Hospital colocation: Higgins blamed for €250m hospital delay

CtrlSource

From an Indo article today:

"SOCIALIST Party leader and former TD Joe Higgins has been accused of holding up plans for a new private hospital in Dublin.

Mr Higgins emerged last night as the sole objector to a €254m health project which would see the Beaumont Hospital sharing its grounds with a private facility belonging to the Beacon Medical Group.

Mr Higgins lodged an appeal to An Bord Pleanala at 5.29pm on Tuesday night, just inside the 5.30pm deadline. He has argued that the proposed site for the Beacon Medical Group's private hospital at Beaumont was originally marked for an extension of psychiatric services.

His objection could delay the project for up to nine months.

Last night Independent TD Finian McGrath, who represents the area and signed a deal with the Government for investment at Beaumont Hospital, said he was "absolutely furious".

"We've €254m projects planned for Beaumont. This is going to be held up possibly for another six to nine months," he said. "Only outsiders objected. It's not on his patch."

He said the deal had included plans to refurbish the old hospital, which would "have had a massive impact on the trolley situation".

Beacon Medical Group's CEO Michael Cullen said hundreds of jobs hinged on the plans and it was incorrect of Mr Higgins to suggest anything was wrong with the planning proposals.
- Aine Kerr Political Correspondent"



The jury (in my head) seems to be out on this colocation thing. i don't like the sound of it. Any policy that allows for the siting of 'for profit' hospitals alongside established public ones seems to be wrong-headed. Historically, it's been done here for years, but existing private clinics like Blackrock, Mater Private and Galway Clinic were complimentary facilites which supplied the privately insured patient with services that were not readily available through the public system.

But now we seem to be facing a situation whereby these new private hospitals will be fully equipped clones of the public ones alongside them. i don't like the idea that these 'for profit' hospitals are being built on publicly owned lands and at what cost to the public system?

Granted, our two tier health service is a mess and i see the merit in the provision of some private healthcare, but not at the expense of the quality and coverage of the public system.

Good people, what are your thoughts?

eoin5

I certainly have socialist ideals but when reality bites you have to let go. People need good reliable healthcare and at the moment in most instances private medicine is more efficient for the country than public due to the horrible mess the public service is in.

Whos going to dismantle the convoluted systems in place? Whos going to give the electricians a kick up the hole when they go on strike because someone changes a lightbulb that they werent supposed to? If no-one can then we may as well just hand over the keys to the private sector.

Hotblack Desiato

CtrlSource wrote: »

The jury (in my head) seems to be out on this colocation thing. i don't like the sound of it. Any policy that allows for the siting of 'for profit' hospitals alongside established public ones seems to be wrong-headed.

It seems to me that the FG/Lab opposition to it is along the same lines; it 'just feels wrong' but FG/Lab never explained why and it helped cost them the last election.

I don't see what the problem is. Getting private patients out of public hospitals frees up more beds for public patients. Win.

sink

I'm all for co-location, I think it will free up beds for public patients. What I am against is private healthcare being subsidised by public funds, especially if the private healthcare is providing treatments that are the same as in the public sector. It just seems completely unfair that our tax reciepts should go towards services we can't afford, when the public services that are availble are underfunded and inadaquate. Private healthcare is fine but it should be paid for by those who avail of it, not by those who don't.

The_Minister

http://www.progressivedemocrats.ie/press_room/2442/
Harney's press release on private hospitals from a few weeks ago.

Basically, for €80m, we get (effectively) hundreds of new beds, since every bed vacated by a private patient will be filled straight away by a public one.

CtrlSource

eoin5, love the way you say you have Socialist ideals and then imply that to have them is unrealistic! Sounds like you don't have any ideas about righting the public health service and don't think anyone else can or should either. Defeatist!

Are the rest of you all PDs? :rolleyes:

Hotblack Desiato

CtrlSource wrote: »

Are the rest of you all PDs? :rolleyes:

Seems to me that opposition to co-location is an article of faith for many people but I've yet to hear a single one deliver a rational, convincing explanation of why they are so opposed.

Sounds like you don't have any ideas about righting the public health service and don't think anyone else can or should either. Defeatist!

