A discussion on the health service co location idea

Voipjunkie

Tristrame wrote:

Regardless they would be a given support wise if they are being talked to and offered something fruity..

Who would be the PDs or the Independents the difference is with both the Government could carry on and therefor the greens influence on policies would be more limited than if FF was dependent on Greens to continue.

Tristrame wrote:

Even if it worked ? I'd understand all kinds of mirth if it didn't but it would be the strange voter if you had a vastly improved health service 5 years hence who dumped their green vote solely on that issue.

The Greens would have to have some faith in the scheme actually improving things and not making them worse their statements so far indicate that they believe that it will make matters worse as these co- located hospitals cherry pick the lucrative work and dump the expensive time consuming work on the public hospitals making the Public hospitals more expensive to run as they are deprived of the income from the private insurance patients as well.

Voipjunkie

Voipjunkie wrote:

their statements so far indicate that they believe that it will make matters worse as these co- located hospitals cherry pick the lucrative work and dump the expensive time consuming work on the public hospitals making the Public hospitals more expensive to run as they are deprived of the income from the private insurance patients as well.

God that seems so all over the place in terms of finding an excuse not to go with a plan
Leaving aside the actual "issue" of the public land and what should be done with it return wise for the state.
The way I understand it is, they expect private hospitals to be up and running faster than say building new public wings (and goodness knows theres plenty of evidence to support that-however damning it is of the public building syrup of a system) and ergo they get to use the now private beds for what they were meant for ,the public patient.
For it to work properly,it would mean no patient that has suffecient private cover could turn down a bed in a private hospital in favour of one in a public hospital.
That would mean all public beds would be used by public patients.

Ok they forego the income got from the likes of VHI etc but another way of looking at that is that that is the price of the states extra beds in the public hospital.
If it means that public patients previously on trollies get into beds quicker in droves then it seems an effecient solution.

You know what,I'm begining to think that the reason theres so much opposition to it, is that it might actually work.

Woe betide any opposition if it does work.If I was them just in case I'd be taking every option possible to publically state some zeno socialist oppposition to it quick smart.
Oh wait they are already doing that.

Depends on your view of a public building programme and procurement of jobs etc vs the private sector (whose motive is usually the primacy of service delivery because it equates to their profit).

Voipjunkie

Tristrame wrote:

God that seems so all over the place in terms of finding an excuse not to go with a plan
Leaving aside the actual "issue" of the public land and what should be done with it return wise for the state.
The way I understand it is, they expect private hospitals to be up and running faster than say building new public wings (and goodness knows theres plenty of evidence to support that-however damning it is of the public building syrup of a system) and ergo they get to use the now private beds for what they were meant for ,the public patient.
For it to work properly,it would mean no patient that has suffecient private cover could turn down a bed in a private hospital in favour of one in a public hospital.
That would mean all public beds would be used by public patients.

Ok they forego the income got from the likes of VHI etc but another way of looking at that is that that is the price of the states extra beds in the public hospital.
If it means that public patients previously on trollies get into beds quicker in droves then it seems an effecient solution.

You know what,I'm begining to think that the reason theres so much opposition to it, is that it might actually work.

Woe betide any opposition if it does work.If I was them just in case I'd be taking every option possible to publically state some zeno socialist oppposition to it quick smart.
Oh wait they are already doing that.

Depends on your view of a public building programme and procurement of jobs etc vs the private sector (whose motive is usually the primacy of service delivery because it equates to their profit).

You managed to completely ignore the whole point

the problem as I see it is that
1 private hospitals will cherry pick the easier more profitable procedures
2 Public hospitals will be down on the income from the private insurance companies
3 Costs of running public hospitals will increase as they are deprived of the income and are left with the more difficult long term hospital stays that the private facilities will not be designed to deal with
4 The for profit facilities will take the most able staff


It of course possible that those issues could be overcome with extra funding for the Hospitals but the experience of the PDs dealing with the Health service suggests that they would be quite happy to have state of the art facilities for those with private medical insurance and leave the public hospitals in absolute ****e and then we are down the road of a US system where those in work with healthcare are fine and those who aren't are ****ed

Voipjunkie

Voipjunkie wrote:

You managed to completely ignore the whole point

No I gave a different spin on it-thats not ignoring anything.
Let me be more specefic using your points...

the problem as I see it is that
1 private hospitals will cherry pick the easier more profitable procedures

They've only got what the insurer sends them which would be the entirety of what is insured if they have the capacity.The more capacity they have the more money they make so it's in their interest to take all the private patients asap.

2 Public hospitals will be down on the income from the private insurance companies

But up on the income that is supposed to be paying for public patients in the first place ie the public coffers.
Secondly that should be offset by a reduction in the outsourcing of public operations to private hospitals.
It's logical that the resources not used by private patients in public hospitals will become available for such an offset.
Did that occur to you at all?

