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 The fallacy of private health care efficiency

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PostSubject: Re: The fallacy of private health care efficiency   Mon May 12, 2008 11:32 pm


Our starting point in the health debate has to be, that the status quo cannot continue, change must come. The vested interests & the ideologically driven will resist with everything they have, that was and is to be expected and so far in that regard, they’ve not disappointed.

Time and experience both here & elsewhere has shown that a 100% state monopoly on the provision of public services does not work and will never bring about customer lead high quality services provided at a sustainable cost. What you get at best is these services being run by people whose main concern is their own welfare with end user welfare coming some way down the list of the organisations priorities.
When you introduce private enterprise into the provision of services you immediately get the benefits of two elements missing from the public only model, fresh new thinking & something realistic to benchmark against, everyone involved, both public & private has to up their game.

If you take Ryanair & Airlingus as an example, (not that I would hold Ryanair up as a model employer) there can be no doubt but for the competition Ryanair introduced Airlingus would now either be gone out of business like so many other European airlines or we would still be paying 4/500 Euro for a round trip to London.

Health obviously is not the airline business, but for any real efficiency or change to come about, in any field, competition is a prerequisite, in the long term, change cannot & will not come without it.

One of the aspects of the French health system not often discussed is the fact that up to 50% of treatments are provided in private hospital facilities, another, is that everyone has to pay 20% of any medical bill, either through private insurance or by stumping up the cash.

A similar system could be introduced here with private insurance companies (at an agreed fixed margin, net of costs) providing relatively low cost community rated policies to everyone in employment and with the state paying for the policy for anyone on social welfare. The costs would probably be in the region of 150.00 Euro pa for a single and 4/500 pa for a family. Obviously the insurance option is still there for anyone who wants to provide cover for more than the basics, for private rooms etc. (This should not be tax deductible imo). The income stream generated is very useful for the management of the hospitals concerned & the better they are at what they do, whether they are public or private, the more income they generate.

There are many ways to improve the provision of services for everyone, to decide exactly what the mix of private & public will be, but in my opinion none will work long term unless the vested interests can be brought to accept & work with the necessary change in the provision of those services. If any other road is chosen, we will simply be throwing good money after bad.
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PostSubject: Re: The fallacy of private health care efficiency   Mon May 12, 2008 11:48 pm

Ireland has always had and still has a mix of public and private health services. Not making any criticism of individuals, it would be difficult to deny that both have been shabby systems that have not functioned well.

Past performance is no indication of future results.

For most people the issue that is most unacceptable is the lack of fair and equal access to health services. Universal Health Care provides a model for equal, or near equal access, in a system that includes public and private facilities. This is not what Mary Harney proposes to do, is it?

Universal Health Care link
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PostSubject: Re: The fallacy of private health care efficiency   Mon May 12, 2008 11:54 pm

tonys wrote:

One of the aspects of the French health system not often discussed is the fact that up to 50% of treatments are provided in private hospital facilities, another, is that everyone has to pay 20% of any medical bill, either through private insurance or by stumping up the cash.

its interesting that people generally don't have any idealogical problems when the State gets the private sector to build public hospitals, but when it comes to the State purchasing actual health care from the private sector, all hell breaks lose.

People think that private healthcare means healthcare that only private health insurance holders can access, based on what they know about places like the Blackrock Clinic and the Mater Private.

The reality is that no private healthcare facility in Ireland can be viable unless the State is one of its largest customers, and all of the colocated hospitals currently under construction have provisioned significant capacity to be used by the HSE.

What this means is that colocation will both free up existing capacity in the public system and deliver new capacity by virtue of the HSE being able to purchase capacity through the NTPF.

This is the model that prevails in pretty much all of the health systems that we seek to emulate, where the State concerns itself with paying the bills rather than being the sole provider and user of the service in question.

It will be interesting to see if the attitude to cololation changes when public patients are been seen in ultra-modern private hospitals at no cost to themselves.
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PostSubject: Re: The fallacy of private health care efficiency   Mon May 12, 2008 11:57 pm

seinfeld wrote:


It will be interesting to see if the attitude to cololation changes when public patients are been seen in ultra-modern private hospitals at no cost to themselves.

