Why is the cost of most things so high in Ireland?

[arbitron]

Have a look at this 2012 article from National Consumer Agency on solicitor fees: https://www.rte.ie/news/money/consumer/2012/0224/291714-solicitors-fees-vary-500-survey-shows/

There is a huge variation in costs, e.g. wills ranged from free to €300, probate from €950 to €6,150...

So maybe the main problem is transparency. If we could all see what professionals (solicitors, GPs, consultants, etc.) charged and make direct comparisons then that would theoretically drive prices down.

 

[arbitron]

So why wouldn't you just go to the USA today if it's such a better deal, sounds like you are going to go? Seems like it would not be possible to incentivise it more...

It could be 5 years in public hospital or 10 years working in the state (public or private), each year worked in Ireland takes 10% or 20% off the balance.

I wouldn't single out medical students per se, but anyone whose training has cost the state > €100,000 and there is a shortage of qualified people in that area should have some sort of clawback.

That doesn't make sense. If you force me to stay here for 5-10 years, I would rather go to USA/Oz for 4-8 years, pay off my debts, have a fun experience abroad/travelling, then come back as a free agent. It isn't just about the money, the work/life balance is often much better abroad. If you look at the data, this is happening anyway, more young doctors than ever are going abroad, and unfortunately they are not coming home like they used to. So if we add the mandatory service into the mix they are hardly going to want to stay.

A lot of people are staying for family reasons. Is that what we want? Should we not want people to stay because the system is fantastic and they want to work in world-class institutions? I prefer incentives to penalties.

You would just have to make everyone take out student loans. Commodifying education is a dangerous road to go down.

 

[cremeegg]

Just looking at energy costs …

My electric usage is low but when standing charges, levies and taxes are added it makes a considerable difference.

For instance, on one bill the charge for usage was €49.66, when the above are added it became €99.71 or an additional 50%.

In another bill the charge for usage was €15.11, which became €63.11 or an additional 76% after add-ons.

Not too hot on the maths there.

 

[cremeegg]

Well it seems contradictory to environmental principles that the less energy one uses, the greater the percentage of additional charges.

the green lobby don't care as long as it means more for them. Sorry to be so cynical but the greens are a new movement, that fact that they are so encrusted with special interests is depressing.

 

[cremeegg]

The simple reason why everything costs so much is because we can afford and are willing to pay.

 

[Firefly]

the green lobby don't care as long as it means more for them. Sorry to be so cynical but the greens are a new movement, that fact that they are so encrusted with special interests is depressing.

That's why they are referred to as Water Melons - green on the outside but red on the inside...

 

[Sophrosyne]

Not too hot on the maths there.

Perhaps I did not phrase this properly.

In the first bill (€99.71) my electric usage (€49.66) represented 50.05% of the bill, the remaining 50.20% (€50.05) referred to add-ons

In the second bill (€63.11) my electric usage (€15.11) represented 23.94% of the bill, the remaining 76.06% (€48) referred to add-ons.

 

[Sophrosyne]

To me the cost of living relates manly to the cost of:

· Utilities – Gas, electricity, waste, TV & phone package

· Groceries – food & household cleaning

· Insurance – Life, Health, House

· Transportation

· Clothing

· Hair

· Health – GP visits, prescription medicines

· House & garden maintenance – new goods, repairs replacements, labour & materials

· Entertainment – Radio, TV, dining out, cinemas, theatres, books, etc


If my children were still young I would add:


· Education & childcare


If I still had a mortgage I would add mortgage costs or for some it would be rental costs.

 

[Purple]

If you don't believe the unions, have a read of a recent paper from Irish medical schools: https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-015-0003-9

Doctors emigrate because they are paid better abroad, have better working conditions, and are treated better. The same for nurses. If you ask them to pay back fees, you will just be encouraging them go to Aus or NZ or USA or Canada where they will finish their training more quickly and be better paid at the end of it.

