did free uni. fees wreck the health system?

silverharp

You might not see these issues as being linked but I go. Given that free university fees was the big educational idea of the 90’s and that all big programmes have an opportunity cost, the taxpayer should get the most “bang” for their buck. What was achieved by universally free fees that couldn’t have been achieved by expanding the grants system? Why did Labour feel the need to give the families of property developers, lawyers, doctors, and all the other skimmers in society free money. Given that middle age and middle class taxpayers have benefited disproportionaly due to the celtic tiger from lowering tax rates, rising property prices and higher salaries and lowering interest rates why did they need this added incentive for something they would have done in any event. The cost to the university system is that the standard of courses will drop due to under funding and there will be an incentive to focus on chalk and talk courses which are cheaper to run.

The opportunity cost?

To my knowledge we have not been training additional medical staff since the 80’s, this has created artificial inflation in salaries and to my mind you can never fix the health system unless you have a ready pool of skilled people. To my mind the money spent on free fees should have been spend on setting up new medical, dental and other types of medical schools. The phrase “joined up thinking” comes to mind.

Akrasia

The fundamental flaw in this line of reasoning, is that it assumes that the government would spend the money they saved on university fees on the health system and wouldn't just have given it all away in tax cuts or built more roads, or white elephants.

silverharp

I disagree, I could have summed up my point as being that the gov. when looking at 3rd level education should have focused on what graduates the country needs instead of focusing on how it’s paid for. Obviously the 3rd level system isn’t producing the right types of graduates, that issue should have been sorted out first before throwing money at the people, the consequences being to hobble the health service.

Zombrex

The health system is wreaked due to years and years of cronic underfunding and miss management

Its not that we don't have the money, its that the government seems totally incapable of investing the money where it needs to go. Why? I've no idea, they seem to just be complete idiots to something that would seem to have a totally obvious solution. But then I didn't vote for them

civdef

Why did Labour feel the need to give the families of property developers, lawyers, doctors, and all the other skimmers in society free money.

Votes.

cuckoo

silverharp wrote:

The cost to the university system is that the standard of courses will drop due to under funding and there will be an incentive to focus on chalk and talk courses which are cheaper to run.

The current incentive is to focus on science and technology courses, which are more expensive to run than the humanities, but will produce the tech literate grads our economy is considered to need.

silverharp wrote:

To my knowledge we have not been training additional medical staff since the 80’s, this has created artificial inflation in salaries and to my mind you can never fix the health system unless you have a ready pool of skilled people. To my mind the money spent on free fees should have been spend on setting up new medical, dental and other types of medical schools. The phrase “joined up thinking” comes to mind.

We have been training additional medical staff - students from non EU countries who are paying hefty fees to the 3rd level institutions.

bonkey

silverharp wrote:

What was achieved by universally free fees that couldn’t have been achieved by expanding the grants system?

What wasn't achieved in Health Care that could have been achieved by tackling some of the massive inherent inefficiencies within itself?

Our current government has effectively proven at throwing money at Health Care doesn't fix much of anything without tackling the underlying issues which have little if anything to do with funding levels.

DublinWriter

silverharp wrote:

To my knowledge we have not been training additional medical staff since the 80’s, this has created artificial inflation in salaries and to my mind you can never fix the health system unless you have a ready pool of skilled people.

Firstly, you're comparing apples and oranges here, your original argument is deeply flawed.

The Health System overall in this country employs just under 100,000 people in clerical, administrative and managerial duties who do not have any contact with patients at all at all!

A study about this time last year (by The Sunday Business Post I think) put that number of staff as relatively 2.5 times the number of staff that are employed in similar positions in the French Health System, arguably a country with the greatest about of militant unionism and restrictive work practises in Western Union.

Now, in light of what you said about training additional staff, take a deep breath. The number of medical doctors that can graduate in any given year in Ireland was capped at 400 in 1974...*and was never changed since!!!*

This figure of 400 includes a large amount of non-EU students who pay the full non EU-Funded whack in fees and will graduate here and will never practise medicine here.

We are also becoming an aging population. With the drop in people smoking and people generally looking after themselves a lot better, people are living longer, and generally need a lot of care in that all important last 25% of their lives.

However, the real problem is that size counts in Ministerial terms. The size of your department gives you the power you are seen to have. Don't expect *any* Minister, even a pragmatist like Harney to cut any sizable amount of staff from their department.

silverharp

DublinWriter wrote:

Now, in light of what you said about training additional staff, take a deep breath. The number of medical doctors that can graduate in any given year in Ireland was capped at 400 in 1974...*and was never changed since!!!*

This figure of 400 includes a large amount of non-EU students who pay the full non EU-Funded whack in fees and will graduate here and will never practise medicine here.

