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 The fallacy of private health care efficiency

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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 3:27 am

seinfeld wrote:
Pax wrote:
seinfeld wrote:
Pax wrote:
seinfeld wrote:
Pax wrote:
seinfeld wrote:
The issue is that public patients cannot access public beds because private patients are sitting in them.

What needs to be done?

Well, certainly not colocation. That's not a solution and only exacerbates the situation (as shown by similar elsewhere).

What then?

I've never heard an opponent of co-location actually answer this question.

You must have missed my posts earlier then where I said we should increase capacity directly within the public system.

Why should we be spending public money to provide capacity for private patients to jump the queue?

The problem is not that we have insufficient public capacity; the problem is that we have insufficient private capacity.

That's another one of your non-sequiturs. The private for-profit capacity you propose is at the public expense.

Using public beds for private patients is also at the public expense.

You suggested your non-solution (which you've already accepted is less efficient) was not at the public expense.
Seriously, after all I've posted, how can you think I'm in favour of our two-tier system? Your repeated points are clearly an illogical irrelevancy and your previous one was a non-sequitur, which I see you've continued again.

seinfeld wrote:

Pax wrote:

It will not free up public beds. It will not increase capacity.

Hmmm. A thousand extra beds in the system, that can be used by the HSE, will neither free up public beds or increase capacity?

I wrote earlier,


Pax wrote:
seinfeld wrote:
Pax wrote:
seinfeld wrote:
I haven't even disagreed with him/her.

It is now obvious you are not engaging honestly here.

I don't recall disagreeing with you. In fact, I probably do agree with you.

Well you have disagreed. As is plainly obvious to any sentient being reading the thread.

seinfeld wrote:

My general view on the subject is that a single tier sytem funded by mandatory universal health insurance is the most efficient and equitable model.

However, tactical solutions to immediate, urgent and specific problems - like colocation - shouldn't be discounted because they don't fit with an over-arching theory. Idealogy guides me; it doesn't blind me.

I agree on idealogy, mine is malleable with what I see in the real world. If the majority of medical journals studies suggest correlations between lung cancer and smoking I take it on board. In the same way, I see colocation as making things worse, not better. I don't find it boring or relevant that it fails to create cognitive dissonance with my idealogy.

Of course colocation is just another example of an implementation of for-profit health care. I've just used the example of medicare using for-profits above and the attendant increased costs and inequity - which you ignored. A similar policy was tried in Australia and it proved to be a disaster for the public health system - again as shown by research into the policy it acted as a tax on the public system and failed to free up beds. It was a subsidy to those who could already access care and to the more expensive for-profit private hospital sector increasing health care inequity unnecessarily.


Parallel Private Health Insurance in Australia: A Cautionary Tale and Lessons for Canada

Quote :
Abstract:
Canada's restrictions on the role of private health insurance for publicly insured physician and hospital services are unique among countries with universal, publicly funded health care systems. Pressure is mounting in Canada, however, to loosen these restrictions and create a parallel system of private finance. Advocates argue that creation of a parallel system of private finance will ensure the sustainability of the public system (by reducing public cost pressures), improve access to the public system (e.g., by reducing wait times), and improve quality in the public system (through competition).

Opponents of parallel private finance argue that it will create "two-tiered" medicine, increase costs, compromise equity and reduce quality and access to publicly financed health care as those with the financial means (and often the strongest voice) exit to private insurance. Australia provides a particularly promising case study for Canada regarding the dynamics of parallel systems of public and private finance.

This paper examines Australia's experience with parallel finance for inpatient hospital services to provide insight regarding:

(a) the effectiveness of a parallel system of private finance in reducing costs and wait times in the public system;

(b) risk selection between the parallel public and private insurance sectors;

(c) the financial redistribution associated with the introduction and maintenance of a parallel system of finance; and

(d) the dynamics of the broader political economy associated with parallel systems of finance.