According to your link the reasons they were contemplating emigrating were "career opportunities (85%), working conditions (83%), and lifestyle (80%)."
GP's in the UK earn between £55,000 and £80,000. That's according to the NHS website.
According to the Competition Authority "fourth training years in GP practices, trainees' salaries are pegged to hospital registrar pay rates and continue to be paid by the HSE. With allowances, these pay rates can vary from €71,900 to €82,400."
According to the same report "The Competition Authority report also shows that GPs in Ireland earn an average of €220,000 a year from treating medical card patients." [broken link removed]

The reality is that Doctors and Nurses and other health service employees, be they "professionals" or just mere mortals, are as much part of the problem as anyone else. Instead of trying to fix the dysfunctional system they just look for more money to work in it.
Now if they can just stop telling lies about what they get paid and also get the Consultants who spent a decade and a half obstructing reforms which would improve patient care and earn hundreds of thousands a year crying crocodile tears about waiting lists and a lack of resources.

 

[arbitron]

According to your link the reasons they were contemplating emigrating were "career opportunities (85%), working conditions (83%), and lifestyle (80%)."

That just highlights the fact that the Irish system is considered to have poorer working conditions, poorer career opportunities, and poorer lifestyle. Would you not emigrate for those things?

GP's in the UK earn between £55,000 and £80,000. That's according to the NHS website.
According to the Competition Authority "fourth training years in GP practices, trainees' salaries are pegged to hospital registrar pay rates and continue to be paid by the HSE. With allowances, these pay rates can vary from €71,900 to €82,400."
According to the same report "The Competition Authority report also shows that GPs in Ireland earn an average of €220,000 a year from treating medical card patients." [broken link removed]

You have said twice now that doctors or the unions are lying about pay, but you haven't provided any proof.

HSE payscales are publicly available here: http://www.hse.ie/eng/staff/benefitsservices/pay/Consolidated-Payscales-1st-April-2017.pdf

The numbers you quoted are from 2009. There have been several changes in the payscale since. The current pay for GP registrars is: €61,404 - €65,920, including allowances. It was even lower until this year. So in fact trainees have taken a €10,000 - €20,000 pay cut, which undermines your argument completely.

HSE salaries dipped down after the crash (not forgetting loss of training grants and other allowances that were not on the payscale and are now gone) but are now going up again. HSE trainee doctors range from €32,938 to €77,283. But the actual workforce is a pyramid, with the majority of doctors on the lower end (€32,938 - €45,224), a minority on the middle scale (€51,578 - €67,993) and virtually none on the upper scale, as those are legacy posts which were closed to new entrants years ago. Is paying a surgeon with 10 years experience a salary of €68,000 exorbitant? What job do you think would deserve that money?

 

[arbitron]

The reality is that Doctors and Nurses and other health service employees, be they "professionals" or just mere mortals, are as much part of the problem as anyone else. Instead of trying to fix the dysfunctional system they just look for more money to work in it.
Now if they can just stop telling lies about what they get paid and also get the Consultants who spent a decade and a half obstructing reforms which would improve patient care and earn hundreds of thousands a year crying crocodile tears about waiting lists and a lack of resources.

According to your quote from my source above, you can see that doctors are actually looking for better career opportunities, better working conditions, and better lifestyles... which betrays your argument about money?

You quoted UK GP earnings previously, but those are salaried GPs who are bottom of the scale, they are not GP partners who are on around £100,000. In Ireland, GPs are not HSE employees, they are effectively private contractors with small guaranteed income, relying on private patients for the rest. In the UK, they are salaried and receive extra funding to build and maintain their practice building and equipment. The UK are also struggling to recruit GPs, with some areas giving golden handshakes of £20,000+.

If you are comparing like with like, you should look at what GPs make doing either a mix of NHS and private work, or private alone in UK. A friend of mine runs a private GP clinic in London and the mid-level docs earn figures that would make you weep. Have a look at this 2011 article: http://www.telegraph.co.uk/news/hea...s-now-thats-what-I-call-a-healthy-salary.html She tells me it's worse now.

