An "Irish NHS" - what needs to change?

AndrewJRenko

Geuze wrote: »

You may recall in 2011 (?), the FG/Lab Govt planned to introduce UHI.

UHI = universal health insurance

Plans were developed, but eventually abandoned.

I think it could be a good idea.

I am not confident about Slaintecare.

It was abandoned because it was unworkable. We're just too small to have multiple UHI providers competing. Let's not waste another decade on this.

Be careful what you wish for with the NHS. My brother tells me about the mad redial rush at 9am when he needs to get back to his GP. It's worse than trying to get through to Ticketmaster for a hot ticket in the old days before online purchase. He has to be ready at 9am with three phones, speed dialling in the hope of getting through to the administrator and booking a slot, 2 or 3 weeks ahead.

Wanderer78

AndrewJRenko wrote:

Be careful what you wish for with the NHS. My brother tells me about the mad redial rush at 9am when he needs to get back to his GP. It's worse than trying to get through to Ticketmaster for a hot ticket in the old days before online purchase. He has to be ready at 9am with three phones, speed dialling in the hope of getting through to the administrator and booking a slot, 2 or 3 weeks ahead.

The NHS has been undermined since its existence, but particularly since 08, elements of it have been privitised, or pushed more so towards it, which is an element of why it preforms as such

Hamsterchops

Why did I pay €60 to see the Doctor? Why did I wait six months for an MRI of my spine, (and get charged for it)? Why are dentists soo bloody expensive here too?

The answer lies in the fact that we're a very small country of four million people approx, it's s small tight privately run monopoly, whereas the NHS is vast with a vast income that caters for all the regions of the United Kingdom, Eng, Scot, NI & Wales, the NHS is not a small underfunded service, it's free, open and inclusive < not perfect, but bloody good none the less.

gctest50

Charles Babbage wrote: »

.

.........because patients spend an extra day in hospital. ........

And the hospital collects about €1000 per night for each patient from the vhi/laya magical money tree

AndrewJRenko

hustlenbustle wrote: »

I think the Irish Medical system is quite good when you get in but it takes far too long to get there. Waiting lists are huge. I am a believer as someone else here said that nothing should be free. Even if you're on a very low income you should have to pay something. For example at the GP - many people seem to go with very little wrong with them because they have a medical card. If even 5 euro was the cost per visit for these medical card holders they wouldn't go unless absolutely necessary. The same with hospital there should be some charge - nothing free. The only people I would accept getting a fully free service with no charge would be those who are seriously ill or disabled. I pay 60 euro per visit so you can be sure I don't go too often!!
I also think once in hospital everyone should pay - again graded according to your income. A very low charge for medical card holders and whatevers there at the moment for the rest of us. They should have better out of hospital services so that an acute hospital isn't the only option depending on what's wrong with you. It seems like everyone packs into the one place - a hospital- regardless of the problem. Again I'd charge for this service.
It seems to me if we want a better health service we have to pay for it - after all even if you get it for free someone has to pay for it. If everyone paid something it would help a lot but I feel that today we expect too much for nothing.

Is there any actual evidence to support this thinking? Who goes to their GO just for the craic? Isn't it better to flag issues early, and let them be treated early and more cheaply, rather than letting things fester?

shesty

The biggest changes would be for the public to realise they have to pay more tax to fund the kind of Health service they rave about on their Continental holidays; for public consultants to only do public work and if they want to do private work, they have to ship out to somewhere like the Beacon full time, where they do private work only and use only the facilities of a private hospital; and for the public (again) to realise that they can give up the health insurance because it is feeding into this hybrid public/private thing we have and making the problem worse.

The rest would lie in systemic changes in the HSE around how money is used,where hospitals are located, how primary care works in the community and similar.I think as someone else said it is too late to go for an NHS model, something similar to the Continent would probably work better.

Hamsterchops

PhoneMain wrote: »

Just wondering do you complain when you have to pay a plumber/electrician/ carpenter/ painter?

No, that's different, but I did complain when they started charging for air at the petrol stations, air should be free, water too, and we should get basic health care for free too IMO.

