An "Irish NHS" - what needs to change?

karlitob

lazygal wrote: »

You sound exactly like one doctor in Holles St I requested not be allowed to treat me based on how he spoke to me.

Did you get a prescription for hugs?

You sound like someone who doesn’t respond to the point but attacks the person cos you don’t like the questions.

Antares35

karlitob wrote: »

That’s not what I said.

To be honest, I'm finding it hard to distill exactly what it is you are trying to say, so I'll leave it there.

lazygal

karlitob wrote: »

Did you get a prescription for hugs?

You sound like someone who doesn’t respond to the point but attacks the person cos you don’t like the questions.

No one is attacking you.
You seem to have an oddly harsh way of posting. Maybe that's just your writing style.

PhoneMain

lazygal wrote: »

I had the master of the hospital as my consultant. She did all my c sections. A midwife would have been no good to me.

Obviously the midwife isnt going to be able to do the csection but they would have been able to do a lot of the same things that the master did up to that point and after it. You obviously went private, if you'd gone public then a registrar would more than likely have done as good a job on it.

The midwives were the ones who were looking after you after the operation as well, not the consultant bar 1 or 2 quick chats!! Believe me, I've worked with midwives and nurses and, as a doctor, I really know the benefit of them.

karlitob

lazygal wrote: »

You're spitting so much venom about choice in maternity care its hard to keep track of what you said.

Take your time. Reread it. Let me know if you’ve any queries.

karlitob

lazygal wrote: »

Women get to decide what's best for themselves. We don't live under the eighth amendment any more.

Haha. Waiting for it. Just waiting for it. Nothing got to do with anything at all on this thread. Instead of engaging in the discussion you accuse me of ...something. Slinging some mud.

What are point are you trying to make?

lazygal

karlitob wrote: »

Take your time. Reread it. Let me know if you’ve any queries.

Nice. Are you this condescending to all your patients?

AndrewJRenko

Economics101 wrote: »

I think that ED (I assume this is A&E) is all public system, at least as far as anything serious is concerned, so not much in the way of "queue-jumping", here. The queue-jumping argument is much more relevant for elective procedures, and where consultant referrals are concerned.

The VHI Swiftcare clinics and similar from other private providers are privatised ED, for the simpler, more basic ED cases at least. They'll take a lot of the cuts and broken limbs and sprains and strains.

karlitob

Antares35 wrote: »

At your booking appointment you will see a consultant and they assess if you are high risk and if so, that will preclude you from opting for midwife led care. So in that sense you are right, you cannot choose to go midwife led just because you want to, if you are high risk.

Yes - as I said.

Antares35 wrote: »

However this does not mean that you HAVE to be high risk to go consultant led, if you are paying privately. My understanding that private patients can opt for consultant led, notwithstanding that their pregnancy might be low risk and they would qualify for MWL if they wished.

I know that. That wasn’t what I said. You do not have to be private to go consultant led either.

High Risk cannot be midwifery led
Low risk can be midwifery led or consultant led or public or private.

The point of the the other posters comment as she is - without any nuance - that a patient (no matter what the clinical speciality is) can demand that a healthcare professional perform a treatment on the sole basis of their choice.

The other poster is not a healthcare professional. I am. A patient cannot make me or a nurse or a doctor perform a treatment, prescribe a drug or conduct an assessment just because they want to - because they have ‘choice’. It must be clinically indicated, based on the assessment by the HCP along with the information provided by the patient - the options are provided and the patient makes an informed decision - ie consent.

Banal comments about ‘choice’ don’t change that.

If you think being not being assigned a consultant at booking and being able to ‘choose’ a private consultant is some sort of ‘choice’. Then so be it.

Clearly the public consultant you didn’t ‘choose’ is the same private consultant you ‘choose’ in private rooms. So a choice I suppose. Where it’s meaningful to you, well that’s gonna cost you €5k to find out.

karlitob

lazygal wrote: »

Nice. Are you this condescending to all your patients?

Just the pains in the hoop.

