Free GP care for Under 6s?

RainyDay

NIMAN wrote: »

As someone who came from NI, and who still uses his GP in the North, my local surgery is jammed constantly with people. Jammed. It can take me nearly 3 weeks for an appointment.

I have the feeling that many of those in my local surgery are there to justify their inability to work, being 'on the sick', depressed etc. NI has a very high figure for people on DLA, anti-depressants etc. In Derry on one census 12% of the population were on DLA. That's a shocking figure.

My point would be that charging a nominal figure to attend the GP would cut the numbers using the service dramatically. If something is free, it is generally abused. I know people in RoI with medical cards, and they are constantly at the Gps with their kids.

A couple of quotes from this report:
http://www.pulsetoday.co.uk/news/finance-and-practice-life-news/half-of-gps-in-favour-of-charging-for-routine-appointments/20003741.article#.VSxqJ5M3nGw

Dr Stephen McMinn, a GP in Bangor, Northern Ireland, said he was in favour of charging patients for appointments. He said: ‘[It] has been shown to work in other countries. There needs to be some pressure to decrease patient demand and expectation.’

Dr Shailendra Bhatt, a GP in Hemel Hempstead in Hertfordshire, said: ‘I work in a walk-in centre. The amount of people who come through the door for practically no reason at all and say “I was out and saw this sign for a walk-in centre where one can see a doctor, so I came in”… People don’t value the things if they get it cheap, worse still if they get it for nothing.’

Surprise, surprise - some GPs are advocating for a measure to get more money for GPs - what did you expect?

Are we really going to take the word of some GPs for this? And as for the 'high percentages on the sick', unless the under-6s need doctors notes for time off Montessori school, it's not really relevant to the current debate.

exgp

BoJack Horseman wrote: »

Was it visit rate for NHS vs Medical Cards?

I remember the CSO advising that the GP visit rate for med card holders was 5 per annum.... For those who pay, its 2 visits per annum.

Not so, it's about 4 visits per annum for private patients and twice that for medical cards. I think that the CSO get their figures from household surveys that ask how many times you went to the GP in the last year and people's memories are inaccurate. The GMS have more accurate stats.

RainyDay

exgp wrote: »

Not so, it's about 4 visits per annum for private patients and twice that for medical cards. I think that the CSO get their figures from household surveys that ask how many times you went to the GP in the last year and people's memories are inaccurate. The GMS have more accurate stats.

Do the GMS have stats on every visit?

exgp

RainyDay wrote: »

Do the GMS have stats on every visit?

They have very accurate stats from GPS who remained on the fee-per-item payment when most GPS changed to the capitation scheme. Those capitation rates were based on visiting patterns from the different age groups analysed for the nine months before the capitation scheme started. The only stats they would have from GPs on capitation now would be from out of hours consultations which are all itemised individually.

RainyDay

exgp wrote: »

They have very accurate stats from GPS who remained on the fee-per-item payment when most GPS changed to the capitation scheme. Those capitation rates were based on visiting patterns from the different age groups analysed for the nine months before the capitation scheme started. The only stats they would have from GPs on capitation now would be from out of hours consultations which are all itemised individually.

Tks for clarification. When did the change from fee-per-item happen?

exgp

RainyDay wrote: »

Tks for clarification. When did the change from fee-per-item happen?

1989.

For Reals

heldel00 wrote: »

Yeah a lot of medical card holders are not so poor!

I was responding to the suggestion that some card holders attend the doctor for the craic.

There are always people who take advantage, we shouldn't penalize across the board, nor should we dole out medical cards automatically.

NIMAN

RainyDay wrote: »

Surprise, surprise - some GPs are advocating for a measure to get more money for GPs - what did you expect?

Are we really going to take the word of some GPs for this? And as for the 'high percentages on the sick', unless the under-6s need doctors notes for time off Montessori school, it's not really relevant to the current debate.

But I think its very relevant to the debate i.e. a free service will be abused, like it is in NI.

People who get GP visits for free take their kids to appts if they have the slightest sniffle. That's abusing the system. If you had to pay at least €10, it might make them think "am I being silly".

Uncle Ben

NIMAN wrote: »

But I think its very relevant to the debate i.e. a free service will be abused, like it is in NI.

People who get GP visits for free take their kids to appts if they have the slightest sniffle. That's abusing the system. If you had to pay at least €10, it might make them think "am I being silly".

I don't think it's abuse however when I had a medical card under the Frontier Workers Scheme I used it. I had no compunction in not using it and not only for when I was sick, but for check ups etc. If I recall correctly I even think I got my nicotine replacement patches on it the first time I tried to give up the smokes. If you are given a service people will use it.

