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An "Irish NHS" - what needs to change?
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Morally it is repugnant and hopefully with Slaintecare the use of PHI to jump the queues in Public hospitals will end.
Hopefully, yes.
But I wonder will people be quick to give up their PHI?
Or will they first want to see the public hosps and their staff meet the 12/13 week Slaintecare waiting time targets?0 -
People chose private healthcare for a wealth of reasons. I don’t have it. I don’t see the point of it. I can’t tell you how many public patients I’ve treated for them all to say ‘I have VHI that’s why I’m being looked after so well’. It’s not. They were admitted as public patients - cos that’s where you go when you’re sick - a public hospital. (EDs don’t close which is why blackrock ‘ED’ is not an ED. It’s hard to call the beacons Ed and Ed when it’s on the first floor). Health insurance is like car insurance - if you don’t use it in that year it’s not worth much to you. I also don’t see the point any person ‘going private’ for their pregnancy. Same doctors, same midwives, same hospitals. If you’re unwell, you’ll be treated by expert clinicians regardless if you private consultant says it’s a good idea to eat your placenta. Irish women could single handedly wipe out private practice in Ireland for one single area of healthcare in one fell swoop.
Regarding why people get health insurance. It's usually access, not the care that you pay for. My dad needed a hip replacement. Took a couple of months, he had insurance. My father in law needed a knee replacement, it took a couple of years because he didn't have insurance. So my father in law suffered for much linger as a result.
As to level of care/etc when it's the same doctors, my mum always tells me the story of when I was a toddler. I suffered with eczema awful, and went to clinic to be sorted. The consultant who saw me was gruff, barely reviewed me and sent me on my way. My mum then went to a private clinic, with the exact same consultant. He spent ages with me making sure all was sorted, because of course he did - he was getting paid for it.
And for pregnancy, you get access to your consultant throughout, there's a continuation and familiarisation that occurs that doesn't in the public system. We didn't go private when my wife was pregnant, but I can see why people would.0 -
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And for pregnancy, you get access to your consultant throughout, there's a continuation and familiarisation that occurs that doesn't in the public system. We didn't go private when my wife was pregnant, but I can see why people would.
Firstly - this just isn’t true. Sure who do you think holds the clinics and delivers the babies. If you think a private consultant is at every private baby’s birth you’ve another thing coming. What do you think a public consultant is doing when they’re not in private rooms? Also, you get reviewed based on need. If you’ve a healthy pregnant why do you need to be seen by an obstetrician at every appointment. People can waste €5k to make themselves feel better but paying does nothing for the outcome of th woman or the child NOTHING. Could you imagine the newspaper headlines if it did.
Secondly - I can see no clinical reason. We have the safest and best obstetric service in the world. The lowest (or close) maternal and baby mortality in the world.0 -
Hopefully, yes.
But I wonder will people be quick to give up their PHI?
Or will they first want to see the public hosps and their staff meet the 12/13 week Slaintecare waiting time targets?
The single payer model is insurances
based. People will have to pay for insurance. The GPs didn’t want what james Reilly was offering back in 2011. They wanted multiplayer in a tiny market. I understand Australia regret the change from single to multi.
Don’t know much more about it than that.0 -
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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.
No real argument about the quality of public v private care: it's all about speed of access. Part of the problem is that in our system, tax-funded hospitals by and large get resources which are not directly dependent on "output" (sorry to use such an industrial term), whereas private facilities depend directly on "output" for their income. The incentive problem is obvious, and even if you throw more money at the public system the incentive problem will still be there.
BTW if one were to nationalise all health facilities and forbid private treatment, some people would simply go abroad. More inequality. Or do you want to forbid foreign travel for medical treatment? We had a referendum on that a few years back!
I’m not sure what you’re on about in your last paragraph.
With regards output - there are outcomes and activity. The health outcomes of people in ireland are fairly high worldwide. We live long. Our women and babies don’t die in childbirth. Our children don’t die. But we have pockets. Some cancers we’re not so good. Others we’re very good. Suicides we’re not so good. Socioeconomic disparity we’re not so good.