Australia's experience provides a number of lessons for Canada, including:

(1) the potential for cost savings through introduction or expansion of a parallel private sector is very limited;

(2)the introduction or expansion of a parallel private finance is unlikely to reduce wait times in the publicly financed system;

(3)there is no simple way to regulate private insurers to pursue public objectives;

(4) it is impossible to create an independent, isolated parallel system of private finance - interactions between the public and private insurance sectors are complex and unavoidable;

(5) quality plays a key role in driving the dynamics between the public and privately financed sectors; and

(6) it is essential to articulate clear policy objectives for health care financing and to design public and private roles consistent with these objectives. Our overall conclusion is that the Australian experience provides a cautionary tale regarding the risks, costs and benefits of a parallel private system of health care finance.


seinfeld wrote:
Pax wrote:

Why not include VHI insurance funds to fund a public only, single-payer single tier system?

What?

The money going towards VHI should go directly towards a single tier system. Don't tell me you haven't heard of that before?

seinfeld wrote:

Pax wrote:

If people want ancillary treatements within private facilities then they can pay them without public subsidy via private for-profit insurance if they want. You know, like they do in France.

Because the private facilities wouldn't exist if the incentives didn't exist.

That's not an answer to the point I made. (And in fairness, you've failed to answer most points raised by most posters here, not just mine...but anyway...) You remove the incentive and pay for a public single tier system. Like they do in most developed nations.

seinfeld wrote:

You answer is to the connumdrum is still: increase public capacity, and my question is still: why should the public purse be financing capacity that is being used by private patients.

I've answered that already. See above. Also, you're not fooling anyone with this stuff Wink
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 3:44 am

Pax wrote:
seinfeld wrote:
You answer is to the connumdrum is still: increase public capacity, and my question is still: why should the public purse be financing capacity that is being used by private patients.
I've answered that already. See above. Also, you're not fooling anyone with this stuff Wink
If you're referring to the Cautionary Tale as being your answer then I'd disagree that it addresses it - Seinfeld has a point I feel with the way our system is currently - as he says, why would we build hospitals with public money for private-paying queue-jumpers?

Is a solution to tax everyone equally, abolish VHI and run it like the NHS - as far as I understand that set up? We seem to have some well established old private hospitals already - does anyone know an exhaustive list of them and have they some stats on it? I know the Bons Secours tend to be private - how did a religious order get to set some private hospitals in the first place?

Subsidising the queue-jumpers to the tune of 40 million per hospital, which would provide beds, equiptment, infrastructure, staff and services etc. for the public too sounds to me like it has some merit and may be a good deal. The private patients pay and the public patients don't and the public also get to use the private facilities ... Sounds like there's a snag there somewhere.

I'm not sure co-location is the same as a full private health care system .. Should we really be asking whether it is a species of a private health care system or not and if not how co-location relates to other private systems? To me it sounds like one bastard.
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 3:58 am

Auditor #9 wrote:
Pax wrote:
seinfeld wrote:
You answer is to the connumdrum is still: increase public capacity, and my question is still: why should the public purse be financing capacity that is being used by private patients.
I've answered that already. See above. Also, you're not fooling anyone with this stuff Wink
If you're referring to the Cautionary Tale as being your answer then I'd disagree that it addresses it - Seinfeld has a point I feel with the way our system is currently - as he says, why would we build hospitals with public money for private-paying queue-jumpers?


Well just to clarify, my point is actually that the non-solution* which is colocation is much, much worse than the 'private-paying queue-jumpers' situation (that's just a distraction on seinfeld's part) and that we should move towards a system where we take out the queue-jumpers and the for-profit element. In the interim we should clearly fund the public system and not colocation.



*(which seinfeld has just agreed with me upthread that funding such for-profit corporate healthcare like co-location, is actually less efficient and is wasteful...)

Auditor #9 wrote:
I'm not sure co-location is the same as a full private health care
system .. Should we really be asking whether it is a species of a
private health care system or not and if not how co-location relates to
other private systems? To me it sounds like one bastard.

To be frank. To me it's clearly the one b'stard!
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 4:22 am

I'd certainly agree that if a system is widely recognised as being more wasteful and inefficient etc. then we should go for the less wasteful one, being the public one in this case. I think too that it's a point worth making that the for-profit ethos might simply not fit in with the idea of healthcare anyway - at some point, services of a medical nature cannot (and maybe should not )be subject to the market. Dentistry seems to operate well under the market down my neck of the woods as it happens though I couldn't tell you about anything else medical - you can't really shop around to have a brain tumour removed, can you?