But that's just the UK, other countries are more attractive.

Some anecdotal evidence for illustration:
Oz (friends earning 150-200k), NZ (150k+), Canada (150-300k, one guy got free house and free Land Rover!), USA (150k+) can also be very lucrative, with the added bonus of better weather and better working conditions. Middle East is also draining hospitals of nurses, managers, docs. In the last few years I know 5 fantastic senior nurses who have moved to Qatar and UAE, 3 docs who have moved to UAE, 2 hospital managers who have moved to Saudi/Qatar. They get higher (tax-free) salaries, more time off, better working conditions.

People feel very strongly about this, to the point of talking about duty to fellow countrymen, etc., but people have to be happy in their work. Those of us who stay in or return to Ireland do so for non-work reasons, e.g. ageing parents. People will take a salary cut to work in a great system, but the HSE is not an attractive system.

I agree with you about (a vocal minority of) consultants being obstructive, but that is changing.

So long as senior civil servants, TDs, Senators, and consultants have private health insurance, they will not be affected and this will be slow to change. If they had to give up their access to private healthcare for 10 years, I reckon the system would improve overnight.

 

[Purple]

The numbers you quoted are from 2009. There have been several changes in the payscale since. The current pay for GP registrars is: €61,404 - €65,920, including allowances. It was even lower until this year. So in fact trainees have taken a €10,000 - €20,000 pay cut, which undermines your argument completely.

Okay, so 4th year trainee GP's are getting over €60,000 a year.

Is paying a surgeon with 10 years experience a salary of €68,000 exorbitant? What job do you think would deserve that money?

Are you seriously suggesting that someone who has been a qualified surgeon for 10 years is earning €68,000 or €8000 a year more than a trainee GP? Will ya go on out'a that!

I know a GP working in Ireland with no GMS list who gets paid more from the HSE than here sister who is a NHS GP in Wales.
Irish doctors are very well paid relative to their UK counterparts. The system they work within is dysfunctional. I would suggest that resources should be put into fixing the system rather than paying people more to work in the current one.

 

[Purple]

According to your quote from my source above, you can see that doctors are actually looking for better career opportunities, better working conditions, and better lifestyles... which betrays your argument about money?

This thread is about fees. My point is that doctors are very highly paid. You said that they are emigrating due to low pay. I pointed out that those who are thinking about emigrating are not doing so due to pay.

You quoted UK GP earnings previously, but those are salaried GPs who are bottom of the scale, they are not GP partners who are on around £100,000. In Ireland, GPs are not HSE employees, they are effectively private contractors with small guaranteed income, relying on private patients for the rest.

No, the average payment per consultation for GMS patients is higher than the average payment for private patients when all of the hidden payments that GMS dostors get are taken into account. The figure of €220,000 I quoted is for GMS payments only. Income from private patients is in addition to that.

If you have a large GMS list you get your practice nurse paid for by the State, you get your practice manager paid for by the State, you get a pension which is in effect the same as a Public Servant, you get grants for improvements to your business such as new equipment, IT infrastructure etc.
You can use all of those resources, for which the State has paid, for your private patients as well.
GP's don't even do out of hours house calls any more; if you call a GP to come to your house at 8pm because your elderly mother has a throat infection you could wait for 2 or three hours only to get a proctologist to your door.

 

[arbitron]

Okay, so 4th year trainee GP's are getting over €60,000 a year.

In fact both 3rd and 4th years are paid more than 60k, which is 10-20k lower than the figures you quoted. If you think that's too high, that's your opinion. GP is a difficult job and they are struggling to get good candidates to take up training. This year they could not fill all places. That suggests that what they are offering is not attractive. How would you calculate their worth?

Are you seriously suggesting that someone who has been a qualified surgeon for 10 years is earning €68,000 or €8000 a year more than a trainee GP? Will ya go on out'a that!