Only kidding. I smile to their faces and pretend your ‘choice’ matters. Just like your private consultant did.

lazygal

karlitob wrote: »

Just the pains in the hoop.

Only kidding. I smile to their faces and pretend your ‘choice’ matters. Just like your private consultant did.

Can you state where you work so those of us who don't want you near us can avoid you.

karlitob

lazygal wrote: »

Can you state where you work so those of us who don't want you near us can avoid you.

Can you state what hospitals you frequent so we can avoid a patient like you.

lazygal

karlitob wrote: »

Can you state what hospitals you frequent so we can avoid a patient like you.

I'm in Dublin so any of those hospitals. Where do you work?

PhoneMain

lazygal wrote: »

I'm in Dublin so any of those hospitals. Where do you work?

I'd like to think trying to identify a poster is against Boards rules.......

lazygal

PhoneMain wrote: »

I'd like to think trying to identify a poster is against Boards rules.......

No need to give their name, just a heads up of the general area. I wouldn't think that the IMO wants doctors calling people a pain in the hoop and saying they want to avoid them on a public forum.

Ted_YNWA

karlitob wrote: »

Did you get a prescription for hugs?

You sound like someone who doesn’t respond to the point but attacks the person cos you don’t like the questions.

karlitob wrote: »

Take your time. Reread it. Let me know if you’ve any queries.

karlitob wrote: »

Haha. Waiting for it. Just waiting for it. Nothing got to do with anything at all on this thread. Instead of engaging in the discussion you accuse me of ...something. Slinging some mud.

What are point are you trying to make?

karlitob wrote: »

Can you state what hospitals you frequent so we can avoid a patient like you.

Mod

Don't post in this thread again.

Economics101

This from RTE's report on Varadkar's FG Adr Fheis speech yesterday:

The Tánaiste said the health services should retain the additional staff and billions of euro in extra funding which was provided to respond to the Covid-19 pandemic.

And in reaction to what he said:

Sinn Féin said it seems it took a global pandemic for Fine Gael to see that Ireland's health services are chronically underfunded

I thought that health funding in Ireland was just about the highest in Europe, when you take into account out demographics and private health insurance. No mention of what must be an extremely inefficient and ineffective system. Beware those who use emergencies such as a pandemic to make permanent power and resource grabs.

astrofool

Economics101 wrote: »

This from RTE's report on Varadkar's FG Adr Fheis speech yesterday: And in reaction to what he said:

I thought that health funding in Ireland was just about the highest in Europe, when you take into account out demographics and private health insurance. No mention of what must be an extremely inefficient and ineffective system. Beware those who use emergencies such as a pandemic to make permanent power and resource grabs.

Precisely, the problem with health isn't money it's organisation and union practices.

SF will tackle neither.

They will go after the private healthcare system (i.e. the bit that works), so on average, the health system in Ireland will get worse.

I have found in recent years (and pre-pandemic) that the private hospitals are getting overwhelmed too. Most certainly their emergency st ices are very limited, and although your consultant might try and get you a bed for a sudden exacerbation of your condition, it is becoming increasingly unlikely a bed be very available. Same if you attend a private hospital ED, when it is open, not always a bed available and sometimes very long times sitting in a chair. I was beside a girl on a chair in a corridor who has been sitting in great discomfort for 7 hours and was told she was booked for theatre at 11pm, so many more hours to wait on that chair. She was likely then only to spend that night or maybe also the next in a bed after the surgery. In a public hospital she might have been able to at least lie on a trolley.

Economics101

A good example is how little critical reaction there is to galloping cost over-runs, despite the lessons of the National Children's Hospital. The next big ticket item is the new maternity hospital at St Vincent's. The media are full of indignation about governance issues (I'm not denying their importance), but the fact that the estimated cost has gone from an original €150m to €300m to €500m (excluding equipment) and is now €800m in total, seems to be seriously under-reported and not critically analysed.
Somewhere in the system there must be a big element of total incompetence or total dishonesty.
The prospects for our health system are truly frightening.