There's still the matter of a private tradition in Ireland which seems to work well; how would you propose to assimilate that? Isn't there EU laws restricting government and other monopolies on business?
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 4:28 am

Auditor #9 wrote:
There's still the matter of a private tradition in Ireland which seems to work well; how would you propose to assimilate that? Isn't there EU laws restricting government and other monopolies on business?

That doesn't apply to healthcare...yet.
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 10:56 am

Seinfeld

Quote :
You answer is to the connumdrum is still: increase public capacity, and my question is still: why should the public purse be financing capacity that is being used by private patients.

There is no conundrum. The co-location option also finances private patients at public cost. Private patients pay insurance and many also pay p.r.s.i. There is no reason why they shouldn't be treated in public hospitals provided they don't jump the queue.

I am in favour in Ireland, because of the low population density (lowest in the EU), of having a single system of regional hospitals that operate as bases for centres of excellence, with a strong structure of primary care at local level. There is no reason why smaller local hospitals couldn't provide maternity services, clinics, 'step down' and therapeutic services. The system should have enough capacity to treat everyone.

Doing away with wastage, like those endless unneccessary cancer follow up consultations, and providing proper step down for elderly patients should help a lot. We have plenty of nurses, not enough G.P.s, too many top managers and about the right number of lower admin - clerical posts. They just need to be working within a rational and well co-ordinated system.

I wouldn't make the HSE managers redundant - they could be redeployed in the public service or voluntary sector. I really don't think they should be paid for doing nothing, it would be demeaning to their abilities and wasteful.

I think that people needing to travel for treatment should get free, comfortable, transport and overnight accommodiation.
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 12:05 pm

cactus flower wrote:
I am in favour in Ireland, because of the low population density (lowest in the EU), of having a single system of regional hospitals that operate as bases for centres of excellence, with a strong structure of primary care at local level. There is no reason why smaller local hospitals couldn't provide maternity services, clinics, 'step down' and therapeutic services. The system should have enough capacity to treat everyone.

Doing away with wastage, like those endless unneccessary cancer follow up consultations, and providing proper step down for elderly patients should help a lot. We have plenty of nurses, not enough G.P.s, too many top managers and about the right number of lower admin - clerical posts. They just need to be working within a rational and well co-ordinated system.

Do you think cost and inefficiency is the main barrier to good public health service, cactus?

There used to be a stronger local network of rural hospitals but a lot have been closed or converted and I wonder is that because of high expense or lack of local population. I'm convinced that there are other issues around the hospitals, the main one being population density and peripherality of location in some cases. It would be interesting to watch it in the cities as that's where the colocated hospitals are going but down around here there will be a centre of excellence in Limerick which is grand for Ennis residents despite their moaning about the hospital but it's the periphery of the county beyond Ennis that's in question - places in West and North Clare are already 30+ miles from Ennis with Limerick another 20 miles beyond that. It gets worse for villagers even farther out in the extreme West - Limerick hospital could be as far as 70 miles from them ... - the solution being to introduce some sort of flying doctor paramedic service... There's regularly half jokes about calling the Coast Guard before the Ambulance if you need a maternity hospital in a hurry. The upshot is that more children are being born in their parents native Clare now instead of neighbouring Limerick - often in their mother's car on the way to the maternity hospital in Limerick city Laughing

I wouldn't mind putting a few sites together which might be watches on the colocation project or containing quick-reference details about it. If you come across any news or watch sites on your net travels please be sure to link to them in your posts.

http://www.irishhealth.com/index.html?level=4&id=13012
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 12:30 pm

Having a baby isn't an illness, so I think there should be local midwives / maternity wards with a helicopter service available for the few occasions when something serious goes wrong. Women in the islands have to leave home a week ahead of time and be induced under the present system, and I know they hate it because of having to be so far away from family. County Cork is the worst situation.