So what are your ideas? Pumping exponentially increasing funds into the existing system is not an option. Banning private healthcare is not an option (and would be disastrous for the public system, anyway.)

Do you think it is sensible or moral that private patients continue to take up beds in public hospitals which are desperately needed for public patients?

eoin5

CtrlSource wrote: »

eoin5, love the way you say you have Socialist ideals and then imply that to have them is unrealistic! Sounds like you don't have any ideas about righting the public health service and don't think anyone else can or should either. Defeatist!

Are the rest of you all PDs? :rolleyes:

Ive lots of ideas, but massive layoffs of high ranking staff wouldnt be too popular I'd say.

CtrlSource

ninja900 wrote: »

So what are your ideas? Pumping exponentially increasing funds into the existing system is not an option. Banning private healthcare is not an option (and would be disastrous for the public system, anyway.)

Do you think it is sensible or moral that private patients continue to take up beds in public hospitals which are desperately needed for public patients?

While expenditure on the Health budget has increased significantly and is approaching the European average, remember our baseline was very, very low and we had a long history of chronic under-funding of the system over decades. It's only in recent years that we've had the money to spend and it does take a long time to see results in Health. i think the HSE is actually doing a reasonable job at reforming the system and sure, there have been mistakes and wastage, but we've just got to learn from that and move on.

On your question about morality; each one of us is a public patient firstly. If you have a serious medical emergency, your best place to go is still the A&E of you nearest public hospital. If you're subsequently stabilised, have private insurance and need surgery (electively), then as the system stands, i think you should be moved to a private facility. But if you are seriously ill and require multidisciplinary expert care, you;re best off being treated in a large, publicly funded teaching hospital.

i have been both a public and private patient on numerous occasions and i can honestly say that the standard of inpatient treatment i received was always higher in the public system.

eoin5 wrote: »

Ive lots of ideas, but massive layoffs of high ranking staff wouldnt be too popular I'd say.

No arguments there!

Hotblack Desiato

CtrlSource wrote: »

While expenditure on the Health budget has increased significantly and is approaching the European average, remember our baseline was very, very low and we had a long history of chronic under-funding of the system over decades. It's only in recent years that we've had the money to spend and it does take a long time to see results in Health. i think the HSE is actually doing a reasonable job at reforming the system and sure, there have been mistakes and wastage, but we've just got to learn from that and move on.

On your question about morality; each one of us is a public patient firstly. If you have a serious medical emergency, your best place to go is still the A&E of you nearest public hospital. If you're subsequently stabilised, have private insurance and need surgery (electively), then as the system stands, i think you should be moved to a private facility. But if you are seriously ill and require multidisciplinary expert care, you;re best off being treated in a large, publicly funded teaching hospital.

i have been both a public and private patient on numerous occasions and i can honestly say that the standard of inpatient treatment i received was always higher in the public system.

None of this answers my questions - why are you opposed to co-location, what alternative(s) would you propose, and do you think it is right that private patients (i.e. elective surgery, convalescents, etc. not emergency admissions who happen to have a VHI card in their wallet) should continue to occupy beds in public hospitals to the exclusion of public patients. Co-location is a means to end this and provide more public beds quickly and cheaply.

Also, what happened decades ago is irrelevant now. The patients on the cancer waiting lists in 1987 are almost all dead now, one way or the other. The hospitals we should have built then would be needing expensive refits by now. Many of the staff we should have employed then would be retired now. The equipment we should have bought then would be obsolete now. It's not an excuse for the poor value for money we are getting and the taxpayer deserves better than having their money thrown into a bottomless pit while receiving a less than acceptable service.

I support Harney and what she is trying to do with the HSE but blinkered resistance from vested interests, consultants, local hospital campaigners, anti-colocationists etc. is making it extremely difficult to implement reform.

sovtek

ninja900 wrote: »

I support Harney and what she is trying to do with the HSE but blinkered resistance from vested interests, consultants, local hospital campaigners, anti-colocationists etc. is making it extremely difficult to implement reform.

