Why is Ireland's healthcare system in shambles?

dxhound2005

mr_fegelien wrote: »

I remember last year being sent a letter by the HSE that my appointment for a nose operation which I had requested for when I was a minor (16yrs old in 2014) was due in a month. I cancelled it.

These stories aren't uncommon. I have private health insurance but even then things like visiting a GP are expensive €60+ only for them to tell you that everything is fine when it's not. This doesn't happen in any other European country.

Don't get me wrong, Ireland has great facilities. I was scheduled on a private insurance for an MRI scan 3 years ago that only cost €200. But for public patients, the waiting list is horrendous.

And our government wants to build the most expensive children's hospital in the world here. What gives?

You are taking your own individual experience to claim that stories like that are not uncommon. Maybe they are and maybe they aren't. But much more common would be millions of stories like mine, who have had good outcomes in their dealings with the service. Those stories don't get reported much.

How on earth would you know what happens in the health services in all the countries in Europe?

Mad_maxx

mr_fegelien wrote: »

What's so poor about the management?

Can anything genuinely be done to fix it? I don't think those in charge are just lazy. There has to be a reason.

The civil service culture which exists here is extremely resistant to change, many will willfully avoid lifting a finger if asked to

Mad_maxx

Mad_maxx wrote: »

The civil service culture which exists here is extremely resistant to change, many will willfully avoid lifting a finger if asked to

Maybe if the change was genuinely beneficial instead of a pr stunt or a knee jerk reaction.

Changes in my place are nearly always badly considered, even worse planned and in response to a suggestion made by someone with no knowledge or experience of the area.

Dav010

mr_fegelien wrote: »

I remember last year being sent a letter by the HSE that my appointment for a nose operation which I had requested for when I was a minor (16yrs old in 2014) was due in a month. I cancelled it.

These stories aren't uncommon. I have private health insurance but even then things like visiting a GP are expensive €60+ only for them to tell you that everything is fine when it's not. This doesn't happen in any other European country.

Don't get me wrong, Ireland has great facilities. I was scheduled on a private insurance for an MRI scan 3 years ago that only cost €200. But for public patients, the waiting list is horrendous.

And our government wants to build the most expensive children's hospital in the world here. What gives?

The answer to your question is simpler than you think.

Your surgery was an elective surgery, there are people who need surgery/need to use the theatres and hospital resources far more that you, hence why your surgery is low priority.

In relation to healthcare elsewhere, Germany has a fantastic healthcare system, France’s also has a good reputation, but in Germany for instance, everyone pays (or used to, I haven’t looked at it for a while) 10.75% of gross earnings in “health tax”, that is deducted from state benefits and pensions as well as from wages. Also, employers have to match that payment, so job offers take this fee into account. As a result, a couple on an average wage could end up paying €9k a year, having never visited a GP. Private health insurance is also available there if you want to be able to choose your surgeon/hospital/jump the que, but it is way more expensive then here at around €5k per year (again it’s a few years since I looked at policies). I also think that French people have to pay into the health system even though they may never use it. I remember reading an article in a German paper about a guy who had just retired and had paid over €100k into health care over the previous few years, but never visited a GP.

Ireland on the other had has a huge percentage of the population who have medical/GP only cards and get free healthcare. That is an incredible benefit to have, I remember years ago being at a medical conference and explaining to American Doctors that millions of people here had access to completely free healthcare, they were astonished and wondered how we did it.

So, while you might think it is inefficient and/or a broken system, next time you want an MRI for an elective procedure, ask the Radiologist how much that X-ray would cost if you had to pay the full amount for it to be taken and interpreted, you would understand that it is very good value here.

In relation to the children’s hospital, the figures are eye watering, but, they are trying to future proof it rather than just building for now, when it is eventually finished, it will be the most advanced childcare facility in the world, so I say spend whatever it takes to help kids here have the best care available.

Edit: I’ve just looked up the German healthcare tax, it has now gone up to nearly 15% of income and is capped at €8.5k per year, so a couple on say €55k each, would be paying a combined €17k in state health insurance/tax.