Geuze

Economics101 wrote: »

I thought that health funding in Ireland was just about the highest in Europe, when you take into account out demographics and private health insurance. No mention of what must be an extremely inefficient and ineffective system. Beware those who use emergencies such as a pandemic to make permanent power and resource grabs.

You are correct.

We overspend on healthcare, relative to the age profile of our population.

The main reason is because the price of healthcare is very high here.

So even though we spend a lot, the volumes aren't high.

Seanergy

Kermit.de.frog wrote: »

People here won't even pay for water ffs. They think clean drinking water magically arrives from the reservoir to their taps courtesy of nature.

The HSE magically think adding fluorosilic acid to the drinking water has no negative knock on health effects.

Science 101: Add acid to water to accelerate rusting iron.

astrofool

Seanergy wrote: »

The HSE magically think adding fluorosilic acid to the drinking water has no negative knock on health effects.

Science 101: Add acid to water to accelerate rusting iron.

Primacy school science:
Countries which add fluoride to water have better dental health with no other side effects, but there are people who think otherwise, we call them loons.

Granadino

Why an "irish NHS". Why can't we look what our European neighbours are doing in Germany, Spain, Italy etc. Why does everything we do have to ape the English? Everything.

Seanergy

astrofool wrote: »

Primacy school science:
Countries which add fluoride to water have better dental health with no other side effects, but there are people who think otherwise, we call them loons.

How is that we ranked 13th for healthiest teeth in Europe last year and not 1st? Easy up on the Loony talk.

Dumping acid into the water was seen by FF as the easier and cheaper solution to training dentists and creating practices half a century ago.

Regarding this thread, we need to stop treating our drinking water as a solution to developing/investing in proper dental health practice.

astrofool

Seanergy wrote: »

How is that we ranked 13th for healthiest teeth in Europe last year and not 1st? Easy up on the Loony talk.

Dumping acid into the water was seen by FF as the easier and cheaper solution to training dentists and creating practices half a century ago.

Regarding this thread, we need to stop treating our drinking water as a solution to developing/investing in proper dental health practice.

Bring it to the appropriate forum or thread then, the science is sound on fluoride, those who deny it are loons.

dulpit

Seanergy wrote: »

How is that we ranked 13th for healthiest teeth in Europe last year and not 1st? Easy up on the Loony talk.

Dumping acid into the water was seen by FF as the easier and cheaper solution to training dentists and creating practices half a century ago.

Regarding this thread, we need to stop treating our drinking water as a solution to developing/investing in proper dental health practice.

https://touch.boards.ie/forum/576

Economics101

Granadino wrote: »

Why an "irish NHS". Why can't we look what our European neighbours are doing in Germany, Spain, Italy etc. Why does everything we do have to ape the English? Everything.

Agreed. I think some of this was touched on earlier on. The British tend to think that the NHS is the world's best, and so do many people in Ireland. Continental Europe has many excellent health systems, generally insurance-based.

CramCycle

Economics101 wrote: »

Agreed. I think some of this was touched on earlier on. The British tend to think that the NHS is the world's best, and so do many people in Ireland. Continental Europe has many excellent health systems, generally insurance-based.

Indeed, although I don't think its fair to say they are insured and we aren't. France is insurance based but that insurance is run by the government for the most part covering a huge chunk of any medical need, 100% where its very expensive or an LTI. You can then by supplementary insurance to cover the small gap between state insurance and the top up you might have to pay. In effect, a huge chunk of it is effectively state covered healthcare but they call it insurance, sort of akin to PRSI. Belgium which I found great was much the same, although it would appear if you didn't work you didn't get it, but I could be wrong about that.

So what these countries call Insurance, as far as I can tell is state subsidised healthcare you pay for out of your taxes. I think the biggest difference is management and the lack of tolerance of administrative waste. The US which is heavily private insurance based, costs a huge amount more in terms of %GDP, as well as an administrative cost that takes up I think around >40% of the overall cost, compared to I think around 6% in the UK, not sure what it is here. I understand we spend less than other EU countries in regards % of GDP but that might not be a fair indicator as GDPs vary. According to the journal.ie Ireland only uses 3% for administrative costs, although I don't know if that figure takes into account wages of admin staff as it seems low.