3 Costs of running public hospitals will increase as they are deprived of the income and are left with the more difficult long term hospital stays that the private facilities will not be designed to deal with

...And where are the longstay difficult patients now? yes they are in the public hospitals already so thats not an added cost.

4 The for profit facilities will take the most able staff

They'll poach them you mean? Possibly but really if that was the case the public hospitals would lose an awfull lot of staff.Maybe but it's a big maybe.

It of course possible that those issues could be overcome with extra funding for the Hospitals but the experience of the PDs dealing with the Health service suggests that they would be quite happy to have state of the art facilities for those with private medical insurance and leave the public hospitals in absolute ****e and then we are down the road of a US system where those in work with healthcare are fine and those who aren't are ****ed

Uhm they only had control of the health sector for 2 years so really you are making an ideological supposition there.
I'd rather deal with specefics than ideologies to be honest.

I mean for example, it costs money to build and staff new wards just as it costs money to fully staff and equip existing ones.
Surely it's more effecient to have those funds soley equiping public patients in existing buildings with existing staff which make up about 50% of the total potential patient load (ie those without insurance).

When you think about it,you free up the resources straight away that would be going into new buildings and new staff and make it available for increasing staff and improving equipment in the existing wards.


p.s I'm splitting this off to the main politics forum as a discussion on co location as its kind of interesting and ot to the thread.

Voipjunkie

Tristrame wrote:

No I gave a different spin on it-thats not ignoring anything.
Let me be more specefic using your points...
They've only got what the insurer sends them which would be the entirety of what is insured if they have the capacity.The more capacity they have the more money they make so it's in their interest to take all the private patients asap.
.

No because the private facilities will not have the full services of a hospital they will be set up to maximise profit and international experience is that the profit is in quick turnover

Tristrame wrote:

But up on the income that is supposed to be paying for public patients in the first place ie the public coffers.
Secondly that should be offset by a reduction in the outsourcing of public operations to private hospitals.
It's logical that the resources not used by private patients in public hospitals will become available for such an offset.
Did that occur to you at all?....

There is no reduction in costs if a hospital now has 600 beds and say 200 of them are private it gets income from those 200 beds from the private insurance companies if all 600 become public beds it now has to bear the full cost of the 600 beds from public coffers. The resources would become available if the funding for those 200 beds is made available will the Government dramactically increase Hospital budgets to take account of the increased cost.
Secondly that is a big assumption that there will be a decrease in the use of private facilities by public patients that presumes that those facilities are going to be available in the public hospital but will they if the experienced medical teams are now over in the co-located private facility

Tristrame wrote:

And where are the longstay difficult patients now? yes they are in the public hospitals already so thats not an added cost..

Yes but now the public hospitals will not have the cross subsidy that the private business gives them

Tristrame wrote:

They'll poach them you mean? Possibly but really if that was the case the public hospitals would lose an awfull lot of staff.Maybe but it's a big maybe..

Why is it a big maybe the public Hospitals are tied into centrally controlled contracts they can not offer improved conditions and if the private for profit companies want a particular speciality they have the money to get it because if they don't get it they don't make money

Tristrame wrote:

Uhm they only had control of the health sector for 2 years so really you are making an ideological supposition there.
I'd rather deal with specefics than ideologies to be honest.

I mean for example, it costs money to build and staff new wards just as it costs money to fully staff and equip existing ones.
Surely it's more effecient to have those funds soley equiping public patients in existing buildings with existing staff which make up about 50% of the total potential patient load (ie those without insurance).

When you think about it,you free up the resources straight away that would be going into new buildings and new staff and make it available for increasing staff and improving equipment in the existing wards.


p.s I'm splitting this off to the main politics forum as a discussion on co location as its kind of interesting and ot to the thread.

There was a guy on RTE one morning talking about compulsory medical insurance those that work buy their own those that don't the government pays for and those in between get a mixture they pay some the Government pays some.

Basically the plan was that everybody is on a level playing field the Hospitals make more money the more people they treat so they can afford more beds etc it is in their interest to keep the hospitals clean and well run because everyone can choose subject to availibility which hospital they want to go to bad hospitals get fewer and fewer patients and improve or close. Everybody gets the same level of care it is they make as much money from treating some one on a pension as they would from treating a businessperson


Hospitals could be licensed and as part of their license set services which may not be profitable would have to be provided to ensure that essential services were provided


It moves the hospitals away from the set budget do what you can with it scenario that we have at the moment for example where the childrens hospital is threatening to lay of staff because the budget is spent.