But as for activity. We’re not so bad. Cancer services are good. Our ED is excellent (there is no such places as A&E). Our admission from ED to the wards is not great but when you consider that we’ve 50% (or so) less beds than scotland and we’re continually at 100% + occupancy rate then I think that’s pretty good output. Considering that investment in the health service hasn’t kept pace with our ageing population for years. In other words, the HSE wasn’t given commensurate increases in funding to match the increase in activity (more people getting older). I’m sure you’ll reference €20bn. If you know if a way to hire 16,500 highly trained healthcare professionals and build 5000 beds in a year - I’m all ears.0 -
I can categorically say I got better care in the private maternity system. It wasn't about making myself feel better. The individual care from my consultant when **** hit the fan was worth every cent. As was the the private room afterwards.Firstly - this just isn’t true. Sure who do you think holds the clinics and delivers the babies. If you think a private consultant is at every private baby’s birth you’ve another thing coming. What do you think a public consultant is doing when they’re not in private rooms? Also, you get reviewed based on need. If you’ve a healthy pregnant why do you need to be seen by an obstetrician at every appointment. People can waste €5k to make themselves feel better but paying does nothing for the outcome of th woman or the child NOTHING. Could you imagine the newspaper headlines if it did.
Secondly - I can see no clinical reason. We have the safest and best obstetric service in the world. The lowest (or close) maternal and baby mortality in the world.0 -
I can categorically say I got better care in the private maternity system. It wasn't about making myself feel better. The individual care from my consultant when **** hit the fan was worth every cent. As was the the private room afterwards.
As did my partner, the horror story that was Holles St a few years ago if you had any issues or were, god forbid, unmarried was nothing short of abuse. Second time we went private, never regretted it for a second, it was a totally different experience. Now you can argue that both children were delivered successfully, and no one died but there was a difference in overall care that simply should not exist.
I say this as someone who fully believes private care should not exist here, it should be fully nationalised, we should flood the healthcare system with doctors and nurses so that no one has to do overtime, so that none of them are constantly exhausted. As someone with many friends and family in the area, nearly all would be happier with no overtime in return for adequate staffing.0 -
I’m not sure what you’re on about in your last paragraph.
With regards output - there are outcomes and activity. The health outcomes of people in ireland are fairly high worldwide. We live long. Our women and babies don’t die in childbirth. Our children don’t die. But we have pockets. Some cancers we’re not so good. Others we’re very good. Suicides we’re not so good. Socioeconomic disparity we’re not so good.
But as for activity. We’re not so bad. Cancer services are good. Our ED is excellent (there is no such places as A&E). Our admission from ED to the wards is not great but when you consider that we’ve 50% (or so) less beds than scotland and we’re continually at 100% + occupancy rate then I think that’s pretty good output. Considering that investment in the health service hasn’t kept pace with our ageing population for years. In other words, the HSE wasn’t given commensurate increases in funding to match the increase in activity (more people getting older). I’m sure you’ll reference €20bn. If you know if a way to hire 16,500 highly trained healthcare professionals and build 5000 beds in a year - I’m all ears.
My last paragraph was in response to some other posters suggesting that total nationalisation of health services was somehow warranted: in what purports to be an open society it is an impossibility. And with reference to another poster, Nye Bevan did not nationalise everything: there were still private hospitals and doctors in private practice, albeit for a very small minority.
Sure we have an ageing population, which has required, and in future will require, more resources. But recurrent expenditure on the public system in Ireland has rocketed in the past 5 years, and we have the spectacle of agreed budgets being exceeded year after year. As for extra beds (5000?), a physical impossibility in a year. But even a multi-year capital programme will be a huge challenge. The Children's hospital debacle shows that something radical needs to be done in terms of capital programme management before more money is wasted. (My suspicion is that the detailed specifications are not properly worked out prior to contracts being signed: you need to "freeze" the specs at some stage - this holds for all complex projects).
As for my misnaming ED as A&E, big deal. When I was much younger they were known as Casualty Departments. Heavens knows what they will be called in a few years, although that decision will probably have to await the deliberations of a HSE Taskforce (or is it Working Group?) :rolleyes:0 -
I can categorically say I got better care in the private maternity system. It wasn't about making myself feel better. The individual care from my consultant when **** hit the fan was worth every cent. As was the the private room afterwards.
Well you can only ‘categorically’ say it from your perspective.
Are you suggesting then that the midwives treated you better during your labour than another women who didn’t pay (cos remember, you don’t pay the midwives anything - only the consultants)
Are you saying that private consultants treat their public patients poorer than their private patients.
Are you saying that the private consultant is on site 24/7 so s/he is there to deliver your baby.
There’s about 60000 births every year and you don’t speak for them. The clinical outcomes however do speak for all involved. There are no clinically meaningful differences in outcomes between public and private maternity care. If you are sick - diabetes, blood pressure issues, or other sort of complications - you will be seen by the experts in your care regardless of whether you want to waste €5k or not.
Why do women not advocate as strongly for private gynaecological care as they do for private obstetric care?
