Doctors and medical card holders

Crasp

Jumboman wrote: »

Debilitating ? most of my family have high BP its a very common condition.

Their is debate as whether or not it is harmfull to human health.

GPs who are in the pockets of the drug companies will of course tell you its dangerous and that you need medication to treat it.

Notice how most GPs will never tell people to excise to treat high BP or depression they will just throw pills at them.

People should try to excise before they take pills for BP or depression but of course their is no money to be made in that.

most people have high BP. Most people have something wrong with them.

I actually have studied medicine for 6 years and high bp is not a made up disease, there are significant associations with stroke and heart disease, perihperal vascular disease and so on. Look at any medical publication in the last 50 years and see for yourself.

Not to mention that high bp is sometimes (although rarely) due to an even more serious underlying condition.

Lifestyle modifications are the first thing any GP will educate the person on. Most people won't bother with it and demand the pills anyway.

Or worse, people will believe the rubbish you are spouting and not manage it at all and end up stroking out or dying of a heart attack.

creedp

Lenin Skynard wrote: »

I know a good few lads in their 20s/30s that have medical cards and haven't seen a doctor once since they were in short pants. If the GP is getting €70 per year per head the GP is doing alright I'd say. Most medical card holders I know have never used it once.

Looking at the €70 capitation figure in isolation is misleading as GPs get more than a capitation payment under the GMS Scheme. The average payment received by a GP per eligible person in 2011 was €257.93 - which is more than 3 time €70.

L1011

creedp wrote: »

Looking at the €70 capitation figure in isolation is misleading as GPs get more than a capitation payment under the GMS Scheme. The average payment received by a GP per eligible person in 2011 was €257.93 - which is more than 3 time €70.

Taking in to account that the capitation increases with advancing age to a very significant sum at the end (>70 nursing home patient, so still unlikely to match the income they'd get off a similar dependency private patient, if such a thing could exist) and there is a disproportionate number of older people with cards, there isn't that much more given per person than the capitation

The other payments are either for a very limited set of specific services, which private patients would be paying more for; or for maternity shared care - which saves the state huge sums over the pre-1980s all hospital based system; or are to partially defray the cost of administrative and nursing staff without which a GP would struggle to deal with more than about a 200 person list. Which would mean that there wouldn't be enough GPs in the entire country to provide medical card services.

The vast majority of GPs in the country would be delighted to be able to throw the entire "running a company" out the window and become staff of the state on 100k or so salaries (with the associated DB pension, as their DC scheme blew itself to pieces during the boom) with their premises and equipment provided. Its only a particularly nice little earner anymore if you manage to establish yourself a private or elderly (but in good condition) medical card practice in a wealthy area. And there's not many of them going. HUGE decrease in private income due to the increase in medical card holders and a reducing willingness to go to the doctor by the remaining private patients; and a fairly hefty reduction in capitation per patient and the removal of distance coding have hit everyone else in every other area.

creedp

MYOB wrote: »

Taking in to account that the capitation increases with advancing age to a very significant sum at the end (>70 nursing home patient, so still unlikely to match the income they'd get off a similar dependency private patient, if such a thing could exist) and there is a disproportionate number of older people with cards, there isn't that much more given per person than the capitation

The other payments are either for a very limited set of specific services, which private patients would be paying more for; or for maternity shared care - which saves the state huge sums over the pre-1980s all hospital based system; or are to partially defray the cost of administrative and nursing staff without which a GP would struggle to deal with more than about a 200 person list. Which would mean that there wouldn't be enough GPs in the entire country to provide medical card services.

The vast majority of GPs in the country would be delighted to be able to throw the entire "running a company" out the window and become staff of the state on 100k or so salaries (with the associated DB pension, as their DC scheme blew itself to pieces during the boom) with their premises and equipment provided. Its only a particularly nice little earner anymore if you manage to establish yourself a private or elderly (but in good condition) medical card practice in a wealthy area. And there's not many of them going. HUGE decrease in private income due to the increase in medical card holders and a reducing willingness to go to the doctor by the remaining private patients; and a fairly hefty reduction in capitation per patient and the removal of distance coding have hit everyone else in every other area.