Population density really is a problem in Ireland because we are being told that centres of excellence can only be achieved with really high population numbers per centre (based on UK model) and those numbers are spread over a really wide area. Then I read somewhere and I think posted a link on this thread that France and Germany who perform better than the UK on most health scores go on much smaller numbers - say 200,000 - which would be about Irish county level - so where is the truth ?

I wonder did whoever did the study showing we needed only 3 or 4 main hospitals in Ireland factor in the stress and delay that occurs when people have to travel 3 hours and back to hospital, or did they just look at countries with much higher population density ?

These centres may be O.K. for cancer - after all the rich fly to the States to get the best treatment - but are not O.K. for A + E and maternity where speed can be a matter of survival.
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 12:45 pm

I've a feeling we'll see some of that 'stress of travelling' you mention above a bit more if A+E services are reduced from hospitals. There was a story reported in the Clare Champion about it last year where someone from Carrigholt in West Clare (nearly 40 miles from Ennis A+E) had a heart attack there but survived though the journey was the twelfth circle of hell for them. They were saying that if A+E at Ennis goes away then they'd have to go another 25+ miles to Limerick where the hospital is at the other side of the city (until that new tunnel opens) and the chances of making it are thus reduced.

This is only the odd story though and wouldn't change policies or the minds of politicians. Collateral damage if you die in the ambulance outside Bunratty...

(this is a different topic though from the private healthcare one so I'll just stop now and head for the beach)
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 5:48 pm

Pax wrote:
Auditor #9 wrote:
Pax wrote:
seinfeld wrote:
You answer is to the connumdrum is still: increase public capacity, and my question is still: why should the public purse be financing capacity that is being used by private patients.
I've answered that already. See above. Also, you're not fooling anyone with this stuff Wink
If you're referring to the Cautionary Tale as being your answer then I'd disagree that it addresses it - Seinfeld has a point I feel with the way our system is currently - as he says, why would we build hospitals with public money for private-paying queue-jumpers?


Well just to clarify, my point is actually that the non-solution* which is colocation is much, much worse than the 'private-paying queue-jumpers' situation (that's just a distraction on seinfeld's part) and that we should move towards a system where we take out the queue-jumpers and the for-profit element. In the interim we should clearly fund the public system and not colocation.

You still haven't answered the question.

If we expand the public system without expanding the private system, the public system, financed by the taxpayer, will continue to be used by private patients.

The only way to stop private patients using the public system is to facilitate the creation of enough private capacity to accommodate all private patients.

Please tell us how you propose to stop private patients using the public system, ie, how you would end the situation in which the public patient is subsidising the private patient.
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 5:51 pm

cactus flower wrote:
Private patients pay insurance and many also pay p.r.s.i. There is no reason why they shouldn't be treated in public hospitals provided they don't jump the queue.


Jesus!!!

That's the whole point!!!!

The only reason that they pay private insurance is that they know they will be able to jump the queue!! Why, in Gods name would you pay private health insurance if you have to queue up for access with public patients?

Really.
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 5:53 pm

cactus flower wrote:

These centres may be O.K. for cancer - after all the rich fly to the States to get the best treatment - but are not O.K. for A + E and maternity where speed can be a matter of survival.

No one is proposing that the COE model be used for anything other than Cancer Surgery.
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 6:00 pm

seinfeld wrote:
You still haven't answered the question.

Oh I certainly have. All you're now offering is illogical non-sequiturs as 'arguments'. Prior to that you were calling peer-reviewed studies a pile of rubbish. Then you moved towards using yawn smilies.

You are not engaging honestly but I'll try one more time - read my posts again. We shouldn't be funding the for-profit private system, and certainly not via the worst of all worlds which is co-location. You know the co-location you are in favour off.
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 6:09 pm

seinfeld wrote:
cactus flower wrote:
Private patients pay insurance and many also pay p.r.s.i. There is no reason why they shouldn't be treated in public hospitals provided they don't jump the queue.


Jesus!!!

That's the whole point!!!!

The only reason that they pay private insurance is that they know they will be able to jump the queue!! Why, in Gods name would you pay private health insurance if you have to queue up for access with public patients?

Really.