Anyway this guy explained it much better than i can and I think he said that New Zealand had moved to that model of healthcare




My fear is that we are going to really move into the 2 tier health service further than we already are where those that can afford it will be well looked after and those that cannot will be ****ed the current model of funding hospitals can not compete for the best staff with purely for profit companies

Voipjunkie

Voipjunkie wrote:

No because the private facilities will not have the full services of a hospital they will be set up to maximise profit and international experience is that the profit is in quick turnover

How do you know that?

There is no reduction in costs if a hospital now has 600 beds and say 200 of them are private it gets income from those 200 beds from the private insurance companies if all 600 become public beds it now has to bear the full cost of the 600 beds from public coffers.

So you are advocating private insurance or the building by the state of more hospitals-the latter would take decades.

The resources would become available if the funding for those 200 beds is made available will the Government dramactically increase Hospital budgets to take account of the increased cost.

Re read what I said-which is cheaper and more effecient-spending money on buildings that wont bear fruit for decades given the slowness of public building programmes and its associated red tape or the government spending the money that you want them to spend on those buildings being put into services instead (more nurses shorter hours,better equipment) servicing the actual public patients in actual public beds.

Secondly that is a big assumption that there will be a decrease in the use of private facilities by public patients that presumes that those facilities are going to be available in the public hospital but will they if the experienced medical teams are now over in the co-located private facility

(1) you should know what I'm talking about there.Public coffers already pay for private facilities to shorten waiting lists.It's called the national treatment purchase fund.
Your whole supposition is based on an assumption that the public hospital loses all its staff or most of them to the new private facility.
Thats a mad assumption,it's not credible.
For a start employee's of public hospitals negotiate contracts and secondly I'm pre supposing that the funds that you want to go into the building programme actually get spent instead where I'm saying they should be and thats on actual public patient care eg more nurses,better pay,shorter hours and better equipment.

Yes but now the public hospitals will not have the cross subsidy that the private business gives them

Well advocate the building of publically owned private hospitals then,if thats all you're interested in.
Mind you that would eat more resources and it would take years to build the white elephants.

Why is it a big maybe the public Hospitals are tied into centrally controlled contracts they can not offer improved conditions and if the private for profit companies want a particular speciality they have the money to get it because if they don't get it they don't make money

Because you free up the public purse away from building the extra room for the extra beds and transfer it into patient care.
Unless you think of course the idea is to reduce the amount spent on health.
Imagine that.A government going to the electorate saying we've reduced spend in health and we've kept the service the same at its current not up to spec[read: long waiting lists ,poor specialist services etc] level.

No government would reduce the spend level so if its already allocated to a building programme , it gets diverted to a more worthwhile one ie patient care.

There was a guy on RTE one morning talking about compulsory medical insurance those that work buy their own those that don't the government pays for and those in between get a mixture they pay some the Government pays some.

Basically the plan was that everybody is on a level playing field the Hospitals make more money the more people they treat so they can afford more beds etc it is in their interest to keep the hospitals clean and well run because everyone can choose subject to availibility which hospital they want to go to bad hospitals get fewer and fewer patients and improve or close. Everybody gets the same level of care it is they make as much money from treating some one on a pension as they would from treating a businessperson

Sounds like a good idea.
I don't know the impact it would have on resources or the ability of a private system to profitably cope with having to deal with 100% of the population.
I know that I spend circa €1200 a year on my plan E VHI,thats €25 a week but then I dont smoke and just drink socially.
Whats available to me for that small investment is second to none should I need it.
I know I involuntarally spend considerably more than that in PRSI for a far less than perfect service.

My fear is that we are going to really move into the 2 tier health service further than we already are where those that can afford it will be well looked after and those that cannot will be ****ed the current model of funding hospitals can not compete for the best staff with purely for profit companies

I've no truck with what you've said regarding the new zealand man.

But what I will say is theres a reason why half the country already believe their private insurance is essential.
You tell me why the public service can't perform as well.
I suspect we both know the answer,it needs reform.
Personally I'd like to see a few years of Harney in there before I decide it's yet another waste or another bend over cow towing to unions protecting a monolythic ineffecient structure.
At least she wasnt of the view that just constantly throwing more money at the problem without a plan was the way to go.

McSpud

There seems to have been almost no debate on this even during the Election. A lot of the objection seems to stem from private bad & you not allowed make profit from Health as if everyone involved is a volunteer.

The current system lacks capacity & the public sector hopeless at delivering on this no matter how much money is thrown at it. People with private health insurance are already subsidised in their stays at public hospitals so surely they could just go to private hospitals so can move people from trolleys to beds?

Strange how no political party has attempted to cost a fully public 1 tier system...

nesf

McSpud wrote:

Strange how no political party has attempted to cost a fully public 1 tier system...

Because it'd be hard to reconcile it with the tax cuts they were promising?


We can have a world class public system but we have to pay the taxman for it. At the moment, the electorate don't seem willing to do that so with two tiers we stay.