Exactly, seinfeld, I think co-location is a great step forward for the Irish health system and will be a decision hailed on in the future as a brilliant step by a visionary Health Minister. We'll even see the fruits of these labours before Mary Harney steps down in 2012. Ireland will have among the best health systems in Europe by that stage.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:00 am

cactus flower wrote:
Universal Health Care provides a model for equal, or near equal access, in a system that includes public and private facilities. This is not what Mary Harney proposes to do, is it?



You mean Universal Health Insurance?

Universal Health Insurance is only economically viable in a system that is highly efficient and witness to significant competition between private sector providers. Why? Because the State has to pay the premia for people who cannot afford to pay the premia themselves, and those premia are based on the cost of providing health care.

Until the cost of providing health care in Ireland plumets, which will only happen when the private sector knocks the public sector into shape, Universal Health Insurance isn't an option.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:01 am

The US system, if that is what MH is modelling our services on, is pretty disastrous, with over nearly 50% of Americans unable to to afford health insurance and serious illness like cancer bankrupting families.

American health service providers are going to Cuba to see how to run value for money health services -

Cuban Health Service
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:03 am

Is there anyone here without private health cover who is arguing in favour of Mary Harney's proposals?
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:03 am

cactus flower wrote:
The US system, if that is what MH is modelling our services on, is pretty disastrous, with over nearly 50% of Americans unable to to afford health insurance and serious illness like cancer bankrupting families.

American health service providers are going to Cuba to see how to run value for money health services -

Cuban Health Service

Well, whatever she's doing, it's working. We're racing up the ECHI charts and survival rates are improving apace across a whole number of diseases.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:07 am

cactus flower wrote:
The US system, if that is what MH is modelling our services on, is pretty disastrous, with over nearly 50% of Americans unable to to afford health insurance and serious illness like cancer bankrupting families.

That isn't what the system is being modelled on. The US system is mucked up because it doesn't have a public system to speak of. We have, the problem is that public patients have to wait an age to use it, because its capacity is being used by the private sector, which doesn't have sufficient capacity of its own.


cactus flower wrote:

American health service providers are going to Cuba to see how to run value for money health services -

Cuban Health Service

Take a look at the service the Cubans themselves have to use:

http://www.therealcuba.com/Page10.htm

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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:09 am

cactus flower wrote:
Is there anyone here without private health cover who is arguing in favour of Mary Harney's proposals?

I will only stop taking out insurance when colocation is fully established.


Last edited by seinfeld on Tue May 13, 2008 12:12 am; edited 1 time in total
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:12 am

Ard-Taoiseach wrote:
cactus flower wrote:
The US system, if that is what MH is modelling our services on, is pretty disastrous, with over nearly 50% of Americans unable to to afford health insurance and serious illness like cancer bankrupting families.

American health service providers are going to Cuba to see how to run value for money health services -

Cuban Health Service

Well, whatever she's doing, it's working. We're racing up the ECHI charts and survival rates are improving apace across a whole number of diseases.

As they were so poor in the first instance there was plenty of room for improvement. They have improved more in N.I., which has a predominantly public system.

NI report link
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:16 am

cactus flower wrote:
Ard-Taoiseach wrote:
cactus flower wrote:
The US system, if that is what MH is modelling our services on, is pretty disastrous, with over nearly 50% of Americans unable to to afford health insurance and serious illness like cancer bankrupting families.

American health service providers are going to Cuba to see how to run value for money health services -

Cuban Health Service

Well, whatever she's doing, it's working. We're racing up the ECHI charts and survival rates are improving apace across a whole number of diseases.

As they were so poor in the first instance there was plenty of room for improvement. They have improved more in N.I., which has a predominantly public system.