Hamsterchops

PhoneMain wrote: »

So does the air and water just magically appear in your tyre or is there costs involved in setting it up?

Similarly, who should pay the GPs salary, the nurses salary, the receptionists salary? What value do you place on a GPs role and years of training? Believe me, if GPs are in it for the money, they'd make a lot more money a lot easier in other careers

Thankfully only air appears in my tyres (not water), and as regards paying the doctors and receptionists, well that's the magic of the NHS, which sadly we don't have

Wanderer78

Hamsterchops wrote: »

Why did I pay €60 to see the Doctor? Why did I wait six months for an MRI of my spine, (and get charged for it)? Why are dentists soo bloody expensive here too?

The answer lies in the fact that we're a very small country of four million people approx, it's s small tight privately run monopoly, whereas the NHS is vast with a vast income that caters for all the regions of the United Kingdom, Eng, Scot, NI & Wales, the NHS is not a small underfunded service, it's free, open and inclusive < not perfect, but bloody good none the less.

the nhs is far from free, there is no free, elements of the nhs are probably far better run than the hse, and vice versa, health systems are extremely complex, all are problematic, but theres clearly something seriously dysfunctional with the hse

Hamsterchops

Hamsterchops wrote: »

What needs to change?

Well firstly we need to be part of a much bigger population of about 65 million people. The reason the NHS is better than the HSE (relatively speaking), is because of the sheer size of the NHS and the costs are spread far and wide, the NHS is moulded on a regional basis, NHS England being the largest, then you also have the NHS in Scotland, Northern Ireland & Wales.

Actually there might be an argument for the NHS being extended down here (from NI) in the event if a United Ireland. Understandably the North would not want to let it go, so maybe as a bargaining chip the NHS is extended into the ROI, obviously with us paying our share.

Now there's a nice thought.

Probably not a runner though, but it would be one way of us actually getting the NHS down here. Free GP visits for all like they have up North.

The NHS works because it's spread across such a large population.

Absolute bollocks

Pandiculation

The biggest issues I find with the HSE are queues / waiting lists in some areas that are utterly ridiculous.

The most stark example of it I had was a relative of mine was booked in for cataract treatment for ages and eventually got an appointment on the treatment purchase found in a private hospital.

That was all great, but it was for just one eye. Seems they won’t do both or put each eye on separate waiting lists. Either way she wasn’t going to be getting covered for more than one eye.

We decided to pool some funds from various family members and just pay for the second one, which cost a few thousand Euro as we were very worried she was losing independence and at risk of falling.

Anyway, that all went fine, until the anaesthetist demanded that they be paid in cash on the day and actually asked for it in the operating theatre!!

We had no way of finding / contacting them beforehand and didn’t even know who they were.

The payment was left for him with the consultant.

The relative was then afraid that she was going to have to do the operation in her senses or something.

Then despite being paid his wife made a rather aggressive call to my relative demanding payment.

The whole thing was chaos and weird.

Honestly was the first time I felt like I wasn’t living in a developed country. Absolutely horrible experience and very embarrassing to be asked for cash in a hospital like that and in those circumstances.

Also why do so many doctors and consultants seem to not be able to accept cards or cheques. Revenue needs to look into some of it. It’s not right.

I’ve had experiences myself where despite full VHI cover a consultant asked me for two post dated cheques ahead of surgery. This was quite a few years ago but it was just bizarre stuff too.

We’re quick to sneer at the American setup but it seems at times we’ve large elements of it here too.

I can’t imagine either of those situations ever happening anywhere else I’ve lived in Europe.

It’s an absolute mess of a system to put it mildly and I think we’ve put up with it for too long. We aren’t exactly doing it on a tiny budget either. Our per capita funding of health is higher than the NHS and in the upper end of the EU spectrum.

Politically, I’m not sure why we put up with such a mess tbh.

You also see it being talked about as a “crisis”. It really isn’t. It’s a chronic situation that’s been going on as long as I can remember.

I don’t buy this woe is me argument that we are too small and we are certainly not lacking the resources to get this working right. Plenty of small countries, and many with far less financial resources, manage to run far better public health services. Even within big countries, these services are often in HSE sized chunks in provinces, states and regions too. So it’s not too hard to compare.