Sorry but from my point of view you've got it ass backwards. The vested interests seem to be people that want to profit from the healthcare system and get government subsidies to do it. All this while Harney seems to be shrinking the public health system and increasing private health care. She is the one standing in the way, not the other way around. All the while paying herself handsomely, along with Drumm and other higher ups. That's seems to me to be the blackhole in the public system. Meanwhile she foams at the mouth when the lower tier of the public service want to get paid fairly. She's eaten up with the Chicago boy's ideology.

The_Minister

sovtek wrote: »

All this while Harney seems to be shrinking the public health system and increasing private health care.

She has increased both actually.

More money (in real and adjusted terms) has been going into the public health system under her tenure then anyone else, and she has set up Breastcheck etc.
It is possible to grow both systems ya know:rolleyes:

SeanW

I have a serious problem with co-location. If private patient really are just "taking up" public beds from public patients at present, then it means one of two things:
1) The public hospitals recieve a fee for hosting private patients and this income will be lost when the hospital is forced to blithely away its land to a privateer, which again there will be an "opportunity cost" i.e. you could have done something worthwhile with it.
2) The taxpayer is subsidising private medicine by hosting private patients at no cost to that insurer. In this case the correct thing to do, in the best interests of the taxpayer and the public patients, is IMHO for the hospitals to begin charging for private-patient services, continuing to do so until either the fees pay for the cost of the service, or the privateers piss off and build their own hospital somewhere else, at NO cost to the state.

Hotblack Desiato

It's actually somewhere in between SeanW. Private health insurers used to get public beds for practically nothing; they pay a LOT more now but probably still not quite the full cost.

Yes there will be an income drop which will have to be made up - but the alternative is to keep 'renting out' public beds to private patients. Hardly right when public patients are in need of those beds.

Co-lo is really just a quicker and (hopefully) cheaper way to get more public beds. The new hospitals are fully private so can be built quickly and without government funding. The vacated beds are then available for public patients (and will need to be then funded out of current expenditure, obviously) so the government gets a lot more public beds at NO capital cost.

is_that_so

I am not entirely convinced by co-location myself, however the timing of the objection suggests pure mischief and I am inclined to put it on a par with the individual who effectively prevented 60,000 people from using trains. To my mind you have a responsibility as a public respresentative and IMO Mr Higgins has shown utter disdain for that.

I also see a very disturbing trend in this type of selfishness, The IFA and SIPTU last week, SF demanding a treaty rewrite, the Shell to Sea campaign, the NBRU, ESB Unions. Whether it is a lack of genuine public interest that allows shrill well-positioned pressure group to thrive or that there is a genuine democracy deficit in this country where the government forces "fait-accomplis" on us I am not sure. Either way it is not a desirable development.

vallo

I don't see why we should accept that our system is unfixable. Merging all the healthboards was a great idea. Now lets imagine that we did this last week instead of all those years ago - and get rid of all the excess people we employ and bring in a unified system to administer the new health service. It is a massive undertaking, so we'll need excellent administrators and balls of steel. But it must be done.
We can spend as much money as we want on healthcare - comparing it with other countries spending or what we used to spend is irrelevant - while there are so many salaries to be paid to people who aren't medics there is too much waste.
The minister has taken the easy option. She'll have shiny new hospitals where she can turn up to cut ribbons.
But the bottom line is that the health service available to those who can pay privately will be better, and by definition the healthcare available to the poor will be worse. I'd have a lot more respect for Ms Harney if she just came out and admitted that.

CtrlSource

ninja900 wrote: »

None of this answers my questions - why are you opposed to co-location, what alternative(s) would you propose, and do you think it is right that private patients (i.e. elective surgery, convalescents, etc. not emergency admissions who happen to have a VHI card in their wallet) should continue to occupy beds in public hospitals to the exclusion of public patients. Co-location is a means to end this and provide more public beds quickly and cheaply.

Also, what happened decades ago is irrelevant now. The patients on the cancer waiting lists in 1987 are almost all dead now, one way or the other. The hospitals we should have built then would be needing expensive refits by now. Many of the staff we should have employed then would be retired now. The equipment we should have bought then would be obsolete now. It's not an excuse for the poor value for money we are getting and the taxpayer deserves better than having their money thrown into a bottomless pit while receiving a less than acceptable service.