Why do the people who quote slaintexare not start a campaign to end private obstetric care? It’s not like the docs would have any choice in the matter if everyone just didn’t show up to their clinics.
I know plenty of women who’ve never gone public and ‘swear by’ the private system when they’ve nothing to compare it against. I know plenty of women who went to different maternity hospitals privately for each of their babies as ‘they heard’ that there was a better private doctor in another hospital. Blah blah blah. Or you ‘had a bad experience’ with x doctor or x system. And as is often the case, people confuse adverse outcomes with poor care. Pregnancy and labour are hard. It’s not 100% within the control of anyone - least not the docs and miwdwices. Clearly things happen - not getting an epidural in sufficient time etx. But healthcare and hospitals are risky places. And it’s not always possible to do whatever wants when everyone wants. If the same time money and effort went into the perinatal support, counselling, women’s health physio, lactation support as it does with going to a private consultant cos it makes you feel better then everyone would be better off. As it is you pay €5k and then when you need help you don’t have it.
I understand the importance of private rooms. We just don’t have enough. You only get a private room if it’s available. If there are sick oeople, women whose babies are dying or died - they get the room. And not on the basis of your money.
And as for ‘shot’ hit the fan. The midwife during labour wasn’t private. The equipment that was used wasn’t private. The anaesthetist who supported the obstetrician if it was that serious wasn’t private. The theatre team if it was that serious wasn’t private. The Reg wasn’t private. The paediatrician who reviewed your baby wasn’t private.
You paid the consultant to make you feel better. Your tax paid for everyone else to ensure you had a safe deliver for you and baby (which I hope you did). But don’t tell me €5k into that consultants pocket meant that you got better care than a women in the same situation as you did who didn’t pay.0 -
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Economics101 wrote: »My last paragraph was in response to some other posters suggesting that total nationalisation of health services was somehow warranted: in what purports to be an open society it is an impossibility. And with reference to another poster, Nye Bevan did not nationalise everything: there were still private hospitals and doctors in private practice, albeit for a very small minority.
Sure we have an ageing population, which has required, and in future will require, more resources. But recurrent expenditure on the public system in Ireland has rocketed in the past 5 years, and we have the spectacle of agreed budgets being exceeded year after year. As for extra beds (5000?), a physical impossibility in a year. But even a multi-year capital programme will be a huge challenge. The Children's hospital debacle shows that something radical needs to be done in terms of capital programme management before more money is wasted. (My suspicion is that the detailed specifications are not properly worked out prior to contracts being signed: you need to "freeze" the specs at some stage - this holds for all complex projects).
As for my misnaming ED as A&E, big deal. When I was much younger they were known as Casualty Departments. Heavens knows what they will be called in a few years, although that decision will probably have to await the deliberations of a HSE Taskforce (or is it Working Group?) :rolleyes:
No - making is a big deal. That’s why the ‘Cork Spastic Clinic’ in the old regional no longer exists.
Casualty is a somewhat derogatory word to the ED people. It hasn’t been A&E in 20 or so years. The HSE didn’t decide anything - it’s clinical advice from the clinical leaders. The people who you go to see in the ED. Maybe you can roll your eyes to them.
Nationalisation. I take your point. But as I’ve said before - the two linchpins of our primary care service are GPs and pharmacists. All private. All are gatekeepers to the accessing the public purse. All need individual contracts to be signed. GPs see out medical card patients, write prescriptions and sick certs that we pay for, then go to the private company to dispense who then charge us for the pleasure. As you’ll see in my other post - there’s a fascination with private obstetric care. But clearly this is unsustainable that private companies are gatekeepers to the public purse. We have limited authority over them to make change. So while I’m not a fan of the extreme nationalisation that you are defending I don’t think our current model is fit for purpose. Something’s gotta change.
Funding has rocketed as the DoH didn’t fund the basic increase is normal activity based on population for years - it’s not just caught up. The funding wasn’t ‘agreed’. The DoH dictate. They didn’t give us enough. How else can you reason out that we have a bed occupancy rate of over 100%. That means we always fill all of our beds always. What more ‘management by the HSE’ do you want? Our OPD and ip service are reported in the ntpf website every month. 600,000 people waiting to be seen. Do you think the docs are just scratching their arse? The clinics are full. The theatres are full. What sort of management do you think is required to create capacity for 1/7th of the population (presuming I have my numbers right). Yes there is slack - better processes and structure are needed. Ict in particular but as I allude below - it’s a capital cost and large scale structural investment is costly on time and money. Local investment and structures are put in place but it’s piecemeal and can create problems of integration down the line. Real problems. As for improving processes - all I can say is that change costs money. Our clinicians are so busy they don’t have the headspace for full review of their processes. Nor do they necessarily have the headspace. There are excellent pockets of course but not everywhere. And if you think a HSE manager can swan in to w consultants clinic and offer help to improve - ha some fun.