Well yes, Seinfeld: it is a bit silly isn't it. We give tax reliefs to the better off to get private health insurance, and then allow them to get priority use of public health services, that are in any event paid for out of general taxes. It is a bit like the same nonsense in the education system where a small top up payment gets you private education paid for by all tax payers.

That is why I am not in favour either of the present system of co-location. I am in favour of people getting treated according to their needs, with a universal health insurance system that everyone pays into according to their means.

But this thread is not about the sanity or morality of the existing health system. That may be why you are not getting the answers you are asking for: they would be off topic.

Why don't you start a thread on the existing system if that is what you would like to discuss?
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 7:57 pm

Pax wrote:
seinfeld wrote:
You still haven't answered the question.

Oh I certainly have. All you're now offering is illogical non-sequiturs as 'arguments'. Prior to that you were calling peer-reviewed studies a pile of rubbish. Then you moved towards using yawn smilies.

You are not engaging honestly but I'll try one more time - read my posts again. We shouldn't be funding the for-profit private system, and certainly not via the worst of all worlds which is co-location. You know the co-location you are in favour off.

I shall persist, Pax.

Lets define the problem:

Private patients using public beds because of absence of private capacity.

Your solution:

Divert all private health premia into public system so that we have a single-tier system where all patients are public.

Fine, except that it isn't possible to implement this solution in Ireland.

We can't ban either the provision of private health care or private health insurance (unless we leave the EU and amend the Constitution so that we can sequester all the private hospitals owned by the religious orders) so we will always have private patients.

These patients have to go somewhere, and currenty they are using the public system, because we don't have sufficient private capacity.

So if we can't legally implement your proposed solution, what *legal* solution do you propose?
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 8:35 pm

Well, I suppose two obvious moves would be to stop tax relief on private medical insurance and to make paying public contributions compulsory.

Also to stop subsidising private hospitals through tax reliefs.

The capacity problem has got nothing whatsoever to do with the principle of how the service should be provided. I would assume that none of us is arguing in favour of underproviding capacity, no matter what system we are talking about?
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 8:41 pm

cactus flower wrote:
Well, I suppose two obvious moves would be to stop tax relief on private medical insurance and to make paying public contributions compulsory.

You keep missing the central point.

There is no point in funding the public system while private patients are using it. You first need to get the private patients out of the public system, otherwise the taxpayer is subsidising the private patient.

Nor can you ban private healthcare.

So for as long as we have private patients, how do we accommodate them without allowing them to use public resources?
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 10:42 pm

Seinfeld said
Quote :
There is no point in funding the public system while private patients are using it.

Are you sure that is what you meant to say?

Quote :
Nor can you ban private healthcare.

Nobody said that.

Quote :
So for as long as we have private patients, how do we accommodate them without allowing them to use public resources?

I really have no idea what that question is intended to mean.
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 11:13 pm

seinfeld wrote:
We can't ban either the provision of private health care or private health insurance (unless we leave the EU and amend the Constitution so that we can sequester all the private hospitals owned by the religious orders) so we will always have private patients.

I never said we should ban it. In fact I pointed out the example of France to you a few posts up.
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PostSubject: Re: The fallacy of private health care efficiency   Sat May 24, 2008 11:59 pm

Pax wrote:
seinfeld wrote:
We can't ban either the provision of private health care or private health insurance (unless we leave the EU and amend the Constitution so that we can sequester all the private hospitals owned by the religious orders) so we will always have private patients.

I never said we should ban it. In fact I pointed out the example of France to you a few posts up.

So the question comes again:

What do you propose we do with the private patients who are using public beds?

Private patients don't use public beds in France, because France as sufficient private capacity. In fact, France has an abundance of private health care facilities and providers (the mix is about 65% public/35% private). Patients have access to both public and private providers through the CMU (they get a larger % rebate when they use a public facility) but the system is composed of both public and private providers.

Interesting that you would use this as an example, given your aversion to private medial care.