RainyDay

NIMAN wrote: »

But I think its very relevant to the debate i.e. a free service will be abused, like it is in NI.

People who get GP visits for free take their kids to appts if they have the slightest sniffle. That's abusing the system. If you had to pay at least €10, it might make them think "am I being silly".

You can keep saying it as often as you like, that doesn't make it true. Going to the doctors is not generally a hugely entertaining experience for a parent with kids. Keeping young kids entertained in a waiting room with a 20 year old abacus and some stinky soft toys is not many parent's idea of fun.

And who defines what abuse is? Going to the doc when one is sick is generally a good idea. The only person who can say that a patient is abusing the service is the doctor in the room, so it is up to that doc to manage the patient's expectations.

Uncle Ben wrote: »

I don't think it's abuse however when I had a medical card under the Frontier Workers Scheme I used it. I had no compunction in not using it and not only for when I was sick, but for check ups etc. If I recall correctly I even think I got my nicotine replacement patches on it the first time I tried to give up the smokes. If you are given a service people will use it.

Indeed, people will use it. And if the Nicotine therapy worked, it would probably have saved the health service considerable expenditure in the long run.

nc6000

It's a nonsense idea, a pre-election stunt.

Timberrrrrrrr

nc6000 wrote: »

It's a nonsense idea, a pre-election stunt.

?????

You know this has been going on quite a while now right?

creedp

RainyDay wrote: »

Indeed, people will use it. And if the Nicotine therapy worked, it would probably have saved the health service considerable expenditure in the long run.

Never understood why NRT was covered under the GMS. The argument that medical card holders are poor so couldn't afford NRT doesn't stack up as patches etc are much cheaper that the fags themselves. This is the problem with everything being free medical card holders were able to pick up the patches for free and use them when they didn't want to go outside in the rain while having a few pints or sell them on to non medical card holders in the same predicament. Scarce public money should be put to better use!

nc6000

Timberrrrrrrr wrote: »

?????

You know this has been going on quite a while now right?

Yes, I'm aware of all the amazing plans James Reilly was going to implement when he became Minister for Health and they all came to absolutely zero. He was so bad that even his good mate Enda had to sack him.

Now this free GP care for under 6s is resurrected in time for it to be implemented before the next election.

It's a stunt.

Timberrrrrrrr

nc6000 wrote: »

Yes, I'm aware of all the amazing plans James Reilly was going to implement when he became Minister for Health and they all came to absolutely zero. He was so bad that even his good mate Enda had to sack him.

Now this free GP care for under 6s is resurrected in time for it to be implemented before the next election.

It's a stunt.

No

It has taken this long because there had to be discussions with doctors about this, you wouldn't be able to implement this until doctors are on board.

RainyDay

creedp wrote: »

Never understood why NRT was covered under the GMS.

Probably for the same reasons as the UK NHS will pay for Weight Watchers in some circumstances - if it works for a significant percentage of people, it will save money down the line.

creedp

RainyDay wrote: »

Probably for the same reasons as the UK NHS will pay for Weight Watchers in some circumstances - if it works for a significant percentage of people, it will save money down the line.

If it is such an important public health issue, why is it considered appropriate to to provide free NRT to persons with a medical card but require a person earning a € over the medical card threshold to pay for it in full? Problem with the 2 tier Irish health system .. full of perverse incenitves and simply perverseness! Much better to target initiatives like on a clinical priority basis not income.

Of course that is the ostensible policy basis underpinning under 6 medical cards .. which is good except for the fact that it is simply a sop for the Govt to claim they are so concerned with implementing health reform and removing the deeply ingrained inequalities in the Irish health system. I wonder how long it will take to extend free GP care to the rest of the population .. maybe the next tranche will conveniently occur in 2020 JIT to buy the next election.

RainyDay

creedp wrote: »

If it is such an important public health issue, why is it considered appropriate to to provide free NRT to persons with a medical card but require a person earning a € over the medical card threshold to pay for it in full? Problem with the 2 tier Irish health system .. full of perverse incenitves and simply perverseness! Much better to target initiatives like on a clinical priority basis not income.

Yes, the problem here is the two-tier system, and the U6 GP care is a good step away from that system, despite what you get from the naysayers.

creedp wrote: »

Of course that is the ostensible policy basis underpinning under 6 medical cards .. which is good except for the fact that it is simply a sop for the Govt to claim they are so concerned with implementing health reform and removing the deeply ingrained inequalities in the Irish health system. I wonder how long it will take to extend free GP care to the rest of the population .. maybe the next tranche will conveniently occur in 2020 JIT to buy the next election.