In 2011 a GP earned €280.31 for each over 70 living in the community and €448.04 per over 70 residing in a nursing home. Its not an insignificant payment. I'm sure being a GP is not as lucrative as it was during the boom but when you talk about huge decreases in private income due to increases in medical card numbers you must also take into a/c the fact that private patients attend the GP much less often during a recession so the guaranteed payment for medical card holders should be welcomed, especially as many of the new medical card holders are young unemployed people who are in the main healthy and dont attend the GP too often.

As for the €100k salary with guaranteed pension, I presume you've factored in the 20% plus cut in gross pay a PS person in that salary scale has endured since 2009.

nice_guy80

People with medical cards go to their doctor far more than those without them

Because its free!!
They also bring their children to the doctor at the slightest sign of a sniffle.

I've seen it in school
The kids out the most often are those with medical cards.

L1011

creedp wrote: »

especially as many of the new medical card holders are young unemployed people who are in the main healthy and dont attend the GP too often.

It would have to be less than once a year for most, seeing as the payment for a younger person is roughly 50 quid a year for men of that age group.

creedp wrote: »

As for the €100k salary with guaranteed pension, I presume you've factored in the 20% plus cut in gross pay a PS person in that salary scale has endured since 2009.

Seeing as I'm talking about a hypothetical salary for now, I'm not sure how this is relevant. 100k just happens to be the figure that people pull out of their arse when coming up with a "justified" payment for GPs, not realising that there's not that many of them actually taking home as much as someone on 100k in the PS, even before taking pensions in to account.

creedp

MYOB wrote: »

It would have to be less than once a year for most, seeing as the payment for a younger person is roughly 50 quid a year for men of that age group.

As I said earlier av payment per eligible person in 2011 is just under €260 pa, which equates to nearly 5 visits per person for every eligible person.

Seeing as I'm talking about a hypothetical salary for now, I'm not sure how this is relevant. 100k just happens to be the figure that people pull out of their arse when coming up with a "justified" payment for GPs, not realising that there's not that many of them actually taking home as much as someone on 100k in the PS, even before taking pensions in to account.

Ah well another thread which becomes a them -v- PS on high salaries and gold plated pensions.

L1011

creedp wrote: »

As I said earlier av payment per eligible person in 2011 is just under €260 pa, which equates to nearly 5 visits per person for every eligible person.

And then you went and claimed the majority of new patients were "young unemployed people" for whom they do not get anywhere near 260 quid a year, using this as a justification for reduced income.

Pick a position and stick with it please. As currently you're trying to use two completely contradictory ones.

creedp wrote: »

Ah well another thread which becomes a them -v- PS on high salaries and gold plated pensions.

No, it hasn't. You appear to be looking for that, though.

craggle

murphaph wrote: »

Agreed but I think you could reduce it to a fiver or a tenner at most (perhaps a tenner for non-card holders and a fiver for card holders) and most people will not go unless in genuine need. A huge part of the problem with medical card patients going to the GP with a sniffle is because if they get a prescription for a few Lemsip then they don't have to pay for them, but if they walk into the chemist and buy Lemsip without a prescription, they pay the normal price like everyone else.

In Germany, where prescriptions are "free" (we pay hefty compulsory insurance every month) they specifically exclude cough and cold stuff...which you pay full price for, even with a prescription. All other things are covered by the insurance.

I know medical card holders who have a cupboard full of prescriptions that they don't need. A lot of these medications, pain kilelrs etc. end up being given to friends and family

you cant get lemsip on the medical card. or any of the coughs and cold remedies you see behind the counter in the chemist. you can get paracetamol but its classed as a painkiller.

maninasia

http://www.boards.ie/vbulletin/showthread.php?t=2055632250&page=2

Average seems to be 100-140k for a GP's individual income. Some earn significantly higher, some earn lower. It seems they are doing better than fine.