I support Harney and what she is trying to do with the HSE but blinkered resistance from vested interests, consultants, local hospital campaigners, anti-colocationists etc. is making it extremely difficult to implement reform.

i am opposed to colocation because i don't want to see the American model of Healthcare spread to this country any more than it already has. i don't want our government to give subsidies and tax breaks to private companies to build on PUBLIC hospital lands. i don't want a government policy that prioritises the spread of private hospitals while at the same time, cuts back on public healthcare and basic public services. i don't like it when our Health Minister appears at the openings of every private clinic and lionises her colleagues in the private sector.

At least 2 senior former HSE public policy advisors now run private companies that are tendering for and have been awarded contracts to provide private health services in this State. And ninja900 talks of “vested interests”!

The PDs have long advocated privatisation as the cure for many ills and this Health Minister is the most ideologically right-wing i ever remember or have read about from our political history. She truly is far closer to Boston than Berlin.

i really don't know how you can say that the historical under-funding of Health is irrelevant. Certainly to talk about it won't change the future, but to say that it has no bearing on the state of the present Health service is nonsense.

The Health budget is not a bottomless pit. i'm sick of people just saying that because it is costly and things aren't better than they are. Proponents of privately run medicine often cite the bottomless pit / black hole argument as a reason to go private. But there are numerous examples of European health systems that are almost exclusively funded but the public purse and provide excellent standards of treatment and care to all their citizens.

i do not want to live in a country where in 10 years time, it is imperative to have exorbitant private insurance if you want to get anything done and where public hospitals are only for the poor and emergency cases - staffed mainly by foreign-trained contract workers, while their Irish counterparts get fat off the proceeds of their cosy private practices, cherry picking their patients and still enjoying tax breaks from the Harney years....

Hotblack Desiato

CtrlSource wrote: »

i am opposed to colocation because i don't want to see the American model of Healthcare spread to this country any more than it already has. i don't want our government to give subsidies and tax breaks to private companies to build on PUBLIC hospital lands.

So you'd rather keep private patients in public hospitals? Does not compute.

i don't want a government policy that prioritises the spread of private hospitals while at the same time, cuts back on public healthcare and basic public services.

Did you read The_Minister's post?

i don't like it when our Health Minister appears at the openings of every private clinic and lionises her colleagues in the private sector.

So you don't like private healthcare. You are of course aware that the public system could not cope if everyone cancelled their private healthcare tomorrow? Really it's a voluntary tax.

At least 2 senior former HSE public policy advisors now run private companies that are tendering for and have been awarded contracts to provide private health services in this State. And ninja900 talks of “vested interests”!

So what? Where they used to work is irrelevant.

The PDs have long advocated privatisation as the cure for many ills

This is NOT privatisation. It is actually going to greatly expand the capacity of the public system.

and this Health Minister is the most ideologically right-wing i ever remember or have read about from our political history. She truly is far closer to Boston than Berlin.

You do know that the German public health system relies heavily on private provision, don't you?

i really don't know how you can say that the historical under-funding of Health is irrelevant. Certainly to talk about it won't change the future, but to say that it has no bearing on the state of the present Health service is nonsense.

It not relevant, we want to fix the system we have now not perform what-ifs on the system we had in 1987 or whenever.

The Health budget is not a bottomless pit. i'm sick of people just saying that because it is costly and things aren't better than they are.

It is a bottomless pit. We have greatly increased expenditure but it is hard to argue that we have acheived value for money for that expenditure. The problem is NOT one of funding it is one of organisation and management.

But there are numerous examples of European health systems that are almost exclusively funded but the public purse and provide excellent standards of treatment and care to all their citizens.

We're all aware of that. That's why we expect better here in Ireland than what we're getting.
Tell me though, do any of these successful health systems use private provision at all?

i do not want to live in a country where in 10 years time, it is imperative to have exorbitant private insurance if you want to get anything done

This is a nonsense argument, the point of co-location is to improve the PUBLIC system.

while their Irish counterparts get fat off the proceeds of their cosy private practices, cherry picking their patients and still enjoying tax breaks from the Harney years....

Are you aware that Harney wants to introduce public-only consultant contracts, precisely to stop this? It appears not.