An icu bed is a million - as highlighted through the pandemic there has been a requirement for about 450 icu beds to reach international norms. That 1/2bn - on a budget at the time of 12 to 16bn. Which service are gonna pick to not get a little bit of the pot to improve their service to their patient. Icu is only one small part of the our health service.
As for capital plans, it seems like your suggesting that all required builds and equipment upgrades can come out of this years allocation. It’s in the service plan what will be built. There’s a published capital plan of what’s needed now - just to keep the show on the road. It’s in the billions. Everyone keeps referencing the highly politicised children’s hospital but no one references the national forensic service in portrane. Large build, on time and on budget. See what can happen when healthcare is not politicised.0 -
As did my partner, the horror story that was Holles St a few years ago if you had any issues or were, god forbid, unmarried was nothing short of abuse. Second time we went private, never regretted it for a second, it was a totally different experience. Now you can argue that both children were delivered successfully, and no one died but there was a difference in overall care that simply should not exist.
Catastrophising language aside (‘horror stories’ come on - you go to a crash in zone 1 or watch a baby die - then talk to me about ‘horror stories’) - I would argue that yes everyone is safe and healthy so a good outcome and I would agree that there shouldn’t be a difference in ‘care’ which is my point about removal of private care from healthcare/obstetrics. You’re basically saying that you paid for the midwives and doctors to be nice to you. And that if you don’t pay they’re not nice to you. Not clearly that’s not the case for all 60000 births every year. And even if it was - money has caused that difference, not need.
Furthermore - if you believe your partner or you has suffered ‘abuse’ at the hands of healthcare professionals you are entitled to your medical notes, you can make a complaint (backed by legislation) to the hospital, you can complain to the ombudsman (backed by legislation) or you can complain directly to the regulatory body of the individual who abused you ( also backed by legislation). In other words, your tax money has funded avenues for you to report and seek a review of your care by structures and process put in by our publicly funded legislature. Interestingly, some of those avenues are not covered for private hospitals - hiqa, complaints etc. Which is another example of how the private sector is not held to the same account as the public sector. I also disagree that ‘abuse’ as you put it doesn’t happen in the private sector. There are plenty of complaints about GPs and pharmacists. And rightly so.I say this as someone who fully believes private care should not exist here, it should be fully nationalised, we should flood the healthcare system with doctors and nurses so that no one has to do overtime, so that none of them are constantly exhausted. As someone with many friends and family in the area, nearly all would be happier with no overtime in return for adequate staffing.
Fine. Of course healthcare is more than just doctors and nurses.
Twitter.com/drmarkmurphy/status/1168269599231631366
Some excellent insights here for those interested0 -
Economics101 wrote: »Sure we have an ageing population, which has required, and in future will require, more resources. But recurrent expenditure on the public system in Ireland has rocketed in the past 5 years, and we have the spectacle of agreed budgets being exceeded year after year.
Yes, h/c expenditure in Ireland is too high, relative to the age profile of our population.
We are spending as much per person, as countries with older populations.
The reason for this is high prices, not high volumes of activity.0 -
Yes, h/c expenditure in Ireland is too high, relative to the age profile of our population.
We are spending as much per person, as countries with older populations.
The reason for this is high prices, not high volumes of activity.
Exactly. While our population is ageing. It’s not the oldest in Europe nor is it the largest population share in Europe. In other words we have a smaller and younger older person population in ireland.
If you think it’s bad now....0 -
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A quick question, at the moment is everyone entitled to use Primary Medical Care centres in Ireland, regardless as to whether or not they hold a medical card?0
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If a GP is based in the PCC, then you pay the GP as normal.
As in, people with GMS don't pay.
People without GMS do pay.
Regarding the other possible services in a PCC, I presume they are all tax-financed?0 -
Spanish Eyes wrote: »A quick question, at the moment is everyone entitled to use Primary Medical Care centres in Ireland, regardless as to whether or not they hold a medical card?
I not sure the question but generally no, Ireland is the only country in the oecd with no universal primary health care service. But if there’s a gp in there you can pay to see. There are a number of primary healthcare centres rhay are effectively public private partnerships with the gps. I might have that arseways - I’m sure someone here can comment.0 -
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If a GP is based in the PCC, then you pay the GP as normal.