If GP's want more private patients reduce the fees to private patients, it's that simple.

mikemac1

creedp wrote: »

many a time I have rang a GP only to get a forwarding number of an after hours service DubDoc or SouthDoc and this only exists in some parts of the country. Other than that its off to the A&E I go ..

All of the country is covered, Westdoc and Shannondoc are others.

creedp

MYOB wrote: »

And then you went and claimed the majority of new patients were "young unemployed people" for whom they do not get anywhere near 260 quid a year, using this as a justification for reduced income.

Pick a position and stick with it please. As currently you're trying to use two completely contradictory ones.

I'm presume you are saying that one of the statements is inaccurate? Please tell me which one?

No, it hasn't. You appear to be looking for that, though.

You have me wrong there but I agree I shouldn't have made that reference.

L1011

creedp wrote: »

I'm presume you are saying that one of the statements is inaccurate? Please tell me which one?

Both.

Firstly that you can simply divide the total payments by the total number of patients to work out an 'average payment per patient' across the entire system - there are very many GPs in areas with huge numbers of young children and younger adults for whom they get very, very low payments and there are (far far fewer) GPs in areas with huge numbers of wealthy >70 medical card holders for which they receive quite a bit. All you get is a mean with zero context as to an actual median. Its mathematically correct but of no use to an honest debate.

And additionally, the increase in medical cards is pretty much across the board rather than being in one specific age category.

creedp

mikemac1 wrote: »

All of the country is covered, Westdoc and Shannondoc are others.

Dont know what happenned there but that is not my quote.

creedp

MYOB wrote: »

Firstly that you can simply divide the total payments by the total number of patients to work out an 'average payment per patient' across the entire system - there are very many GPs in areas with huge numbers of young children and younger adults for whom they get very, very low payments and there are (far far fewer) GPs in areas with huge numbers of wealthy >70 medical card holders for which they receive quite a bit. All you get is a mean with zero context as to an actual median. Its mathematically correct but of no use to an honest debate.

You'll find many an argument supported on here and elsewhere based on an average .. what you are arguing is that individual GPs earn less than the average which of course also means that others earn more. Could look at a few other statistics if you prefer like 71% of GPs received more than €120k from PCRS in 2011 or 43% received more than €210k and of course that doesn't include their private income from the 60% of the population that aren't covered by the GMS. All in all I'd say that a large number of GPs do very well under the GMS and when you add in private income even better. As always some GPs are in difficulty but that doesn't take away from those doing very well.

And additionally, the increase in medical cards is pretty much across the board rather than being in one specific age category.

Yes indeed but I dont think I said that all new medical card holders were in this bracket. I think I said many.

L1011

creedp wrote: »

You'll find many an argument supported on here and elsewhere based on an average .. what you are arguing is that individual GPs earn less than the average which of course also means that others earn more. Could look at a few other statistics if you prefer like 71% of GPs received more than €120k from PCRS in 2011 or 43% received more than €210k and of course that doesn't include their private income from the 60% of the population that aren't covered by the GMS. All in all I'd say that a large number of GPs do very well under the GMS and when you add in private income even better. As always some GPs are in difficulty but that doesn't take away from those doing very well.

You do realise that generally anyone receiving more than 210k will have at least one other staff GP as an employee? Alongside multiple admin and nursing staff. You're acting as if its cash in to their pocket.

These are not salary payments, they are payments to a company/business to provide a service.

creedp wrote: »

Yes indeed but I dont think I said that all new medical card holders were in this bracket. I think I said many.

You implied enough were to offset the huge increase in workload.

creedp

MYOB wrote: »

You do realise that generally anyone receiving more than 210k will have at least one other staff GP as an employee? Alongside multiple admin and nursing staff. You're acting as if its cash in to their pocket.