CtrlSource

ninja900 wrote: »

So you'd rather keep private patients in public hospitals? Does not compute.

If you read one of my earlier posts in the thread you'll see that i don't want to keep private patients clogging-up public beds unnecessarily. Finally something we agree on! (i think). However, i don't want to see private patients being excluded from the public system. They're taxpayers and human beings and should be able to receive care in the public system if they wish, but should have their elective surgeries and treatments in private facilities if their insurance covers it.

Did you read The_Minister's post? [about investment in the public system]

Yes, but i was referring to cutbacks that are taking place in things like community services, some elective surgeries, ward closures, hiring freezes etc. i accept that there has been massive investment in the public system over the last decade. Much needed. i don't consider it a waste. It's been vital.

So you don't like private healthcare. You are of course aware that the public system could not cope if everyone cancelled their private healthcare tomorrow? Really it's a voluntary tax.

Yep, it's true that the system would be more on its ass than it is now if that happened. But your point is kind of ad hominem since i never suggested that such a thing should happen. My health is privately insured btw.

So what? Where they used to work is irrelevant.

Really? Do you think it's acceptable for someone employed at a senior advisory level shaping public policy to then, a few months later, setup a company that seeks to profit from the provisions in that policy?

This is NOT privatisation. It is actually going to greatly expand the capacity of the public system.

Misnomer. It will free up some beds already in the system.
But it won't, by definition increase the capacity of the public system.

You do know that the German public health system relies heavily on private provision, don't you?

i wasn't aware of that. Are you aware that the Swedish one relies very little on private funding?

It not relevant, we want to fix the system we have now not perform what-ifs on the system we had in 1987 or whenever.

Fair enough. i personally believe in providing context to strengthen an argument but if you want to leave the past out of it, grand.

It is a bottomless pit. We have greatly increased expenditure but it is hard to argue that we have acheived value for money for that expenditure. The problem is NOT one of funding it is one of organisation and management.

i don't agree with you about the pit with no bottom. But you're right that management has a lot to answer for and the organisation of the Health Service could have a lot of its fat trimmed (middle managers, some administrators and other bureaucrats should go).

...do any of these successful health systems use private provision at all?

You appear to think that i'm totally against private provision. i'm not. As i said, i'm privately insured and will remain so until such time that i can access public healthcare as quickly as i can private.

This is a nonsense argument, the point of co-location is to improve the PUBLIC system.

Now that's just sounds like propaganda tbh!

Are you aware that Harney wants to introduce public-only consultant contracts, precisely to stop this? It appears not.

Not only does she want to, but she is doing so. One of the Consultants' gripes about public-only contracts is that many of them can make more mula from just private work. If a lot of them take this line and move exclusively into the private sector, there won’t be enough home grown top-level expertise in the public system. Okay, a doctor's a doctor you might say. But there are practices and protocols in place here that really protect the patient.

For example; Consultants act as advocates for their patients and don't mind criticising their employers, when it is in the best interests of patient care. If the Government gets its way, publicly employed Consultants will have to gain the approval of hospital managers before talking to the media, or making public statements about their hospital, standards of care, provision of service etc.

If we add large numbers of foreign-trained Consultants to that, we risk removing that 'duty of care' sentiment – primary concern for the patient first and the non-medical hospital authorities second

Hotblack Desiato

CtrlSource wrote: »

If you read one of my earlier posts in the thread you'll see that i don't want to keep private patients clogging-up public beds unnecessarily.

We do agree on that. Therefore more private hospitals will have to be built. Co-location does this.

They're taxpayers and human beings and should be able to receive care in the public system if they wish, but should have their elective surgeries and treatments in private facilities if their insurance covers it.

Agreed also, I don't think anyone said otherwise.

i accept that there has been massive investment in the public system over the last decade. Much needed. i don't consider it a waste. It's been vital.

It's vital yes but that doesn't mean that a large chunk of it was not wasted. In other words we should have got much better value for that money.

Really? Do you think it's acceptable for someone employed at a senior advisory level shaping public policy to then, a few months later, setup a company that seeks to profit from the provisions in that policy?

If there's nothing in their contract of employment to stop them, then yes.
If you start putting restrictions on what people can do after they resign, you will have to pay them more, because you are taking a right away from them.