Geuze

CramCycle wrote: »

I understand we spend less than other EU countries in regards % of GDP but that might not be a fair indicator as GDPs vary. According to the journal.ie Ireland only uses 3% for administrative costs, although I don't know if that figure takes into account wages of admin staff as it seems low.

GDP is inflated by MNC activity here.

Look at healthcare exp pp instead.

We overspend.

Kermit.de.frog

I feel a lot of NHS propaganda seeps in here from Britain due to proximity and size difference which distorts reality for a fair few people who echo the same message. The reality is it is not that much better than the standard of service you get here with the HSE.

CramCycle

Kermit.de.frog wrote: »

I feel a lot of NHS propaganda seeps in here from Britain due to proximity and size difference which distorts reality for a fair few people who echo the same message. The reality is it is not that much better than the standard of service you get here with the HSE.

The only tangible difference for most is the charge at point of access. I do wonder, a and e charge if really stuck you can just not pay but I wonder would a GP refuse you access if you couldn't afford payment.

Geuze

CramCycle wrote: »

The only tangible difference for most is the charge at point of access. I do wonder, a and e charge if really stuck you can just not pay but I wonder would a GP refuse you access if you couldn't afford payment.

If your income is low that you can't afford a GP, you would probably have a GMS card?

Although you may be referring to people whose incomes are above the GMS cut-off, but not high.

CramCycle

Geuze wrote: »

If your income is low that you can't afford a GP, you would probably have a GMS card?

Although you may be referring to people whose incomes are above the GMS cut-off, but not high.

Pretty much, and there are a reasonable number of people who fall into that group. They are in that bracket where (and I am making huge assumptions, plenty of people who tick none of these boxes) they are typically young, so not often that ill but they have large expenditure on low pay, which is doable until something goes wrong. I was in that boat for years in my youth. Some though never have a huge increase in wage with age, never get quite enough for a mortgage so are paying large rent for life. The system will catch you but it catches you through sheer dumb luck and a lot of people don't realise they have to effectively cheat the system. Basically 55euro for a GP plus the script after the fact won't break the bank (although it might) but it will mean you don't have a comfortable end to the week or month. And for some, their cost/benefit analysis will say, don't go, and for most that will be fine but for some it can be a life altering choice. Also I just looked at the threshold limits for the card, there is a huge amount of people who earn more than that but don't have enough to cover a GP or A&E visit. €304 a week if living alone, so roughly €1350 a month net, take rent, food, travel etc out of that and in Dublin that 55euro is your petty cash. And that's just the GP visit card, not a medical one. A full time minimum wage job makes you ineligible effectively. I mean you cheat the system by not paying the A&E fee, or lying to your GP and saying you will sort them out later, if you are in that bad a shape.

McGiver

Geuze wrote: »

GDP is inflated by MNC activity here.

Look at healthcare exp pp instead.

We overspend.

Exactly by about 40% and rising. Anybody who mentions GDP (or an indicator derived therefrom) and Ireland in one sentence is either ignorant or a manipulator.

GNI* is all what we must use, as the OECD, IMF, EU, Government of Ireland and the Revenue do.

And yes, if you look at GNI per capita health care spending in Ireland it would be probably the highest, but realy poor bang for the buck...

Note: irish Debt/GNI ratio is 105%+ post-covid, just if someone wanted to say that Ireland cleared all its debt. It's heavily indebted, Dail/Gov reports say that in black and white.

McGiver

Geuze or anyone with a good knowledge of the HC here - why there is a tendency to look up to NHS and use it as the gauge to measure everything against it?

In terms of policy, why copy the UK NHS? And then also coy it badly. Why not look at the Netherlands or France or Belgium or Austria?

maccored

the NHS is pretty ****e. why copy it at all?

McGiver

maccored wrote: »

the NHS is pretty ****e. why copy it at all?

NHS has very many great experts for sure, in London, which is an Alpha++ global city, no surprise!