In France the levy is around 6% of gross income but the person still has to pay the Doctor/Hospital and then apply to be reimbursed a percentage of the fee, so even with the levy on your income, it is not free.

BrianD3

There is a malaise in the public service generally, the health service gets a lot of attention because it is massive and seriously impacts on people's lives. There are similar problems in other state bodies, quangos, local authorities etc. it's just that these are on a much smaller scale and the services provided are less critical.

It is much too simplistic to blame the problem on unions or on administrators who weren't made redundant when the health boards were merged. My experience of unions in the public service is that they are often toothless and that union members are just as aware of the shambolic service provided as the "service users" are.

New employees come into the public service enthusiastic and idealistic. It usually takes a couple of years for them to realise that there are major systemic problems and legacy issues and that no amount of effort on their part will change anything. As more years pass, motivation drops, they become institutionalised and start counting down "x years to my pension".

dxhound2005

BrianD3 wrote: »

There is a malaise in the public service generally, the health service gets a lot of attention because it is massive and seriously impacts on people's lives. There are similar problems in other state bodies, quangos, local authorities etc. it's just that these are on a much smaller scale and the services provided are less critical.

The social welfare budget payout of €20 billion plus a year seems to be administered efficiently. The only significant savings would have to come from the big three, Welfare, Health and Education. Anything else is just tinkering round the edges, and might please populist anti public service voices, but would not save much money.

I can only go by the published figures, not having your detailed knowledge of what goes on in all those bodies.

https://whereyourmoneygoes.gov.ie/en/

Dav010

Dav010 wrote: »

The answer to your question is simpler than you think.

Your surgery was an elective surgery, there are people who need surgery/need to use the theatres and hospital resources far more that you, hence why your surgery is low priority.

In relation to healthcare elsewhere, Germany has a fantastic healthcare system, France’s also has a good reputation, but in Germany for instance, everyone pays (or used to, I haven’t looked at it for a while) 10.75% of gross earnings in “health tax”, that is deducted from state benefits and pensions as well as from wages. Also, employers have to match that payment, so job offers take this fee into account. As a result, a couple on an average wage could end up paying €9k a year, having never visited a GP. Private health insurance is also available there if you want to be able to choose your surgeon/hospital/jump the que, but it is way more expensive then here at around €5k per year (again it’s a few years since I looked at policies). I also think that French people have to pay into the health system even though they may never use it. I remember reading an article in a German paper about a guy who had just retired and had paid over €100k into health care over the previous few years, but never visited a GP.

Ireland on the other had has a huge percentage of the population who have medical/GP only cards and get free healthcare. That is an incredible benefit to have, I remember years ago being at a medical conference and explaining to American Doctors that millions of people here had access to completely free healthcare, they were astonished and wondered how we did it.

So, while you might think it is inefficient and/or a broken system, next time you want an MRI for an elective procedure, ask the Radiologist how much that X-ray would cost if you had to pay the full amount for it to be taken and interpreted, you would understand that it is very good value here.

In relation to the children’s hospital, the figures are eye watering, but, they are trying to future proof it rather than just building for now, when it is eventually finished, it will be the most advanced childcare facility in the world, so I say spend whatever it takes to help kids here have the best care available.

Edit: I’ve just looked up the German healthcare tax, it has now gone up to nearly 15% of income and is capped at €8.5k per year, so a couple on say €55k each, would be paying a combined €17k in state health insurance/tax.

In France the levy is around 6% of gross income but the person still has to pay the Doctor/Hospital and then apply to be reimbursed a percentage of the fee, so even with the levy on your income, it is not free.

You aren't mentioning that one can (and most do)opt out of the public system above a particular salary and provide for themselves though private health insurance which is what most people do. Germany public health insurance is mostly a safety net for low income workers. It works well.

Dav010

[Deleted User] wrote: »

You aren't mentioning that one can (and most do)opt out of the public system above a particular salary and provide for themselves though private health insurance which is what most people do. Germany public health insurance is mostly a safety net for low income workers. It works well.