I recall hearing something about plans to extend it from U6 to U12 within a fairly short period, a year or two iirc - though I'm open to correction on this.

creedp

RainyDay wrote: »

Yes, the problem here is the two-tier system, and the U6 GP care is a good step away from that system, despite what you get from the naysayers.



I recall hearing something about plans to extend it from U6 to U12 within a fairly short period, a year or two iirc - though I'm open to correction on this.

I'd be surprised if it will happen that quick- or it would be publicised much more by Govt given its election year - especially given that they had to throw a further E30m at the scheme to buy off the GPs and get it over the line.

exgp

The contract on offer to GPs at present isn't just to cover the U6s but also the over 70s, diabetics and asthmatics. The common chronic diseases should be covered in primary care and GPs are able to do it. Universal free GP care is an ambition of the ICGP. the IMO and the NACGP. I hope I live to see it.

fly_agaric

Timberrrrrrrr wrote: »

No

It has taken this long because there had to be discussions with doctors about this, you wouldn't be able to implement this until doctors are on board.

I assume all that's happened to clear the jam is they've managed to make it worth the docs while now (a little more gravy available to keep them happy and troika are safely over the horizon where they can no doubt comment on vote-buying that might go on but not actually stop it).

Timberrrrrrrr

fly_agaric wrote: »

I assume all that's happened to clear the jam is they've managed to make it worth the docs while now (a little more gravy available to keep them happy and troika are safely over the horizon where they can no doubt comment on vote-buying that might go on but not actually stop it).

And there's your problem right there.

Of course they have "made it worth their while" did you expect the doctors of the country to suddenly start children under 6 for free?

ct5amr2ig1nfhp

Perhaps someone on higher wages has paid considerably more tax? Why shouldn't they get a benefit also?
And I'm not saying it's fair. For example, I'd be for having child benefit means tested.

A minimum cost should be introduced as others have said, with a monthly/yearly cap. EUR 5 or 10 per visit to keep people from abusing the system.

allthedoyles wrote: »

Medical card renewals are been refused like never before ,so it looks to me like Government policy is to get tough with recent applications especially the discretion part.

So free for all under 6's , there will be many losers .

Why should any couple with income of say €50,000 each with health insurance paid for by their employers , be entitled to bring their under 6 to GP for free.

fly_agaric

Timberrrrrrrr wrote: »

And there's your problem right there.

Of course they have "made it worth their while" did you expect the doctors of the country to suddenly start children under 6 for free?

Oh don't worry I'm not so naive!
I was speaking of extra money compared to usual medical card patient, same as with non means tested "golden" cards for pensioners given during the boom years (a similar vote buyer). don't know what they are expected to get per child so I said I "assume".

fyfe79

I know this thread is 2 months old but I can't see a fresher one so I'll add here. Sorry if there is a more relevant place.

I've just seen on the news that this will come in on 1st July and South Tipp has by far the lowest uptake in Ireland among GP's at only 8%, while Donegal has the highest at 93%. Why the huge swing? Has there been some kind of union movement in South Tipp to make sure so few GP's sign up?

As a parent living in Clonmel with 2 kids under 5 I'm pretty sickened by this. Even if I try to move to one of the 8%, they'll more than likely turn me away as a new client as they'll be servicing existing clients first and foremost. This leaves the majority of GP's to continue charging 50 euro a visit with little recourse to clients. It seems like a cartel, almost!

Are they concerned with overloading of work? Are they worried about too much paperwork? Why are they against it?

BoJack Horseman

fyfe79 wrote: »

Are they concerned with overloading of work? Are they worried about too much paperwork? Why are they against it?

There was 'X' number of patients that GP's could squeeze €50 a pop from..... That will be reduced.

I'm baffled that the government are giving GP's a choice of opting in.

fyfe79

Has the government set a figure for what the GP's can claim back? Even so, I would have thought that South Tipp is actually not as expensive as other territories so it wouldn't affect them as much. I see people on this thread mentioning 60 to 80 euros for visits elsewhere, so if anything, I'd have expected the acceptance in ST to be higher than Dublin, for instance.

Yeah it seems bizarre for the government to offer the option to them. In counties with a high acceptance (Donegal, for example), it would be a death blow for the remaining 7% of GP's not to accept as their clients will simply ggo to one of the 93% instead. But in areas like mine, we've very little choice given the 92% rejection. Could this lead to legal claims of inequality based on location, I wonder?