As in, people with GMS don't pay.
People without GMS do pay.
Regarding the other possible services in a PCC, I presume they are all tax-financed?
It doesn’t mean they’ll accept. Lots of services don’t accept referrals without a gp / GMs. In other words, if you pay for a gp and she refers you to physio in the primary health centre they won’t see you privately - you go on the list like everyone else. If you go see the gp on gms and they refer to physios - you still go on the list.
A lot of services not use the medical card as the sole method for managing their waiting lists. In the instance above, they might not accept the private patient at all as they’re not gms. As I note, Ireland is the only country on oecd where Primary care is not universal.
Mad really0 -
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What exactly does this mean? I often wonder.
Does it mean that people abroad don't have to pay to go to the GP?
As a legislative right, Irish citizens do have a universal entitlement to primary care treatment. GMS holders do, but all other persons don’t. We have subsided hospitals and medication care. Very good subsidies in my view. But full cost in the community.
https://www.tandfonline.com/doi/full/10.1080/23288604.2018.15517000 -
As a legislative right, Irish citizens do have a universal entitlement to primary care treatment. GMS holders do, but all other persons don’t. We have subsided hospitals and medication care. Very good subsidies in my view. But full cost in the community.
https://www.tandfonline.com/doi/full/10.1080/23288604.2018.1551700
"The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care.1"
Surely everybody has equal access to a GP?
Some may have to pay, yes, okay.
But all people have the right to go to a GP, nobody is excluded, and there isn't a waiting list that can be jumped if you have insurance.
In France, people also have to pay to go to a GP.
How can it be then said that France has something that Ireland doesn't have?0 -
The one thing I do believe is totally wrong is the fact that you can't access the public health nursing services for a lot of services unless you have a medical card.
As for pregnancy, you do not need to see a consultant unless there is an issue, it should be midwife-led care all the way, in the UK the woman would be seen by a midwifery team all through pregnancy and would spend very little time in a hospital even a first time mother could be discharged 6 hours after giving birth, however, they would be visited at home by the team and a lactation consultant would visit them in their home Appointments are much better coordinated and organised.
Hear it can be a bit shambolic not in terms of care but in terms of appointments.0 -
I had no interest in midwife led maternity care when pregnant.0
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I had no interest in midwife led maternity care when pregnant.
Midwives are going to be vastly more experienced than a lot of the doctors that you may encounter during your pregnancy!! A lot of the doctors you will see may be SHOs (level above intern but below regs who are below consultants) and in reality they may have max 6 months experience (if they're GP trainees) or have less than 2 years experience in obstetrics.0 -
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Midwives are going to be vastly more experienced than a lot of the doctors that you may encounter during your pregnancy!! A lot of the doctors you will see may be SHOs (level above intern but below regs who are below consultants) and in reality they may have max 6 months experience (if they're GP trainees) or have less than 2 years experience in obstetrics.
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.0 -
Firstly - this just isn’t true. Sure who do you think holds the clinics and delivers the babies. If you think a private consultant is at every private baby’s birth you’ve another thing coming. What do you think a public consultant is doing when they’re not in private rooms? Also, you get reviewed based on need. If you’ve a healthy pregnant why do you need to be seen by an obstetrician at every appointment. People can waste €5k to make themselves feel better but paying does nothing for the outcome of th woman or the child NOTHING. Could you imagine the newspaper headlines if it did.
Secondly - I can see no clinical reason. We have the safest and best obstetric service in the world. The lowest (or close) maternal and baby mortality in the world.
I went for midwife led care on both my pregnancies because I wanted that continuity of care. Mostly saw the same midwife each time. I cannot find one single fault with the care I received. The only long wait time I had was at the initial booking appointment but that is generally expected to be around two hours because you're in and out for different tests etc. When I needed an epidural, there was an anesthetist there within ten minutes. When it looked like I might need an assisted birth (which thankfully in the end I didn't) they already had someone in place for that. I really don't think anyone will be deprived medical attention they require simply because they are public or have gone midwife led.0 -
mariaalice wrote: »That is interesting why? all the evidence would say it's the best way to go.
I wanted a consultant and a specific consultant. As I needed sections I'm even more glad it wasn't midwife led. And if you've any issues you need a consultant anyway so I'd rather have one I know and not whoever is available. I'm done with pregnancies but I'd go consultant led every time.
I found the advice on breastfeeding atrocious from all the nurses on my first.0 -
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The state should provide the best evidence-based health care it can, but the state cant support the choices people are making because of a nonevidence base perception that private hospitals or private health care will have 'better'.0
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