You are getting confused between consultants and registrars. If you look at the HSE payscale, you will see that a registrar who is 10 years into training earns less than 70k. They do entire surgical lists independently, with consultant supervision as required.

I know a GP working in Ireland with no GMS list who gets paid more from the HSE than here sister who is a NHS GP in Wales.
Irish doctors are very well paid relative to their UK counterparts. The system they work within is dysfunctional. I would suggest that resources should be put into fixing the system rather than paying people more to work in the current one.

Exactly, if they have no GMS list then they are fully private and not salaried, so why are you comparing 1 private GP in Ireland with 1 public GP in Wales?

You keep saying Irish doctors are very well paid, but what is that based on? There are 7,000 trainess in Ireland alone across 57 different specialties - do you think each one is well paid? I would like to see real data.

 

[arbitron]

This thread is about fees. My point is that doctors are very highly paid. You said that they are emigrating due to low pay. I pointed out that those who are thinking about emigrating are not doing so due to pay.

No, your quote only shows that pay is not the only issue. It is part of the problem. Regardless of the reasons for doctors leaving, the fact is they are leaving and posts can't be filled, which then pushes up costs.

No, the average payment per consultation for GMS patients is higher than the average payment for private patients when all of the hidden payments that GMS dostors get are taken into account.

What is the source for that?

GP's don't even do out of hours house calls any more; if you call a GP to come to your house at 8pm because your elderly mother has a throat infection you could wait for 2 or three hours only to get a proctologist to your door.

Is there any evidence for any of this? It sounds like opinion. You are claiming no GPs do out of hours - can you link to this? And how does it relate to fees in Ireland?

 

[Purple]

What is the source for that?

There. The average payment to GMS doctors per patient visit was €65. The report also cites the feminisation of GP services and the resulting increase in part time work; female GP's are far more likely to work short hours. Cuts in recent times may have reduced that gap slightly as GP's "just happen" to increase their fees for private patients in order to maintain their income.

Is there any evidence for any of this? It sounds like opinion. You are claiming no GPs do out of hours - can you link to this?

You don't even have to be a qualified GP to work as a GP! You do need to be qualified to get a GMS list. Any qualified doctor can work for an out of hours GP service.

 

[Purple]

No, your quote only shows that pay is not the only issue. It is part of the problem. Regardless of the reasons for doctors leaving, the fact is they are leaving and posts can't be filled, which then pushes up costs.

I was quoting your source. It shows that over 80% of doctors who were thinking about leaving (lost think about it, very few do it) money wasn't an issue.
The fact that they are leaving is not the reason posts can't be filled. Posts can't be filled because so many doctors can make a great living working part time so two GP's are doing one job and because of the dysfunctional system they helped to create and help to maintain.
Why not fix the problem instead of permanently treating the symptoms?

 

[Purple]

Exactly, if they have no GMS list then they are fully private and not salaried, so why are you comparing 1 private GP in Ireland with 1 public GP in Wales?

No, the GP's who do not have a GMS list still get a very large amount of their income from the HSE. In the case I know personally the income from the HSE for the Irish GP with no GMS list was higher than the total income of the UK based GP. I can't say that's universally true.

You keep saying Irish doctors are very well paid, but what is that based on? There are 7,000 trainess in Ireland alone across 57 different specialties - do you think each one is well paid? I would like to see real data.

 

[arbitron]

There. The average payment to GMS doctors per patient visit was €65. The report also cites the feminisation of GP services and the resulting increase in part time work; female GP's are far more likely to work short hours. Cuts in recent times may have reduced that gap slightly as GP's "just happen" to increase their fees for private patients in order to maintain their income.

You don't even have to be a qualified GP to work as a GP! You do need to be qualified to get a GMS list. Any qualified doctor can work for an out of hours GP service.