Most Germans (73m out of a population of 83m) are members of the government state insurance scheme, you have to earn above €62.5k for it not to be mandatory to pay into it. But private health insurance is very expensive and it is a legal requirement to be insured.

https://www.howtogermany.com/pages/healthinsurance2.html

coolshannagh28

The Health sector like other public sectors in Ireland suffers due to constant expansion , in other countries with a Left /Right political split the expansion of public services under Left focussed administrations is tempered by rationalisation when more Right governments take power whereas our historic centre split ensures continual expansion and inefficiency.

breezy1985

A massive amount of HSE money goes into keeping people alive. I was shocked at just how many hospital facilities are for elderly treatment and also how many houses and centres around the country are being used by mental health.
Cutting back on that isn't really an option unless you want more homeless and death

Dav010

breezy1985 wrote: »

A massive amount of HSE money goes into keeping people alive. I was shocked at just how many hospital facilities are for elderly treatment and also how many houses and centres around the country are being used by mental health.
Cutting back on that isn't really an option unless you want more homeless and death

This is a very good point, people are living much longer and have come to expect/take for granted, treatments that a generation ago would only have been available to the most wealthy. It is not uncommon for people to be placed on medications that cost thousands every month, which keep them alive for extended periods, free of charge or with a low cost through the drug payment scheme.

YellowBucket

I wouldn’t use the USA as a model for healthcare. It’s producing bad outcomes on a population basis, including being the only developed country with falling life expectancy while it’s also by far and away the most expensive system in the world. It’s costs have spiralled since the 1980s when it was very comparable to richer European country’s levels of expenditure to a situation where that’s almost doubled in $ terms.

The way the USA is headed the health system will become unsustainable.

Also it’s made an absolute dogs dinner of the COVID situation, in part because of patchy access to public health.

If Ireland wants to follow a model some of the Northern European systems work extremely well. So does Australia and NZ seems to be fairly successful as a model of public health too.

My view of it is we should move to a German type universal insurance system and minimise the bloat with direct provision of healthcare by the HSE. The NHS isn’t really doing a great job as things become more and more technically complex and expensive. I don’t think it’s the model we should be trying to mirror. It was great for its time, but medicine has changed enormously.

markodaly

crossman47 wrote: »

You forgot one of the biggest of all - our own attitudes. I include those who head straight for A&E for minor issues and those who want a hospital in close proximity. Our cancer treatment is top class because a Canadian (Prof. Keane) insisted on centres of excellence and, in fairness, he got political backing from Mary Harney.

This is true, and Mary Harney and the PD's paid a big price politically.

We have a very localism, Healy-Rae attitude to health care in Ireland, one of the reasons why its a bit dysfunctional.

Dav010

Dav010 wrote: »

Most Germans (73m out of a population of 83m) are members of the government state insurance scheme, you have to earn above €62.5k for it not to be mandatory to pay into it. But private health insurance is very expensive and it is a legal requirement to be insured.

https://www.howtogermany.com/pages/healthinsurance2.html

Hmmm. I and most of my Colleagues are insured privately because it is cheaper than public for us.
I said most who have the option to do so, do. You deliberately misrepresent what I said.
What were your reasons for remaining with Gesetzlichekrankenversicherung or are you just spouting opinions as facts on a forum where you don't expect to be corrected?

dxhound2005

coolshannagh28 wrote: »

The Health sector like other public sectors in Ireland suffers due to constant expansion , in other countries with a Left /Right political split the expansion of public services under Left focussed administrations is tempered by rationalisation when more Right governments take power whereas our historic centre split ensures continual expansion and inefficiency.

Expansion is necessary where there is increase in population. Ireland's population has gone up by more than a million in the last 20 years. Through this time the percentage of workers in the public service has not gone out of line with the past, or with international comparisons. Nor is there any evidence for increased inefficiency.