The point of my post was to highlight how a decision in one area can effect other areas, and your statement sums it up perfectly. there are plenty of things wrong with the health service but if you don't have enoungh front line staff then all the shiney new buildings or how efficient or not won't matter a damn. I'm guessing the budget for new medical schools comes from education and not health so we back to joined up decision making

cuckoo wrote:

The current incentive is to focus on science and technology courses, which are more expensive to run than the humanities, but will produce the tech literate grads our economy is considered to need.

great, however I'm sure I read that some of our medical schools may not be recognised abroad which comes down to funding/quality of the courses, which questions the free fees policy

As we don't live in an ideal world I tend to prefer policies that deliver services that work over and above how fair it is.

Victor

DublinWriter wrote:

The Health System overall in this country employs just under 100,000 people in clerical, administrative and managerial duties who do not have any contact with patients at all at all!

Its 100,000 total, not 100,000 admin.

DublinWriter wrote:

However, the real problem is that size counts in Ministerial terms. The size of your department gives you the power you are seen to have. Don't expect *any* Minister, even a pragmatist like Harney to cut any sizable amount of staff from their department.

The Dept of Health is actually quite small at 1,000-2,000, most of the staff are actually employed by the HSE and the frontline organisations.

The_Minister

DublinWriter wrote:

Now, in light of what you said about training additional staff, take a deep breath. The number of medical doctors that can graduate in any given year in Ireland was capped at 400 in 1974...*and was never changed since!!!*
.

Thats being fixed.

Cork

The health system is wreaked due to years and years of cronic underfunding and miss management

Funding? The government has massively increased the health spend.

Mis-management? Yes.

The service could be made more efficent. We had cases recently of staff at one hospital arriving late to work.

We need a lean and effective health system.

A+E services are also been abused as a defacto doctor service. Drunks turning up at hospitals? Ancahol piosoning?

Consultants with their private practices after being trained by the state.

billy the squid

The last time I filled out a CAO form they asked me for €760. I wouldnt exactly call that free.

Calina

billy the squid wrote:

The last time I filled out a CAO form they asked me for €760. I wouldnt exactly call that free.

Compares very well to £2500 per year which was what I had to pay when I filled out a CAO form.

bonkey

billy the squid wrote:

The last time I filled out a CAO form they asked me for €760. I wouldnt exactly call that free.

I wouldn't exactly call the CAO a university either.

jc

Zombrex

Cork wrote:

Funding? The government has massively increased the health spend.

Increased from "virtually nothing" to "still not nearly enough" is still underfunding. And that has only happened in recent years. The underfunding problems in the Health Service are decades old

bonkey

Wicknight wrote:

Increased from "virtually nothing" to "still not nearly enough" is still underfunding.

Ireland now pay more per capita for their healthcare than anyone in Europe.

Its quite difficult to understand how this is "still not nearly enough". I could understand if a huge amount of the expenditure was going into one-off restructuring / acquisition costs, but it ain't.

The underfunding problems in the Health Service are decades old

The Health Service is no longer underfunded, unless one can show why Ireland is such a unique case that it needs a far higher percentage of GDP pumped into it than other European nations.

To date, the only way this seems possible is to accept that the inefficiencies in the Irish system cannot or should not be solved, and should instead simply be paid for.

jc

bonkey

bonkey wrote:

Its quite difficult to understand how this is "still not nearly enough". I could understand if a huge amount of the expenditure was going into one-off restructuring / acquisition costs, but it ain't.
jc

Bonkey I have a cousin who is a surgeon in a large regional hospital here.
He told me the other day they were ringing people to come in for elective surgery.The first 10 or 12 people on the list couldnt come because they were booked into private hospitals to have the job done or it was already done in a private hospital under the dept of health's treatment purchase scheme.
The thing is, the dept never bothered to tell the public hospital and still dont that the patient has been sorted.
There have been several days when surgeons are sitting around in public hospitals twiddling their thumbs over a simple admin fcuck up like that.

The admin system in Irish hospitals from what I'm told is very fat,extremely ineffecient and burns money.
Yet when lobby groups like patients together call protest meetings, they are hard set to gather up a 100 people to go to them.
In this new Ireland,this new selfish Ireland people care more about whats in their pockets it seems than in the peripheral areas that are classed being quality of life things.
It seems to most at least still the health service is too peripheral to get enough politicians worried about votes.
This is why I think we have Mary Harney promising more tax cuts but not promising to sack the likes of the people who are regularally doing the admin cóck up that I mentioned.

bonkey

Earthman wrote:

Bonkey I have a cousin who is a surgeon in a large regional hospital here.
...
The admin system in Irish hospitals from what I'm told is very fat,extremely ineffecient and burns money.