Misnomer. It will free up some beds already in the system.
But it won't, by definition increase the capacity of the public system.

These beds are in public hospitals but dedicated to private patients. It will increase the capacity of the public system to end this.

i wasn't aware of that. Are you aware that the Swedish one relies very little on private funding?

I am aware that there are a range of successful models in use in Europe. A lot of the co-lo objectors seem to be against any private provision in principle and I have no time for them. As you said, you're not one of those.

If the Government gets its way, publicly employed Consultants will have to gain the approval of hospital managers before talking to the media, or making public statements about their hospital, standards of care, provision of service etc.

Do you have a cite for this? Incidentally this is already the case for most public servants.

If we add large numbers of foreign-trained Consultants to that, we risk removing that 'duty of care' sentiment – primary concern for the patient first and the non-medical hospital authorities second

Xenophobic scaremongering tbh.

CtrlSource

ninja900 wrote: »

If there's nothing in their contract of employment to stop them, then yes.
If you start putting restrictions on what people can do after they resign, you will have to pay them more, because you are taking a right away from them.

i've believed for a long time that you need to pay good people properly to encourage them to stay in the public sector. This concept was first explained to me by a family friend who spent years as a missionary in places like Hong Kong, Singapore. There, top government officials were highly qualified and often recruited from the private sector. This improved efficiency. Brendan Drumm, if he was more effective, would be well deserving of his package + bonus.

i really have a problem with so-called policy advisers going in to the Department for 6 months or a year, suggesting what should be in a particular policy (in this case colocation) and then feck off back to the private sector and tender for the work! These people are free to work in whatever job they like, but their public service contract should stipulate that they cannot seek to profit from their work in the HSE for 3 - 5 years minimum after leaving.

Do you have a cite for this? Incidentally this is already the case for most public servants.

Not exactly, but working on it. It was one of the bones of contention during the contract negotiation.

Xenophobic scaremongering tbh.

In fairness, it's not. i don't care where my Doctors are from, but i do care where they were trained and if they match up to the standards here. On the broader point about duty of care to the patient vs. loyalty to the hospital employer, this was told to me by a family member who is a surgeon and who hopes to one day be a consultant and also mentioned by a Consultant i attend. They have interests vested in the system to be sure, but i can vouch for the fact that the family member is very much committed to passing on his knowledge and skills - as well as caring for patients - within a strong public system

SkepticOne

The whole collocation thing doesn't make any sense. The reasoning given is that it will free up beds for public patients in publically owned hospitals. Great, but wait a minute: we own those public hospitals therefore we get to decide what proportion (if any) of private patients get to use publicly owned hospitals. If we want to increase the number of public beds then why not just increase the fee for private beds until such time that it becomes economical for private health companies to build their own facilities on their own unsubsidised land.

BTW, I'm not against public land being used for private purposes pe se, just that the philosophy behind colocation needs to be examined.

SkepticOne

ninja900 wrote: »

Yes there will be an income drop which will have to be made up - but the alternative is to keep 'renting out' public beds to private patients. Hardly right when public patients are in need of those beds.

Co-lo is really just a quicker and (hopefully) cheaper way to get more public beds. The new hospitals are fully private so can be built quickly and without government funding. The vacated beds are then available for public patients (and will need to be then funded out of current expenditure, obviously) so the government gets a lot more public beds at NO capital cost.

It seems to me that the real purpose of collocation is rapid generation of cash now in return for lost revenue from public patients over a longer period.

Here's what I think should be done.

1. Public hospitals should be only for public patients.
2. Private health providers should build their own hospitals on land they purchase at full market rates.
3. Excess land owned by the department should be sold at full market rates if they are to be sold.

This would happen on a phased basis over several years. Problem solved!

The_Minister

SkepticOne wrote: »

The whole collocation thing doesn't make any sense. The reasoning given is that it will free up beds for public patients in publically owned hospitals. Great, but wait a minute: we own those public hospitals therefore we get to decide what proportion (if any) of private patients get to use publicly owned hospitals. If we want to increase the number of public beds then why not just increase the fee for private beds until such time that it becomes economical for private health companies to build their own facilities on their own unsubsidised land.