NI report link

I have to disagree with you there, this thread is an endorsement of Ireland's record and an indictment of the NI's health system.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:18 am

cactus flower wrote:
Ard-Taoiseach wrote:
cactus flower wrote:
The US system, if that is what MH is modelling our services on, is pretty disastrous, with over nearly 50% of Americans unable to to afford health insurance and serious illness like cancer bankrupting families.

American health service providers are going to Cuba to see how to run value for money health services -

Cuban Health Service

Well, whatever she's doing, it's working. We're racing up the ECHI charts and survival rates are improving apace across a whole number of diseases.

As they were so poor in the first instance there was plenty of room for improvement. They have improved more in N.I., which has a predominantly public system.


The EHCI report being referred to is a measure of performance in the public system. We came in 16th. The NHS, which has been funded since the 1940s, came in 17th. No one is arguing about the amount of work to be done. The issue is whether or not we are trending in the right direction.

cactus flower wrote:

NI report link

What would your response be if either AT or I posted a link to the HSE website backing up a claim about the wonders of the Irish Health Service.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:28 am

Your Cuban link wasn't exactly from an agenda free source. If you want to find worse go and look at the sick old people living on the streets in New York. Or have a look at St Ita's.

Is there a link here to the EHCI report, BTW ?
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:35 am

cactus flower wrote:
Your Cuban link wasn't exactly from an agenda free source.

Plenty of pictures though, aren't there?


ECHI is here

http://www.healthpowerhouse.com/


Last edited by seinfeld on Tue May 13, 2008 12:38 am; edited 1 time in total
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:38 am

seinfeld wrote:
cactus flower wrote:
Your Cuban link wasn't exactly from an agenda free source.

Plenty of pictures though, aren't there?

They're very off-putting.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:46 am

I must check out the Cuban Health Service because that fella looks to be in fine fettle to me. He is sitting up drinking a cup of tae. He looks to be also enjoying a fine Cuban cigar. He has the life of Reilly
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:47 am

seinfeld wrote:
cactus flower wrote:
Your Cuban link wasn't exactly from an agenda free source.

Plenty of pictures though, aren't there?


ECHI is here

http://www.healthpowerhouse.com/

Are you saying that we haven't had deaths from bedsores in private nursing homes in Ireland?
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:50 am

cactus flower wrote:
seinfeld wrote:
cactus flower wrote:
Your Cuban link wasn't exactly from an agenda free source.

Plenty of pictures though, aren't there?


ECHI is here

http://www.healthpowerhouse.com/

Are you saying that we haven't had deaths from bedsores in private nursing homes in Ireland?

Yes, that's clearly what I'm saying.

Really.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:52 am

cactus flower wrote:
Ireland has always had and still has a mix of public and private health services. Not making any criticism of individuals, it would be difficult to deny that both have been shabby systems that have not functioned well.

Past performance is no indication of future results.

For most people the issue that is most unacceptable is the lack of fair and equal access to health services. Universal Health Care provides a model for equal, or near equal access, in a system that includes public and private facilities. This is not what Mary Harney proposes to do, is it?

Universal Health Care link

As I understand it what she proposes to do is to facilitate the provision of more bed capacity, in the private sector admittedly, but which the public system can also avail of. In any event even if the new hospitals were 100% used for private patients, the public system will benefit immediately by those beds previously being kept for private patients now being available exclusively for use by the public system.
Other than on ideological grounds I really can’t see the objection.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 12:58 am

cactus flower wrote:
seinfeld wrote:
cactus flower wrote:
Your Cuban link wasn't exactly from an agenda free source.

Plenty of pictures though, aren't there?


ECHI is here

http://www.healthpowerhouse.com/

Are you saying that we haven't had deaths from bedsores in private nursing homes in Ireland?

There would be cases of that even in Austria, number 1 on the list and it wouldn't stop there health system from being the best in the world. We have to look at the broader picture and avoid getting bogged down in minutiae. No system is perfect, no system is functioning as it should. That does not mean that the system is bad since it is the nature of systems to have some degree of failure. What we should do is concentrate on reducing that failure to an absolute minimum.