I also don’t buy the notion that we are underfunding it. There’s huge public money going into healthcare here but the system is just not setup correctly.

Also where it works, it often works well. I’ve elderly relatives in advanced cancer care in the public system and you couldn’t fault the treatment they are getting. It’s very high tech and has comprehensive supports. So we can do it in some areas but once you get into electives and so on, it’s a total mess.

Hamsterchops

Deleted User wrote: »

Absolute bollocks

Thanks you, I'll take a bow

mariaalice

Personally, I do think some sort of basic insurance scheme is the way to go and everyone pays something to it, however, individuals should be allowed to purchase other insurance plans that allowed cove beyond the basic if they want.

The system should be free at the point of use for GP care and incentivise community care in other words all ancillary care should be in a community care center or In a GP practice.

There should be nurse lead clinics that do sexual health, vaccinations, post, and pre-delivery care, well-woman, and well-man clinics, aged care that is not medical, and so on, no one needs a doctor for any of that care. It would be cheaper and more efficient to do it that way.


They also need a top-notch IT system.

Trex.

mariaalice wrote: »

Personally, I do think some sort of basic insurance scheme is the way to go and everyone pays something to it, however, individuals should be allowed to purchase other insurance plans that allowed cove beyond the basic if they want.

The system should be free at the point of use for GP care and incentivise community care in other words all ancillary care should be in a community care center or In a GP practice.

There should be nurse lead clinics that do sexual health, vaccinations, post, and pre-delivery care, well-woman and well man clinics aged care that is not medical, and so on, no one needs a doctor for any of that care. It would be cheaper and more efficient to do it that way.


They also need a top-notch IT system.

Sounds like nonsense

mariaalice

Trex. wrote: »

Sounds like nonsense

How so?

Pandiculation

mariaalice wrote: »

How so?

They appear to have closed their account so we’ll never know!

RandomViewer

PhoneMain wrote: »

So does the air and water just magically appear in your tyre or is there costs involved in setting it up?

Similarly, who should pay the GPs salary, the nurses salary, the receptionists salary? What value do you place on a GPs role and years of training? Believe me, if GPs are in it for the money, they'd make a lot more money a lot easier in other careers

€20billion of tax collected towards it, if they want to charge ,no state aid

RandomViewer

PhoneMain wrote: »

Pretty poor understanding of our healthcare set up there buddy.

€60 plus the same again in the chemists puts a lot off going to the doctor, high doctor costs leads to poor health outcomes for many, how is this poor understanding?

RandomViewer

PhoneMain wrote: »

"If they want to charge, no state aid". Do you expect patients to be seen for free so?

I think a fee, say €10-20 and the same for prescriptions, people dying because the don't qualify for medical card and can't afford doctor,

Geuze

RandomViewer wrote: »

€60 plus the same again in the chemists puts a lot off going to the doctor, high doctor costs leads to poor health outcomes for many, how is this poor understanding?

GPs charge 50+, 60 in your case.

French GP charge 25.



Irish GP gets 60 for vaccination, nearly double the UK rate.

Healthcare is way too expensive here.


A consultant in France charges 60. Bear in mind France is a high-cost society.

micosoft

jimmycrackcorm wrote: »

I'm not surprised that so many in a poll want an NHS style system here. If you asked if pubs should give out beer for free then you'd get the same results.

The problem is the NI NHS is not the same as the England NHS. Worse in many cases esp GP care. A lot of myth building in UK media has blinded people to relative performance.

dulpit

People have mentioned a 2 week plus wait for GP on the NHS. Do you need to schedule your illness or what's the story?

Tallyho !

dulpit wrote: »

People have mentioned a 2 week plus wait for GP on the NHS. Do you need to schedule your illness or what's the story?

This would apply to non-urgent cases.Population growth in some areas hasn't been matched by infrastructure spending.
Welcome to Brexit.

BrianD3

2 weeks' wait for a GP appointment, GP surgeries not answering the phone - sounds familiar. That is something that many people living outside of cities in Ireland will have experienced.