Iwasfrozen

Free GP care for Under 6s?

It's not free, someone else is paying for it.

nice_guy80

Buying the election, buying the election.

once you give something for free, it will promote abuse of it and it is very hard to take the 'free' element of it

BoJack Horseman

nice_guy80 wrote: »

Buying the election, buying the election.

once you give something for free, it will promote abuse of it and it is very hard to take the 'free' element of it

Buying the last election.

It was a promise for 2011.... Yet to be delivered.

As to abuse, if you are a parent you know you don't want your child to be ill & you don't want to be bringing them to doctors surgeries unnecessarily.

Babies are not hypochondriacs.

medicine12345

fyfe79 wrote: »

Has the government set a figure for what the GP's can claim back? Even so, I would have thought that South Tipp is actually not as expensive as other territories so it wouldn't affect them as much. I see people on this thread mentioning 60 to 80 euros for visits elsewhere, so if anything, I'd have expected the acceptance in ST to be higher than Dublin, for instance.

Yeah it seems bizarre for the government to offer the option to them. In counties with a high acceptance (Donegal, for example), it would be a death blow for the remaining 7% of GP's not to accept as their clients will simply ggo to one of the 93% instead. But in areas like mine, we've very little choice given the 92% rejection. Could this lead to legal claims of inequality based on location, I wonder?

It must be a combination of it not being financially viable and them not having the resources to staff it.

As for why the government gave them the option - GPs are self-employed, they can do what they want and the government can't make them do something that mustn't be viable.

Most GP practices around the country are really struggling financially these days and at the end of the day they're running a business and need to be able to pay their staff, etc..

BoJack Horseman

Really, we just need far more GP's.

As its a private business, there is nothing stopping the marketplace from supporting many more.

Something has to break the '€50 for 10 mins' grip on the market.

nice_guy80

BoJack Horseman wrote: »

Really, we just need far more GP's.

As its a private business, there is nothing stopping the marketplace from supporting many more.

Something has to break the '€50 for 10 mins' grip on the market.

I think most of them are quite reasonable in their pricing.

BoJack Horseman

nice_guy80 wrote: »

I think most of them are quite reasonable in their pricing.

Some consider €50 reasonable.

Others don't.

creedp

nice_guy80 wrote: »

I think most of them are quite reasonable in their pricing.

Most people might also think that McDonald's in reasonable but what if you have a number of young kids who are always hungry .. would you visit McDonalds' each time one of them said they were hungry or would you wait for a while and see would they forget they were hungry?

exgp

The reason many GPs are against it is they would rather see the money that's being spent on this under 6's scheme being spent on people that can't afford to see their GP by increasing the income limits for granting a medical card and also spending the money on children with life long disabilities such as DOwn's syndrome and not on a lot of under 6 year olds whose parents can afford to pay.

€50 for ten minutes may seem a lot but the average private patient only sees their Dr four times a year; that's €200. Universal Health Insurance has been estimated to cost €1650 per person per annum. For a family of four-€6600.000

RainyDay

exgp wrote: »

The reason many GPs are against it is they would rather see the money that's being spent on this under 6's scheme being spent on people that can't afford to see their GP by increasing the income limits for granting a medical card and also spending the money on children with life long disabilities such as DOwn's syndrome and not on a lot of under 6 year olds whose parents can afford to pay.

This is spinning. Universal coverage has to start somewhere.

If GPs are really concerned about what people can afford, they can drop their prices.

Iwasfrozen

BoJack Horseman wrote: »

Really, we just need far more GP's.

As its a private business, there is nothing stopping the marketplace from supporting many more.

Something has to break the '€50 for 10 mins' grip on the market.

This. The answer is less barriers to entry, less unionization and less price fixing.

medicine12345

Iwasfrozen wrote: »

This. The answer is less barriers to entry, less unionization and less price fixing.

What barriers to entry? There has been alot in the news lately about how they cant get GPs to take on certain medical card lists in some areas. Any GP could set up there own private practive. There are loads of young GPs qualifying everyyear in Ireland but the current situation isn't feasible so they go to Canada, Australia, etc instead..

Clearlier

Iwasfrozen wrote: »

This. The answer is less barriers to entry, less unionization and less price fixing.

What kind of barriers to entry are you thinking of? A huge barrier for example is the length of time it takes to train as a GP but I'd like my GP to have completed their training.

What unions are you thinking of? It's illegal for GP's to collectively bargain.

I don't see price fixing in operation. Prices are high but there's not insignificant variation.