Based on Harney's record and the statistics we have to hand, we are in the process of doing that.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 1:05 am

Quote :

As I understand it what she proposes to do is to facilitate the provision of more bed capacity, in the private sector admittedly, but which the public system can also avail of. In any event even if the new hospitals were 100% used for private patients, the public system will benefit immediately by those beds previously being kept for private patients now being available exclusively for use by the public system.
Other than on ideological grounds I really can’t see the objection.
tonys


I find it very difficult to see what the end result is intended to be. There would be entirely separate cohorts of consultants in the private and public sectors working out of duplicated facilities in the same campus. Seeing as one of our biggest problems in attaining excellence is that a large population catchment is needed for each operational hospital unit, the duplication would appear to be damaging. How would that be overcome? And what is the rationale of distribution of these tax incentivised facilities (they are in essence publicly funded from diverted tax take given to private individuals). At the moment as was seen from the Limerick case, there is no proper system of regulation of private hospitals. Does MH have a plan for that?

Quote :
Brussels, 1st October 2007

Ireland has the 16th most consumer friendly healthcare system in Europe, according to the 2007 Euro Health Consumer Index (EHCI) launched today in Brussels. This is a score that shows that the massive investments in healthcare have provided positive results, even if more should have expected. Ireland is just in the middle group along with Czech Republic, the UK, Malta, Spain and Slovenia. The Euro Health Consumer Index for 2007, the annual survey of EU healthcare, ranked the Irish healthcare service as 16th out of 29 countries for their public healthcare systems. Austria tops the rankings with a score of 806, followed by the Netherlands (winner in 2005), France (winner in 2006) and Switzerland, Germany and Sweden.
In five categories, covering 27 performance indicators, Ireland scores 592 points out of a potential 1,000.
“First and foremost, cut the waiting times for most treatments – they are still far too long! Although it is doing far better overall this year than in the 2006 Index, Ireland remains at the
bottom for waiting times”, concludes Dr. Arne Björnberg Research Director for the Euro Health Consumer Index.
What more could be done in Ireland?
“Looking at the scale of investment in Irish healthcare, you should reasonably expect better access than in Greece or Latvia – but it’s not.

From the ECHI link.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 1:08 am

I'm on the record as being in favour of a fully socialised health service, free at the point of delivery. The stark reality is that the ability to pay determines your access to treatment and something that happened recently in my own family was the proof of that. Having said that I don't object at all to what you have described tonys, because being utterly realistic fully socialised medicine is just not going to happen in this country, perhaps not even in the context of a United Ireland, and anything that creates bed space is to be welcomed.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 1:20 am

cactus flower wrote:
Quote :

As I understand it what she proposes to do is to facilitate the provision of more bed capacity, in the private sector admittedly, but which the public system can also avail of. In any event even if the new hospitals were 100% used for private patients, the public system will benefit immediately by those beds previously being kept for private patients now being available exclusively for use by the public system.
Other than on ideological grounds I really can’t see the objection.
tonys


I find it very difficult to see what the end result is intended to be. There would be entirely separate cohorts of consultants in the private and public sectors working out of duplicated facilities in the same campus. Seeing as one of our biggest problems in attaining excellence is that a large population catchment is needed for each operational hospital unit, the duplication would appear to be damaging. How would that be overcome? And what is the rationale of distribution of these tax incentivised facilities (they are in essence publicly funded from diverted tax take given to private individuals). At the moment as was seen from the Limerick case, there is no proper system of regulation of private hospitals. Does MH have a plan for that?

The end result is 1,000 hospital beds provided at no capital cost to the tax payer and provided much sooner that they could be provided by the public service. This is not a public service pipe dream, this is private enterprise, not a shilling can be made until the hospital doors open, rest assured they’ll open and soon.
One immediate result will be no more waiting on a trolley in the A&E waiting for a bed. You need to be in hospital? you’re in hospital, trolley problem solved.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 1:21 am

Sorry Tony, but that doesn't answer my questions. Also I don't accept that letting someone off taxes otherwise due is 'no cost'.
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