These are not salary payments, they are payments to a company/business to provide a service.

Did I mention salary anywhere?

You implied enough were to offset the huge increase in workload.

I simply made a point that many of the new medical card holders are relatively young people (and their dependants) who have lost their jobs in the recession - these are not necessarily going to hammer down the GPs door simply because they now have a medical card. I was implying no more than that.

maninasia

This has all been discussed before and I have provided the link earlier.

You do realise that generally anyone receiving more than 210k will have at least one other staff GP as an employee? Alongside multiple admin and nursing staff. You're acting as if its cash in to their pocket.

These are not salary payments, they are payments to a company/business to provide a service.

A nicely subsidized business, a lot of costs can be claimed back from the state including admin and nursing staff salaries.

I guess that GPs are doing just fine? Why? Because they have not significantly reduced their fees. If they wanted to, they could add massive numbers of customers (patients) by this simple change, however it seems they don't really want/need more customers (patients).

L1011

creedp wrote: »

Did I mention salary anywhere?

You said that 210k was "doing very well". As if this was 210k in their pocket.

creedp wrote: »

I simply made a point that many of the new medical card holders are relatively young people (and their dependants) who have lost their jobs in the recession - these are not necessarily going to hammer down the GPs door simply because they now have a medical card. I was implying no more than that.

And yet you then denied you'd made that claim all of two posts ago.

maninasia wrote: »

A nicely subsidized business, a lot of costs can be claimed back from the state including admin and nursing staff salaries.

The figures given include the absolute entirety of practice support for salaries. The payments do not fully cover the salary of one staff member for each type, let alone the more than one that surgeries that get the full payment usually have.

maninasia wrote: »

I guess that GPs are doing just fine? Why? Because they have not significantly reduced their fees. If they wanted to, they could add massive numbers of customers (patients) by this simple change, however it seems they don't really want/need more customers (patients).

There is a finite number of people sick at any given time.

GMS payments are so paltry that practices with mixed lists rely on private income to stay going, so you're never going to get major reductions there - although there's very few practices that haven't reduced their fees in the past half a decade. There are private only practices that have hugely reduced fees due to the reduction in private patients.

maninasia

There is a finite number of people sick at any given time.

Let's look at the logic here. It's correct and yet it is irrelevant unless you understand how many sick people actually go to the doctor when symptoms occur.

Many people can't afford or justify going to the doctor at rates around 50 euro a visit. But when you drop it to 25 Euro/visit or less things could change drastically.

The current system does not give adequate patient coverage, what it does is look after the sick who present, but not look after the sick who do not, and that is a medical health failure in my book.

It should not be up to private patients to subsidize others and GPs income and get limited coverage themselves, that's warped.

creedp

MYOB wrote: »

You said that 210k was "doing very well". As if this was 210k in their pocket.

You can interpret what I say any way that pleases you. I'm not going to get into a tit for tat argument about what you think I was implying in the above quote.

And yet you then denied you'd made that claim all of two posts ago.

You keep referring to what I was implying in my post - see below for what I actually said. I referred to the increase in medical card numbers due to the recession and said many of them are young unemployed people. I never said all new medicalcard holders are young unemployed people and I never implied anything about impacts on work load except to point out that this category are likely to be relatively healthy and thefore wouldn't be frequent visiters to a GP which would compensate for their lower capitation fee. If you disagree with this view that's fine.

creedp wrote: »

In 2011 a GP earned €280.31 for each over 70 living in the community and €448.04 per over 70 residing in a nursing home. Its not an insignificant payment. I'm sure being a GP is not as lucrative as it was during the boom but when you talk about huge decreases in private income due to increases in medical card numbers you must also take into a/c the fact that private patients attend the GP much less often during a recession so the guaranteed payment for medical card holders should be welcomed, especially as many of the new medical card holders are young unemployed people who are in the main healthy and dont attend the GP too often.