The only fully public system I know is in Canada, but Canada isn't in the EU, so they have that option.
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PostSubject: Re: The fallacy of private health care efficiency   Sun May 25, 2008 12:14 am

Well your argument Seinfeld is that the only reason anyone pays for private insurance is to jump the queue because of lack of capacity. As I have said several times already, the answer is to increase the capacity of the public service, stop paying tax relief on private insurance and stop subsidising the private system by ending reliefs, grants, tax incentives etc. By your admission if the public service was good for everyone, the vast majority would use it. By your admission thus the private system requires that the public system be kept at an inadequate level. I am not going to answer the same question again.
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PostSubject: Re: The fallacy of private health care efficiency   Sun May 25, 2008 12:17 am

seinfeld wrote:
Pax wrote:
seinfeld wrote:
We can't ban either the provision of private health care or private health insurance (unless we leave the EU and amend the Constitution so that we can sequester all the private hospitals owned by the religious orders) so we will always have private patients.

I never said we should ban it. In fact I pointed out the example of France to you a few posts up.

So the question comes again:

What do you propose we do with the private patients who are using public beds?

That was addressed several times already. Your faux concern for private patients in public hospitals is countered by your fevered ideological support for co-location.

seinfeld wrote:

Private patients don't use public beds in France, because France as sufficient private capacity. In fact, France has an abundance of private health care facilities and providers (the mix is about 65% public/35% private). Patients have access to both public and private providers through the CMU (they get a larger % rebate when they use a public facility) but the system is composed of both public and private providers.

Interesting that you would use this as an example, given your aversion to private medial care.

The only fully public system I know is in Canada, but Canada isn't in the EU, so they have that option.

You are incorrect about France. In fact, according to the OECD et al, it is a complete misconstruing of the French system.

Which means those French figures are incorrect and misleading. Almost 80% of France's total health spending is publicly funded, about 10% is paid for by mutual non-profit insurers (mutuelles) and private insurers, and the remainder is paid for directly by patients.

The majority of the 10% of private sector insurance in France is non-profit - 80%, and these are known as mutuelles and operate on the principle of solidarity. France has never embraced market competition as a public policy strategy for providing health coverage and controlling costs. Simply because it increases costs as evidenced by the US system and elsewhere.
Also, the the provision of universal health care based on need was one of the aims of the French resistance during WWII.

Private health insurance serves as a complementary function in the French system, private insurance is not purchased to avoid public sector queues or to access a different type or quality of care than what is available to patients with only public coverage.


Seriously seinfeld, as amusing as this is for me, stop digging. As CF pointed out this thread is about the efficiency or not of private for-profit health care. As you've --already agreed-- with me on for-profit health provision's intrinsic inefficiency and increased bureacracy in comparison to public non-profit healthcare, then I feel we are only going in round in circles.

In sum. Start yer own thread on this subject that is bothering you, as suggested by CF a few posts up.
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PostSubject: Re: The fallacy of private health care efficiency   Sun May 25, 2008 1:43 am

Pax wrote:
seinfeld wrote:
Pax wrote:
seinfeld wrote:
We can't ban either the provision of private health care or private health insurance (unless we leave the EU and amend the Constitution so that we can sequester all the private hospitals owned by the religious orders) so we will always have private patients.

I never said we should ban it. In fact I pointed out the example of France to you a few posts up.

So the question comes again:

What do you propose we do with the private patients who are using public beds?

That was addressed several times already. Your faux concern for private patients in public hospitals is countered by your fevered ideological support for co-location.

You haven't answered the question. You have proposed a system (the diversion of private premia into the public system) that would illegal under EU Law (not to mention politically impossible) and hurled lots of personal abuse.

The question again:

If there isn't enough private capacity to accommodate private patients, how do you create it?

Pax wrote:

seinfeld wrote:

Private patients don't use public beds in France, because France as sufficient private capacity. In fact, France has an abundance of private health care facilities and providers (the mix is about 65% public/35% private). Patients have access to both public and private providers through the CMU (they get a larger % rebate when they use a public facility) but the system is composed of both public and private providers.

Interesting that you would use this as an example, given your aversion to private medial care.

The only fully public system I know is in Canada, but Canada isn't in the EU, so they have that option.

You are incorrect about France. In fact, according to the OECD et al, it is a complete misconstruing of the French system.