BoJack Horseman

medicine12345 wrote: »

What barriers to entry? There has been alot in the news lately about how they cant get GPs to take on certain medical card lists in some areas. Any GP could set up there own private practive. There are loads of young GPs qualifying everyyear in Ireland but the current situation isn't feasible so they go to Canada, Australia, etc instead..

Why aren't there masses of new young GPs setting up practices who don't take on medical card patients?
(Accepting medical card patients being a choice).

Iwasfrozen

Clearlier wrote: »

What kind of barriers to entry are you thinking of? A huge barrier for example is the length of time it takes to train as a GP but I'd like my GP to have completed their training.

What unions are you thinking of? It's illegal for GP's to collectively bargain.

I don't see price fixing in operation. Prices are high but there's not insignificant variation.

Any trained GP should be able to set up a surgery, the more surgeries there are the more competition there is the more prices will fall. Cost is at the moment a huge barrier to entry and the government should provide more support to small businesses.

Clearlier

Iwasfrozen wrote: »

Any trained GP should be able to set up a surgery, the more surgeries there are the more competition there is the more prices will fall.

What makes you think that they can't?

Edit - re: cost (I replied before you had completed/edited your post it seems) - doctors have a pretty high earning potential. It really wouldn't be that hard for one to raise the necessary funding if there was a business opportunity.

medicine12345

BoJack Horseman wrote: »

Why aren't there masses of new young GPs setting up practices who don't take on medical card patients?
(Accepting medical card patients being a choice).

Theres a few in certain areas in dublin. Not sure, guess there mightn't be enough private patients who come on a regular basis elsewhere

medicine12345

Iwasfrozen wrote: »

Any trained GP should be able to set up a surgery, the more surgeries there are the more competition there is the more prices will fall. Cost is at the moment a huge barrier to entry and the government should provide more support to small businesses.

They can.

creedp

exgp wrote: »

The reason many GPs are against it is they would rather see the money that's being spent on this under 6's scheme being spent on people that can't afford to see their GP by increasing the income limits for granting a medical card and also spending the money on children with life long disabilities such as DOwn's syndrome and not on a lot of under 6 year olds whose parents can afford to pay.

€50 for ten minutes may seem a lot but the average private patient only sees their Dr four times a year; that's €200. Universal Health Insurance has been estimated to cost €1650 per person per annum. For a family of four-€6600.000

Funny I've never seen that argument used against the previous decision to provide universal free GP services to wealthy over 70's. Maybe the fact that GPs were offered capitation rates which were a multipe of those applying to under 70's was sufficient to overcome their concerns about providing services to sick children.

exgp

RainyDay wrote: »

This is spinning.i Universal coverage has to start somewhere.

If GPs are really concerned about what people can afford, they can drop their prices.

It isn't spin. GPs spend a lot of their time trying to get medical cards for their patients as well as services. They are well aware of patients problems with the system. As for Universal Coverage, this has been the policy of the Irish College of GPs since the eighties.

As for lowering fees, some practices have but with FEMPI cuts of 43% on GMS fees many practices are in trouble. Rates, taxes and the cost of living have gone up. I know GPs who have emigrated and there are many GP positions unfilled.

RainyDay

exgp wrote: »

It isn't spin.

I disagree. The 'what about the sick kids who are over-6' could just as easily apply to the other proposal - what about the wealthy kids with Down Syndrome who the GPs want to get an automatic medical card, at the expense of the poor little 4 year old who's Mammy on minimum wage can't afford to bring him to the doc, but still doesn't have a medical card. It's a moot point.

You have to start somewhere with universal coverage.

nice_guy80

We need more recruits in medicine in Ireland

there are too many barriers to entry - limited place and training positions. Too many foreign students enrolled thus denying Irish students place - the foreign students are a cash cow for colleges.

the medical profession (IMI) keep the numbers of recruits down as it keeps the status quo in terms of the level of pay these recruits can expect to earn due to the supply and demand for doctors.

the whole area needs to be looked at

exgp

RainyDay wrote: »

I disagree. The 'what about the sick kids who are over-6' could just as easily apply to the other proposal - what about the wealthy kids with Down Syndrome who the GPs want to get an automatic medical card, at the expense of the poor little 4 year old who's Mammy on minimum wage can't afford to bring him to the doc, but still doesn't have a medical card. It's a moot point.

You have to start somewhere with universal coverage.

I agree with you, we do need to start somewhere with universal coverage but not with universal health insurance. I also agree with you on your point about the needy four year old and the wealthy Down's syndrome child. That's why I think the money available should be targeted at the needy.