BTW, I'm not against public land being used for private purposes pe se, just that the philosophy behind colocation needs to be examined.

Firstly we have contracts with those companies, so we can't just start milking them.:)
Secondly, that would raise prices for people with private health insurance (about half the country), since the cost of those beds would rise, and there would be a large delay in financing and building the new hospitals.
Also, co-location grows both the public and private number of beds for certain, whereas your method just transfers beds from private to public without making sure that more private beds will become available. At current demand, every bed vacated by a patient going private is immediately filled by a public patient, so decreasing the number of private beds without making sure that more are available would only increase pressure on public beds even more.
Also, you seem to miss that it is considered a good thing that the private hospitals are next to public hospitals.

SkepticOne wrote: »

It seems to me that the real purpose of collocation is rapid generation of cash now in return for lost revenue from public patients over a longer period.

Here's what I think should be done.

1. Public hospitals should be only for public patients.
2. Private health providers should build their own hospitals on land they purchase at full market rates.
3. Excess land owned by the department should be sold at full market rates if they are to be sold.

This would happen on a phased basis over several years. Problem solved!

:eek:

OK. Firstly, the amount of revenue lost is less than the cost of building those beds would be. Since, atm, every public bed vacated by a private patient is filled by a public patient, then building more private beds is essentially the same as building more public beds. So the cost of that lost revenue, does not match the cost of building and maintaining those private beds in public hands.

Secondly, your solution isn't a solution. It would get us a quick influx of cash, then nothing.
Under co-location, we retain ownership over the land, and we get to ensure that they don't change their minds and build a shopping complex after a decade or so (which, if they got planning permission, they could if we sold it). Leasing it as we are ensures that we still hold long-term ownership of the land, and we get to control its disposal.

SkepticOne

The_Minister wrote: »

Firstly we have contracts with those companies, so we can't just start milking them.:)

Fine but those contracts will eventually expire. If our supposed goal (I suspect it is not really a goal) is to increase public beds then we can do it this way. The government is in ultimate control over how many beds are public and how many are public.

Secondly, that would raise prices for people with private health insurance (about half the country), since the cost of those beds would rise, and there would be a large delay in financing and building the new hospitals.

No one is saying this needs to happen overnight just like building on state owned land will take years.

Also, co-location grows both the public and private number of beds for certain, whereas your method just transfers beds from private to public without making sure that more private beds will become available. At current demand, every bed vacated by a patient going private is immediately filled by a public patient, so decreasing the number of private beds without making sure that more are available would only increase pressure on public beds even more.

But the state's responsibility is not to provide 'private' beds. It is for private companies to provide private beds. This is where I think things have gone wrong over the years.

Also, you seem to miss that it is considered a good thing that the private hospitals are next to public hospitals.

I don't think it is a good thing. I think it is better to keep public and private separate with separate staff working in each. Otherwise we are really talking about one big hospital which is the core of the problem.

OK. Firstly, the amount of revenue lost is less than the cost of building those beds would be. Since, atm, every public bed vaocated by a private patient is filled by a public patient, then building more private beds is essentially the same as building more public beds. So the cost of that lost revenue, does not match the cost of building and maintaining those private beds in public hands.

No because your assuming that the state has a responsibility to provide a certain proportion of private beds. I think the state is being ripped off by private health providers and certain members of the medical profession, supposedly state employees, who feel that income from private patients is their right.

Secondly, your solution isn't a solution. It would get us a quick influx of cash, then nothing.
Under co-location, we retain ownership over the land, and we get to ensure that they don't change their minds and build a shopping complex after a decade or so (which, if they got planning permission, they could if we sold it). Leasing it as we are ensures that we still hold long-term ownership of the land, and we get to control its disposal.

Under co-location we retain ownership but what is ownership without control? We will have handed over control to private companies.

CtrlSource

The_Minister wrote: »

...Also, you seem to miss that it is considered a good thing that the private hospitals are next to public hospitals.

Why is it a good thing and who considers it so?

Since, atm, every public bed vacated by a private patient is filled by a public patient...

Is it not 50:50 whether a vacated bed is filled by a public or private patient atm?