That report is from 2010, and the data is 2008. Almost 10 years ago. Since then there have been FEMPI cuts (2009 onwards), including a significant decrease in GP and pharmacy fees, as well as decreased weighting for seeing patients over 70 (who tend to need more time and resources). So the figures you are quoting are out of date and out of context. There is also no detail there, just 1 mention of an average, no breakdown. Do you have anything up to date and relevant?

I don't know what point you are trying to make re: out of hours care. Again, have you any source that says qualified GPs are no longer doing out of hours cover? And how does that affect fees? Surely if any doctor can do it, it would decrease cost through competition?

I was quoting your source. It shows that over 80% of doctors who were thinking about leaving (lost think about it, very few do it) money wasn't an issue.
The fact that they are leaving is not the reason posts can't be filled. Posts can't be filled because so many doctors can make a great living working part time so two GP's are doing one job and because of the dysfunctional system they helped to create and help to maintain.

Indeed you were quoting my source, that wasn't the problem, the issue is your misreading of it. If you read the full paper, 65% state that pay is a factor.

You say very few emigrate but the recent RCSI report highlights it as an issue and states that emigration is rising among doctors aged 25-34.

You say that posts can't be filled because people are going part time. If it's a great and well paid job that everyone should want, why were they unable to recruit enough trainees to start the scheme this year?

No, the GP's who do not have a GMS list still get a very large amount of their income from the HSE. In the case I know personally the income from the HSE for the Irish GP with no GMS list was higher than the total income of the UK based GP. I can't say that's universally true.

How are they getting that income from the HSE? Can you give specifics?

Why not fix the problem instead of permanently treating the symptoms?

What is the solution?

 

[Purple]

That report is from 2010, and the data is 2008. Almost 10 years ago. Since then there have been FEMPI cuts (2009 onwards), including a significant decrease in GP and pharmacy fees, as well as decreased weighting for seeing patients over 70 (who tend to need more time and resources). So the figures you are quoting are out of date and out of context. There is also no detail there, just 1 mention of an average, no breakdown. Do you have anything up to date and relevant?

Are you suggesting that their income has dropped to a level at which they are now below the incomes of their UK counterparts? The FEMPI cuts to GP's were an average of 7.5% and yet the NAGP come out with "cuts up to 38%". At best that's a misrepresentation of the facts, or a lie as us plebs call it.

I don't know what point you are trying to make re: out of hours care. Again, have you any source that says qualified GPs are no longer doing out of hours cover? And how does that affect fees? Surely if any doctor can do it, it would decrease cost through competition?

My point is that GP's, along with Hospital Consultants, want it both ways; lavish pay but outsource the heavy lifting to someone else.

Indeed you were quoting my source, that wasn't the problem, the issue is your misreading of it. If you read the full paper, 65% state that pay is a factor.

Yes, but not a main factor. You do know the difference between thinking about something and actually doing it? I often think about losing weight, training to run 10k or taking up karate again. I don't do it though.

You say very few emigrate but the recent RCSI report highlights it as an issue and states that emigration is rising among doctors aged 25-34.

Yes, but they include the non-Irish doctors who trained here but never intended to stay here. I can't find figures on what percentage of students in TCD, RCSI, UCD etc are foreign but my experience 20 years ago was that in TCD the class was over one third foreign students who were never going to stay here. When the RCSI present the emigration figures without that caveat they are at best misrepresenting of the facts, or lying as us plebs call it.

You say that posts can't be filled because people are going part time. If it's a great and well paid job that everyone should want, why were they unable to recruit enough trainees to start the scheme this year?

Because of the dysfunctional nature of the medical industry.

How are they getting that income from the HSE? Can you give specifics?

Smear tests, Prenatal examinations, vaccines, postnatal examinations and all the other schemes that the HSE pays for which are delivered through GP's.

What is the solution?

There is no big answer; there are thousands of small answers. It would be great to see Doctors unions and Nurses unions (sorry, Professional bodies) offering solutions that don't center around their own pay or taking more money from the public to try to fill the bottomless pit..