Which means those French figures are incorrect and misleading. Almost 80% of France's total health spending is publicly funded, about 10% is paid for by mutual non-profit insurers (mutuelles) and private insurers, and the remainder is paid for directly by patients.

The majority of the 10% of private sector insurance in France is non-profit - 80%, and these are known as mutuelles and operate on the principle of solidarity. France has never embraced market competition as a public policy strategy for providing health coverage and controlling costs. Simply because it increases costs as evidenced by the US system and elsewhere.

http://www.civitas.org.uk/pubs/bb2France.php

"French national insurance makes no distinction between public and
private hospitals and patients have complete freedom of choice. Public
hospitals provide about 65% of beds and the remainder are private
(about 20% are for-profit and about 15% non-profit)

http://www.iedm.org/main/show_mediareleases_en.php?mediareleases_id=172

"There are 1,052 hospitals in France's private for-profit health care
sector, accounting for 37% of all health care establishments with full
hospital capacity and 21% of beds. This is about double the size of the
private for-profit sector in the United States, which comprises 15% of
hospitals and 12% of beds. "These private health care providers play an
indispensable role in the French system, in a country with social
democratic traditions, and they do not pose a threat to the
accessibility or universality of care," say economists Yanick Labrie
and Marcel Boyer. "This runs counter to the line taken by defenders of
the status quo in Quebec, whose thinking goes against the approach
taken in most developed countries."
"


Pax wrote:

Private health insurance serves as a complementary function in the French system, private insurance is not purchased to avoid public sector queues or to access a different type or quality of care than what is available to patients with only public coverage.

I haven't disputed this, but the fact this is why Irish people purchase private health insurance should indicate to you how seriously dysfunctional the current system is, and why something (legal) needs to be done to change it.
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PostSubject: Re: The fallacy of private health care efficiency   Sun May 25, 2008 2:06 am

Pax wrote:
Seriously seinfeld, as amusing as this is for me, stop digging. As CF pointed out this thread is about the efficiency or not of private for-profit health care. As you've --already agreed-- with me on for-profit health provision's intrinsic inefficiency and increased bureacracy in comparison to public non-profit healthcare, then I feel we are only going in round in circles.

In sum. Start yer own thread on this subject that is bothering you, as suggested by CF a few posts up.
Perhaps we can agree that this thread has run its course now but provided much food for thought as well as valuable studies and data that could be used in another thread on the existing system.

The discussion up to now has been a theoretical one on the subject of efficiency in public versus efficiency in private health care and we all seem to have come to some agreement that for-profit health care isn't necessarily made efficient by the market in the same way that other businesses and products respond to the market.

The discussion has also been theoretical with regard to Ireland as Ireland has a hybrid system of bastardized public/private which is getting more mongrel as we speak. Private health care has had a good long tradition here - please correct me if I'm wrong on that - and the public care system has also had a good run too so both species of business can be dissected here to all our heart's content.

Some questions are left unanswered - if public health is so much more efficient than private then why isn't it a lean machine in our country? The perception is that the HSE is famously top heavy and riddled with greedy consultants and cantankerous nurses constantly looking for pay rises and all sorts of other piss-taking that seems to justify the need for a dictatorship in the organisation, one who is willing to cull, cull, cull and import foreigners at half the cost as well as...

Some other questions are why haven't we provided those beds we always seem to be in need of? Is it a political decision only or are there structural reasons for wanting to go down the colocation route? Do we have to go down that route anyway once Lisbon gets ratified and we have to provide public alongside care provided privately? Is the argument for a fully public system moot and academic now in the event of a 'Yes' vote next month?

So many questions, so little server space. If you are generally agreed that this thread is looping then it'll be closed and a new one opened on the existing system and what it is, how it works, how much it costs, where we expect it to go, how we will adjust it to meet our needs ...

And I'd be so happy if ye'd all play the ball not the man. Or as Declan Ganley says, "Policy not Politics, David".
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PostSubject: Re: The fallacy of private health care efficiency   Sun May 25, 2008 2:30 am

seinfeld wrote:
You haven't answered the question.

I have.

seinfeld wrote:
You have proposed a system (the diversion of private premia into the public system) that would illegal under EU Law (not to mention politically impossible) and hurled lots of personal abuse.