But overall it's s**e, compared to the continental Europe, based on my own experience, if you ask me.

maccored

McGiver wrote: »

NHS has very many great experts for sure, in London, which is an Alpha++ global city, no surprise!

But overall it's s**e, compared to the continental Europe, based on my own experience, if you ask me.

according to my parents and siblings living in the north, it's pretty bad. My mother has a two month wait to get her bloods done. even here is better than that

Grueller

RandomViewer wrote: »

Dobby was the reason for most of the objections, in a lot of cases people had already paid large fees for a water connection and development fees when they built the house, NCT came in without a hitch 12 years earlier, people saw blatant criminal corruption in Irish water and objected, as I said the ESB had an existing database and another levy on the bill would have gone unchallenged,

What about those with their own private water supply?

riclad

The NHS is not perfect but it's better than the American system where people are going on gofundme for basic medical treatments
And people here can also pay private medical insurance
Eg in America it can cost 5000 dollars for a woman to have a baby in hospital
There are long waiting lists for operations in the hse or to see a consultant

McGiver

riclad wrote: »

The NHS is not perfect but it's better than the American system where people are going on gofundme for basic medical treatments
And people here can also pay private medical insurance
Eg in America it can cost 5000 dollars for a woman to have a baby in hospital
There are long waiting lists for operations in the hse or to see a consultant

Yes, and? Everyone knows the US system is unsustainable. Pointless mentioning it.

Ireland is in Europe, in the European Union. Why using the NHS as a benchmark or even a model for the HSE?

Look beyond the UK, look into European systems. The Dutch one is very reasonable for example. So is the German, both have let's say "market" elements, but are well regulated on the gov level.

AndrewJRenko

https://boards.ie/discussion/comment/117606758#Comment_117606758

This was FG policy for years, follow the German or Dutch universal insurance model. Except when they got into power and started doing the proper policy research, they worked out that it wasn't going to work on a small island like ours.

Economics101

https://boards.ie/discussion/comment/117634623#Comment_117634623

I agree that FG may not have done enough homework on universal insurance. This doesn't mean that it was a bad idea. I would say that an insurance model takes a lot of power away from HSE and DoH administrators and civil servants. It would also take power away from health service unions (who at times appear to run the show) - imagine if your hospital's revenue was not from a guaranteed state grant, but from what the hospital could earn.

It would take an awful lot of cojones to take on these vested interests and win.

AndrewJRenko

https://boards.ie/discussion/comment/117634662#Comment_117634662

It would give all that power that you've taken away from the State to one or two private insurers, whose sole objective is to make money for their shareholders. Scary.

dulpit

https://boards.ie/discussion/comment/117634662#Comment_117634662

Why would we want a health service run by entities who's sole focus was on revenue? That's a horrible idea...

Economics101

https://boards.ie/discussion/comment/117635077#Comment_117635077

https://boards.ie/discussion/comment/117635799#Comment_117635799

I hope no-one thinks that I am talking about an un-regulated insurance market or a badly-regulated one (like the USA). Insurance-based systems properly regulated can produce good outcomes as in France, Germany and many other European countries. We need more power to the clients/patients and less to the civil servants, who. like almost everyone else pursue their own interests. Of course governments will always subsidise healthcare whether insurance-based or not. It would be hugely important to ensure that the benefits of these subsidies are not captured by the insurers.

I think that there is a fair potential for subsidy-capture in any system

AndrewJRenko

https://boards.ie/discussion/comment/117639071#Comment_117639071

We don't have the scale to get the economies of scale available to insurers in Germany, France and others.

https://boards.ie/discussion/comment/117635077#Comment_117635077

I've heard it all now from you. Willing that people continue to suffer and die at the hands of our health service rather than see changes that simply go against your ideology,

I don't know how you can sleep soundly at night or live with yourself.

AndrewJRenko

https://boards.ie/discussion/comment/117648661#Comment_117648661

I sleep fairly well thanks, given that my analysis matches with just about every health expert in the country. It's nothing to do with ideology. It's just a fact that our market is too small for universal health insurance, as FG found when they had a huge majority in Government and still couldn't make it happen.