In simplistic terms if 15% of workers are in the public service, then problems in people's lives are 7 times more likely to be cause by the private sector.

jester77

Dav010 wrote: »

Most Germans (73m out of a population of 83m) are members of the government state insurance scheme, you have to earn above €62.5k for it not to be mandatory to pay into it. But private health insurance is very expensive and it is a legal requirement to be insured.

https://www.howtogermany.com/pages/healthinsurance2.html

For me, private is cheaper. I pay well over €600 a month for one of the basic plans, and I have to cover the first €800 a year in medical costs before I can make a claim. That is just for me, kids are extra. If I was publicly insured I would be paying a lot more than that per month, but I would be covered from the 1st euro.

Dav010

[Deleted User] wrote: »

Hmmm. I and most of my Colleagues are insured privately because it is cheaper than public for us.
I said most who have the option to do so, do. You deliberately misrepresent what I said.
What were your reasons for remaining with Gesetzlichekrankenversicherung or are you just spouting opinions as facts on a forum where you don't expect to be corrected?

To be honest, it has been a while since I spent time working in the German health system so I had to quickly look it up this morning to get more up to date info. One of the Doctors in my practice is German so we do talk occasionally about their health care system. The figures I quoted are from the site I linked, I had a quick look through a few others and they also had similar numbers taking into account the new Act passed this year. But if 88% of the population are paying the State scheme, I’m not sure how you would say most who have the option to do so are opting out.

I will bow to your personal experience though, certainly when I lived there, private health insurance was more expensive than State (at the time it was about 10% of earning) and it would seem odd to me that the German Government would penalise lower paid employees by making them pay the mandatory State insurance, while allowing people earning over €62k to pay less to a private insurer. But maybe that is the way it is.

dxhound2005

If the private insurance system was abolished then it would be a saving for everyone? Because without knowing anything about it, the privately insured use the same services as those in the other scheme?

https://www.dw.com/en/german-public-health-insurance-cheaper-without-private-option-study-says/a-52403484

German public health insurance cheaper without private option, study says.

Germany is the only country in the EU that allows for completely separate public and private health insurance. But a new study suggests that insurance would benefit everyone if Germany abolished private health insurance.

YellowBucket

markodaly wrote: »

This is true, and Mary Harney and the PD's paid a big price politically.

We have a very localism, Healy-Rae attitude to health care in Ireland, one of the reasons why its a bit dysfunctional.

Yeah. That’s a huge issue and it’s becoming worse as medicine becomes more and more technology focused as some services can’t be delivered at a local level and absolutely need centres of excellence, at least if you want them to be deliverable at all and have good outcomes.

If you take something like radiotherapy. It needs extremely high tech and expensive equipment, maintained by a team of scientists with specialisation in physics as well as technicians, radiotherapists, radiation oncology specialists and so on.

The last thing anyone would want is to use an obsolete machine in a small hospital with limited numbers of patients and lack of expertise, yet that’s what’s regularly demanded in public discourse.

breezy1985

Centres of excellence are the way to go but only if we have the public transport or somes sort of hospital shuttlebus to go with it.

Igotadose

One other massive problem is the Irish attitude of 'anything for a quiet life.' There's an illusion that you can actually bring legal proceedings against the HSE. Try it sometime. You'll find it nearly impossible unless it might result in a massive payout, i.e., someone needs to die from mistreatment. And maybe not even then.

But as Irish seem conditioned to not complain and to take what 'authority' is dishing out, the HSE benefits as there's no 'easy' way to bring complaints - you might fill in a form, then someone who works for the HSE, so they're incented to NOT let complaints result in anything meaningful, processes it. You can appeal when you find the processing inadequate, and the appeal administrator will, of course, be incented to side with the HSE against you. So, good luck there.

Ireland needs an attitude change. HSE gets away with so much because we roll over for them.

YellowBucket

In my experience of more so the 'voluntary' hospitals than the HSE has been that when someone's a public patient they're treated like they're a charity case and should just shut up and get what they're given. That's certainly the experience I noticed in some of the two-tier hospitals with public/private divisions in Dublin.

One of the larger Dublin hospitals in particular was shocking. The administrators treated an elderly relative of mine like dirt on a few occasions. Stuff like rudely blanking people (Carol Beer style) at reception and so on was common.