No I haven't. I've proposed a universal single-tier system that is not illegal under EU law. It is most certainly not politically impossible as it has been achieved in practically all developed nations. Many developing nations are moving towards similar.

I'll leave most of the contributors here to decide on who has been the most honest and the less abusive over this debate.

seinfeld wrote:

The question again:

If there isn't enough private capacity to accommodate private patients, how do you create it?

I've answered that point repeatedly as has CF. You've repeatedly ignored it. We can all can see that.


seinfeld wrote:

Pax wrote:

seinfeld wrote:

Private patients don't use public beds in France, because France as sufficient private capacity. In fact, France has an abundance of private health care facilities and providers (the mix is about 65% public/35% private). Patients have access to both public and private providers through the CMU (they get a larger % rebate when they use a public facility) but the system is composed of both public and private providers.

Interesting that you would use this as an example, given your aversion to private medial care.

The only fully public system I know is in Canada, but Canada isn't in the EU, so they have that option.

You are incorrect about France. In fact, according to the OECD et al, it is a complete misconstruing of the French system.

Which means those French figures are incorrect and misleading. Almost 80% of France's total health spending is publicly funded, about 10% is paid for by mutual non-profit insurers (mutuelles) and private insurers, and the remainder is paid for directly by patients.

The majority of the 10% of private sector insurance in France is non-profit - 80%, and these are known as mutuelles and operate on the principle of solidarity. France has never embraced market competition as a public policy strategy for providing health coverage and controlling costs. Simply because it increases costs as evidenced by the US system and elsewhere.

http://www.civitas.org.uk/pubs/bb2France.php

Well done on linking and quoting civitas seinfeld. I think we should be honest on our political allegiances and ideologies. I see yours has no correspondence to the reality of health care in France, - as I posted about earlier,- and is comparable to civitas' ( IEAs etc , et als) views, on for instance -climate change, and tobbaco. Your abhorrence of peer-reviewed medical journal studies as being 'piles of rubbish' wouldn't be associated with that Phillip Morris, eh, inclination..., would they? Wink

http://www.sourcewatch.org/index.php?title=Civitas
"Founded in 2000, it was formerly the Health and Welfare Unit of the Institute for Economic Affairs."


http://www.sourcewatch.org/index.php?title=Institute_for_Economic_Affairs
Quote :

The Institute of Economic Affairs (IEA) is a London-based, influential, right-wing think tank.
It is part of a very wide international network of similar
organisations, offering financial, operational and strategic support to
a large number of these. Among many other groups, via its founders Antony Fisher, Ralph Harris, and Arthur Seldon, it spawned the Atlas Economic Research Foundation, the University of Buckingham, and the International Policy Network, which the IEA appears to fund and run directly. The IEA manages the funding of the Centre for Research into Post-Communist Economies [1]
The IEA enjoyed its highest influence during the right-wing Tory administration of Margaret Thatcher. Milton Friedman
believes the IEA's intellectual influence was so strong that "the
U-turn in British policy executed by Margaret Thatcher owes more to him
(i.e., Fisher) than any other individual." [2]
The IEA describe their mission as being "...to improve public
understanding of the fundamental institutions of a free society, with
particular reference to the role of markets in solving economic and
social problems."

http://www.sourcewatch.org/index.php?title=European_Science_and_Environment_Forum

Quote :
The ESEF was linked, via shared staff (Julian Morris and Roger Bate), to the Institute of Economic Affairs and later the International Policy Network and the Sustainable Development Network. The IEA itself has links to the Adam Smith Institute and FOREST,
the UK smoker's rights organisation, and Roger Bate continued to work
for the IEA in London, while officially being the Director of the ESEF
in Cambridge.

In 1996, Roger Bate approached R.J. Reynolds Tobacco Company for a grant of £50,000 to fund a book on risk, containing a chapter on passive smoking [1]. However, the request was denied and the money was never received. In 1997, the ESEF published What Risk? Science, Politics and Public Health, edited by Roger Bate which included a chapter on passive smoking; the book's publication was carefully supervised by Philip Morris.
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