And I'd bet that if your cousin was in admin, he/she would be telling you how the doctors (or some subset like concultants) are overpaid and are basically milking the system for all that its worth.

I dunno when it was, but I remember someone (probably Victor...its like the type of thing he'd know) posting up that the admin of the various health boards consumes a "massive" 3% of annual expenditure.

I don't pretend to be an expert on the subject. I'm not sure what parts are broken, what parts are badly structured, and what parts are actually ok. I only know that everyone points the finger at someone else, and meanwhile the taxpayer gets shafted in terms of value for money.

Getting back towards the original topic, the point I was making was more that increased expenditure hasn't fixed much, so I don't see the logic in suggesting that had we diverted cash from education to health a few years earlier, things would be much better.

To be honest, I'm more of the opinion that had we done so, our education would be in worse shape than it is now (which is little to be proud of in the first place) and our health-care would be little better off, if at all.

Yes, a lot of our infrastructure (transport, health, whatever) has suffered from chronic longterm underinvestment. It has also suffered from chronic longterm mismanagement, misstructuring etc. Now that we've got money to throw at problems, we're beginning to see a different perspective.

We can finally afford to fix things. However, inherent in that are two points that we seem to be very slow in learning:

1) Money alone won't fix the problem
2) All solutions take time, even the good ones.

As a general rule, when we fail to accept one of these two points, we generally look for a scapegoat.

jc

The_Minister

Earthman wrote:

The admin system in Irish hospitals from what I'm told is very fat,extremely ineffecient and burns money.

Thats what I've heard over and over, but the governments hands are tied. The worst that they can do is whitewall them.

The_Minister

bonkey wrote:

I dunno when it was, but I remember someone (probably Victor...its like the type of thing he'd know) posting up that the admin of the various health boards consumes a "massive" 3% of annual expenditure.

3% is alot but I think its more then that.

bonkey wrote:

1) Money alone won't fix the problem
2) All solutions take time, even the good ones.

I think thats part of it. Harney will be ousted and Rabbitte will get in and he will undo all of Harneys reforms, then he will be ousted.........

bonkey

bonkey wrote:

And I'd bet that if your cousin was in admin, he/she would be telling you how the doctors (or some subset like concultants) are overpaid and are basically milking the system for all that its worth.

Normally I'd run with that,but this guy is operating on people when on call and on duty with little sleep.He's not in the blackrock clinic salary bracket by a long shot yet.

I dunno when it was, but I remember someone (probably Victor...its like the type of thing he'd know) posting up that the admin of the various health boards consumes a "massive" 3% of annual expenditure.

I dont know where he got that either but when I said it burns money,I didnt just mean in admin salaries,I meant in bad management.

I don't pretend to be an expert on the subject. I'm not sure what parts are broken, what parts are badly structured, and what parts are actually ok. I only know that everyone points the finger at someone else, and meanwhile the taxpayer gets shafted in terms of value for money.

Getting back towards the original topic, the point I was making was more that increased expenditure hasn't fixed much, so I don't see the logic in suggesting that had we diverted cash from education to health a few years earlier, things would be much better.

To be honest, I'm more of the opinion that had we done so, our education would be in worse shape than it is now (which is little to be proud of in the first place) and our health-care would be little better off, if at all.

Yes, a lot of our infrastructure (transport, health, whatever) has suffered from chronic longterm underinvestment. It has also suffered from chronic longterm mismanagement, misstructuring etc. Now that we've got money to throw at problems, we're beginning to see a different perspective.

We can finally afford to fix things. However, inherent in that are two points that we seem to be very slow in learning:

1) Money alone won't fix the problem
2) All solutions take time, even the good ones.

As a general rule, when we fail to accept one of these two points, we generally look for a scapegoat.

jc

Yeah I see all that and I couldnt agree more with the anaylsis.
I've probably said this before in other threads on this subject but I think contrasting the effeciency of the public system with the private system tells the story.
When you see governments paying for private care for their public patients something is seriously wrong with the public system(not that we need to be told this, my local hospital came last in the league for being very dirty recently-the outside and inside of it is dreadfull)
I dont doubt that doctors and especially specialists being more effecient in their private practices is part of the problem.
That will be the next grilling my cousin will get from me the next time this conversation comes up.