My grandmother was brought into the same hospital (when she had terminal cancer) for random appointments. She'd be sitting on a hard chair for up to 6 hours for no reason. Doctor would call her in and more or less have a conversation that could have been concluded in 2 minutes by phone. Also on several occasions she was called in and they'd lost her files and had no idea why she was there.

Oddly, my mom went into CUH for major cardiac surgery as a public patient, and I found that to be quite the opposite, yet that's fully HSE.

So I don't know if it's the HSE or individual hospital cultures and the fact that a lot of them morphed out of the poor-law / union law model and were effectively charities and still seem to imagine that's what they are.

Strumms

The problems in hospitals are the managers and indeed *some* consultants. Frontline staff...doctors, nurses, carers, physios , psychologists, catering...all slog their guts out for people...I found this first hand during a rather long hospital stay...

dxhound2005

Igotadose wrote: »

One other massive problem is the Irish attitude of 'anything for a quiet life.' There's an illusion that you can actually bring legal proceedings against the HSE. Try it sometime. You'll find it nearly impossible unless it might result in a massive payout, i.e., someone needs to die from mistreatment. And maybe not even then.

But as Irish seem conditioned to not complain and to take what 'authority' is dishing out, the HSE benefits as there's no 'easy' way to bring complaints - you might fill in a form, then someone who works for the HSE, so they're incented to NOT let complaints result in anything meaningful, processes it. You can appeal when you find the processing inadequate, and the appeal administrator will, of course, be incented to side with the HSE against you. So, good luck there.

Ireland needs an attitude change. HSE gets away with so much because we roll over for them.

Your legal advisers (from the private sector) did not give you a good quality of service judging by what you have written. Assuming that you did try the legal route. Or you might have had unrealistic expectations for your claim. You shouldn't appoint yourself as a spokesperson for "the Irish".

Juza1973

Water John wrote: »

Don't think you can say, it's a shambles. Lots of bureaucratic problems and poor management. But get seriously ill and you'll get a world class service for free.

Which is great, but what I found terrible is the fact that I cannot do analysis freely even if I pay for them. The hospital has the last say if the analysis is needed or not - and they tend to postpone action for at least half a year even if some values are above the norm. Having a private insurance does not help that much as private insurances don't help you with choosing how to cure yourself, in two instances I was told to send a quotation and they would tell me if I was eligible for a refund rather than just telling me which possible doctors to choose. It is really too chaotic.

PhilOssophy

Former Former wrote: »

That's pretty much exactly what you should do.

You don't need to close them all but they should be downgraded substantially, so that they would be basically primary care centres and if you need something more specialised you go to a bigger town.

You'd obviously need more than 5 or 6 but the current model is not right.

I 100% agree with that. But the original post which I replied to made out that we should have 1 in every major city and every other hospital closed. I don't agree with that, there should be a decent level of care available but then if you need something major done then of course you go to a specialist hospital in a city, I wouldn't even say town.
An air ambulance would cost a fortune and would be picking up lads from a football match with a broken leg or the like. That would be an insane waste of money.

and Ireland's population is relatively young but still the health service is a black hole. It will get worse as the society ages.

dxhound2005

Deleted User wrote: »

and Ireland's population is relatively young but still the health service is a black hole. It will get worse as the society ages.

The increase in longevity over the last few decades has been nothing short of astounding. That would point to a very effective health service.

breezy1985

Strumms wrote: »

The problems in hospitals are the managers and indeed *some* consultants. Frontline staff...doctors, nurses, carers, physios , psychologists, catering...all slog their guts out for people...I found this first hand during a rather long hospital stay...

I don't know anything about the top people but I have worked with and been seen to by the frontline and they are the best of the best. They want a better society and HSE just like everyone else and give everything they have for the job

dxhound2005

dxhound2005 wrote: »

The increase in longevity over the last few decades has been nothing short of astounding. That would point to a very effective health service.

I'm not talking about fertility ratio or infant mortality ratios. Being born is the most natural thing in the world and in the absence of a truly toxic environment most kids survive.
Ireland spends per capita similar amounts to France or Germany. It shouldn't need to as Irelands "capita" isn't of the same quality as those two countries; it is younger