratio is the relationship between two numbers.

Measure such as treatments delivered per €1000 of spending.


It is easy to confuse the outputs of the health service with overall health outcomes.


When it comes to health outcomes, life expectancy for men in Lithuania is low, partially because a staggering one man in 25 dies by suicide. This is a societal phenomenon, and there is not much that more doctors and nurses can do about it.

 

[Leo]

This one.

I said 'outcomes of interaction with health services goes further than that.' Can you point out where that statement mentions efficiency?

Measure such as treatments delivered per €1000 of spending.

OK, but to be clear, a measure of how many X you get for € is not a ratio.

It is easy to confuse the outputs of the health service with overall health outcomes.

That was my point alright: 'That chart only shows life expectancy and mortality from heart disease, outcomes of interaction with health services goes further than that. '

 

[Purple]

I find that pretty bizarre, and insulting, but that is your prerogative to be so if you wish.
The discussion will hopefully continue on topic now.

You are taking lines out of context and misrepresenting what I'm saying, thereby taking the thread further off topic.
The comment you quoted was from a post about what can happen if the system is made more productive. You presented it as if I'm suggesting cuts without improving processes and then asked me questions based on your false premise.

How else should I take your comments?

 

[Protocol]

One of the reasons for the problems in the h/c system is that the price levels are so high.

The price level of hospital services is 181% of the EU average in 2011.

So even though we spend a lot, we get less, as the price level is so high.

See here:

Comparing Hospital and Health Prices and Volumes Internationally

Health services account for a large and increasing share of production and expenditure in OECD and Eurostat countries but there are also noticeable differences between countries in expenditure per capita. Whether such differences are due to more...

www.oecd-ilibrary.org

 

[WolfeTone]

The comment you quoted was from a post about what can happen if the system is made more productive.

I don't think anyone disagrees with what can happen if any system is made more productive.
My point was that in making the system more productive and efficient does not always and necessarily transfer into cost savings. In the private sector it may just mean increased revenues, in the public sector it could just be better delivery of services.

It is of course possible that new processes, training, technology etc can result in cost savings in the round but in general terms they typically require investment (more spending) before the fruits of those efficiencies are borne.
In the end, decisions have to be made as to what measures are taken to spend public money.
As can be seen above, and from this topics sister thread about specific cuts and savings, there is a variance of opinion on what measures should be taken.

My point is that nobody disagrees with the Fiscal Advisory Council because fundamentally what they are saying makes sense.
But the FAC has no remit, and is therefore effectively redundant on what specific measures should be taken in order to adhere to its advice.

Eg - The FAC advises
"For 2019, the Government should stick to its existing plans as contained in SPU 2019. This means that no additional within-year increases should be introduced without offsetting measures."

Yesterday however, the government announced a €10m package for the Defense forces. I saw no mention of offsetting this cost. The government is not adhering to the FAC advice.
Does the FAC have advice on how or where this cost should be offset? No it doesn't.
So should Defence forces have to make do with incomes that place its members on FIS? Or should their incomes be increased with this €10m package? If so, where should the offset occur?
I'm not asking you to answer these questions, just emphasizing the inadequacies of the FAC relative to the political issues facing the (every) government.
In turn, to me, the FAC is a waste of resources because it offers nothing that is not already inherently understood. That it is not inherently adhered to is a consequence of political considerations far beyond its remit.

 

[Purple]

I don't think anyone disagrees with what can happen if any system is made more productive.
My point was that in making the system more productive and efficient does not always and necessarily transfer into cost savings. In the private sector it may just mean increased revenues, in the public sector it could just be better delivery of services.

In the Public it could mean the delivery of the same services at a lower cost or, more likely, the delivery of the same services faster and therefore at a lower cost.

It is of course possible that new processes, training, technology etc can result in cost savings in the round but in general terms they typically require investment (more spending) before the fruits of those efficiencies are borne.

When it comes to LEAN and the process improvements that deliver the biggest results, the low hanging fruit, it usually costs very little. Changing inefficient structures and removing layers of bureaucracy requires very little investment relative to the savings. It usually means people just taking responsibility for their own actions.

In turn, to me, the FAC is a waste of resources because it offers nothing that is not already inherently understood. That it is not inherently adhered to is a consequence of political considerations far beyond its remit.

When I listen to the populist tripe spouted by Trade Unions, most of the Independent Alliance, the Shinners and many in FF it is far from a given that the message being given by the FAC is inherently understood. I know opposition politicians are populist until they are in power and have to deal with reality but in economic matters when ideology trumps reality it is very dangerous.

 

[WolfeTone]

When I listen to the populist tripe spouted by Trade Unions, most of the Independent Alliance, the Shinners and many in FF it is far from a given that the message being given by the FAC is inherently understood.

But it is FG in power for last 6,7yrs? They are the ones making decisions....they are the ones 'not adhering' to FAC advice? They are the ones who sanctioned a €10m pay package for Defence Forces without any notably offsetting of that cost elsewhere.
So basically, across the whole political spectrum there is nobody representing the values of fiscal prudence as advised by the FAC. Would that have something to do with the remit of the FAC being wholly inadequate to appropriate effective and practical advice on fiscal matters? I would think it does.
Abolish it.

 

[Purple]

So basically, across the whole political spectrum there is nobody representing the values of fiscal prudence as advised by the FAC.

Ah there is. Pascal in trying to keep the lid on things and, taking everything into account, is doing a good job.