GPs not taking on new patents (even private) is a related issue.

As GPs are contractors for the publlc health service, the state and HSE can wash their hands of the problem. Not enough GPs in a particular area - not our problem, shur we can't force GPs to setup a practice somewhere. Too many people for the number of GPs, ah that's the Council's fault for giving planning permission for too many houses.

The NHS may have its problems but as there is a structure and more direct responsibility, the problems could be solved much more easily than the problems with the Irish health service.

Pandiculation

BrianD3 wrote: »

2 weeks' wait for a GP appointment, GP surgeries not answering the phone - sounds familiar. That is something that many people living outside of cities in Ireland will have experienced.
.

That's a growing issue in suburban and city centre Ireland too.

McGiver

PhoneMain wrote:

Just wondering do you complain when you have to pay a plumber/electrician/carpenter/painter?

Only a demagogue would compare a GP to a plumber.

Healthcare is not an ordinary service but an essential need. Different rules must apply to healthcare and the provision thereof. Almost all countries in the EU and most of the civilised world agree on this.

Only the US seem to think that healthcare is a fully commercial service that should be traded in an open market. This is a road to hell and leads to massive spiralling leeching by the HC providers and insurance companies on everyone else including the state. Ireland should steer clear of this.

McGiver

Charles Babbage wrote:

In the Irish health system you have false economy, you save €1000/week by not having an additional person in the diagnostics dept, which results in operations being delayed by a day costing €10,000/week because patients spend an extra day in hospital. But there is never a rational comparison of these costs. If things were run efficiently then the present budget would pretty much provide free health care, charging patients €20 for a doctor might still be advisable for policy reasons.

Absolutely.

I wouldn't mind a token GP charge either. Serves as a regulator and soft deterrent from overuse.
Up to 20 euro, no problem

jimmycrackcorm

pauly58 wrote: »

Fourty years ago the NHS worked superbly, the National Insurance contribution was reasonable & basically the system worked, fast forward & now they treat the world & his wife for free & it's all overloaded. Nye Bevan never envisaged such levels of immigration when the NHS was devised. If they charged anyone without a National Insurance number as do the Canadians, it might work.

Immigration hasn't been the problem behind the stress on the NHS. It's well-proven during the Brexit campaign that immigrants contribute more financially to the UK than they get in benefits.

Healthcare has gotten more expensive in the last forty years but also illness outcomes and life expectancy have massively improved. The funding for the NHS has not matched this growth. Forty years ago there were no expensive MRI machines and a fraction of the drugs available.

The Canadians have their own problems also.

McGiver

AndrewJRenko wrote:

It was abandoned because it was unworkable. We're just too small to have multiple UHI providers competing. Let's not waste another decade on this.

Why not? Works fine in Austria and Czechia. Not huge countries by any measure. Or Finland, same size, also peripheral market.

UHI/NHI is absolutely essential for any sort of Continental style health care reform.

NHS is out of question, it's a British one-off project, can't be duplicated here 70 years later, in a much smaller country with a different preconditioning.

jimmycrackcorm

PhoneMain wrote: »

So you want a significant proportion of the patient population to start paying for going to a GP? Good luck being the politician trying to push that through. Just so you know, the majority of my patients that I see every day are medical card patients including children.
Also, if you think GP is the gravy train, why do we have such a shortage of GPs with a large proportion of those retiring in the coming years being unable to be replaced and a lot of graduating GPs planning to emigrate in the coming years .
Also, GP is one of the most efficient sectors of the healthcare system mainly because they are free of HSE bureaucracy. Yet you want to change that.

My OH had a friend with a medical card that brought their child to the doctor for every little sniffle and scratch. We had to pay so we only brought ours when it was absolutely necessary.

Our GP / Doctor shortage is down to the artificial restrictions we have in the numbers we train. ITs a highly protected profession that we still seem to regard as being demi-Gods. The last time I went to the doctor, he looked up a book in front of me to find what drug to prescribe. Then I went to a pharmacy to pick up a standard course of tablets that the overly paid pharmacist just had to pick off the shelf.

But these things aren't ever challenged. It's like challenging religion.