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 Alternatives to co-location

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PostSubject: Alternatives to co-location   Sun May 25, 2008 2:06 am

If I go along to my local county hospital in the next fews days and ask the people sitting in the beds in the wards how they are paying for their healthcare, approximately 40-50% will tell me they are paying for it with private health insurance.

Thereafter, if I go along to Admin, and they let me see the public waiting lists, I'll find lots of patients who don't have private health insurance who would have presented at public outpatient clinics *before* most of the people sitting in the beds upstairs.

Rapid, neo-liberal, baby-eating facist that I am, I think that's unfair.

I think people who have private health insurance and who want to be treated before people who don't have private health insurance should go along to their local private hospital to be treated.

The only problem is, there isn't a private hospital.

Instead, the consultant with whom they had a private consultation will have slotted them into one of the public beds that consultant has access to as part of his/her contract with the HSE.

If there was a private hospital, the consultant could slot them into one of the beds in the private hospital, thereby leaving the public bed free for someone on the public waiting list.

Now, let say co-location is scrapped.

How do opponents of co-location propose that private hospitals are created to allow consultants place their private patients in beds other than beds that were put in place for public patients?

*Please note that EU prevents us from banning the provision of private medical care, so the the creation of a single-tier system which everybody *has* to use is not an option.
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 12:11 pm

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How do opponents of co-location propose that private hospitals are created to allow consultants place their private patients in beds other than beds that were put in place for public patients.

Your question is tautological Seinfeld, and in so far as it is a question, has been answered on another thread. I won't be engaging with it again.
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 2:20 pm

cactus flower wrote:
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How do opponents of co-location propose that private hospitals are created to allow consultants place their private patients in beds other than beds that were put in place for public patients.

Your question is tautological Seinfeld, and in so far as it is a question, has been answered on another thread. I won't be engaging with it again.

Good grief.

You said on the other thread that the question wasn't consistent with the theme of that thread and that I should start another thread.

Nobody on this Forum has answered the question about alternatives to co-location.

Nobody.
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 2:27 pm

Readers will judge for themselves.
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 2:32 pm

cactus flower wrote:
Readers will judge for themselves.

Why not just give your answer on this thread?

Can you propose an alternative?


Another question.

If use of the for-profit sector is such a bad idea, why is 20% of in-patient bed capacity provided by the for-profit sector in France, which apparently has the best health system in the whole world?
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 5:36 pm

well they say col-location gets rid of the private beds from public hospitals but why give the opportunity to build on public land?
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 5:44 pm

lostexpectation wrote:
well they say col-location gets rid of the private beds from public hospitals but why give the opportunity to build on public land?

Fair point.

One argument would be that the public land isn't actually producing any return for the State while it is lying idle, so why not develop private health care capacity on it.

Prior to the public land becoming available, there was very little development activity in the for-profit sector.
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 6:18 pm

I've a very simplistic and basic argument against co-location. However, I'm more than willing for holes to be picked in it and people to make me come round to their point of view.

Currently private health insurance in Ireland is relatively cheap, when compared to other countries. This seems to be the case owing to the fact that our private healthcare system is essentially subsidised by the State by 'piggy-backing' on the public hospitals and healthcare system. Most of the infrastructure in the public hospitals with private wings is paid for by the State and most of the consultants derive their primary income from the State. This makes private healthcare very affordable here, hence so many people have it.

It seems to me, however, that the co-location plan is based on a premise that there will be a similar percentage of the population holding private health insurance into the future. This seems to me to be a fallacy, at least on a simplistic level, because of the following reasons. Running an entirely privately funded hospital, which holds all the infrastructure of a large public hospital will increase the cost of running private health insurance companies greatly. This will lead to an obvious increase in the cost of private health insurance. In tandem with this, assuming that co-location works in the short term, there will be an enormous reduction in the waiting time and an increase in the quality of care in the public hospitals.

Consequently, you will have a situation where public waiting lists are short and private healthcare is very expensive. The obvious result of that, to my mind anyway, is people ceasing to pay private health insurance and moving back towards the public system... and then you end up with an equally dire situation.

----

In response to the actual point of this thread, a scheme of compulsory health insurance would, to me, be a much better idea.
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 6:38 pm

We could just shoot old people and poor people. They're the ones who always seem to be in hospital. We'd be find then.
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 6:41 pm

johnfás wrote:
I've a very simplistic and basic argument against co-location. However, I'm more than willing for holes to be picked in it and people to make me come round to their point of view.

Currently private health insurance in Ireland is relatively cheap, when compared to other countries. This seems to be the case owing to the fact that our private healthcare system is essentially subsidised by the State by 'piggy-backing' on the public hospitals and healthcare system. Most of the infrastructure in the public hospitals with private wings is paid for by the State and most of the consultants derive their primary income from the State. This makes private healthcare very affordable here, hence so many people have it.

It seems to me, however, that the co-location plan is based on a premise that there will be a similar percentage of the population holding private health insurance into the future. This seems to me to be a fallacy, at least on a simplistic level, because of the following reasons. Running an entirely privately funded hospital, which holds all the infrastructure of a large public hospital will increase the cost of running private health insurance companies greatly. This will lead to an obvious increase in the cost of private health insurance. In tandem with this, assuming that co-location works in the short term, there will be an enormous reduction in the waiting time and an increase in the quality of care in the public hospitals.

Consequently, you will have a situation where public waiting lists are short and private healthcare is very expensive. The obvious result of that, to my mind anyway, is people ceasing to pay private health insurance and moving back towards the public system... and then you end up with an equally dire situation.

That would appear to be the primary risk associated with colocation, and it concerns me greatly.

However, the presumption shouldn't be made that only patients with fully loaded private health insurance will use co-located hospitals.

The HSE, both directly and through the NTPF, intends to purchase services from co-located hospitals, so if it is the case the more and more patients come back to the public system, the HSE will be able to use the colocated hospitals to meet that demand.

Over the course of the next 10 years, we will be able to conduct compartive analysis of the treatment of public patients both under the current system and the colo system. It will interesting to see how the costs break down, and what impact colocation has on public waiting lists.

----
johnfás wrote:

In response to the actual point of this thread, a scheme of compulsory health insurance would, to me, be a much better idea.

Most agree on that, but that doesn't address the point that private patients currently don't have anywhere to go, which is why consultants insist on treating them in public hospitals, thereby displacing public patients.

Countries that operate systems of mandatory health insurance have considerable private capacity. The insurance covers access and costs in both the public and private facilities, but no one is ever displaced from a public bed because a consultant has insisted that the bed be used for his/her private patient.

Mandatory health insurance is also very expensive, and therefore politically problematic, although that could change as private premia start to rise. Ironically, co-location could be the catalyst to final convince Irish people that Universal Health Insurance is a better option, but I won't hold my breath.
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 7:09 pm

I agree that private hospitals should be built to get private patients out of public hospitals. I believe that the Department of health must regulate the manner in which Private Hospitals conduct their activities. I do not believe the providers of private hospitals should get any favourable treatment in tax breaks, land concessions etc. because if it such a great idea, it should be able to stand on its own two feet. I would be very much against the misuse of public money or public facilities to facilitate private gain.
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 7:45 pm

Slim Buddha wrote:
I agree that private hospitals should be built to get private patients out of public hospitals. I believe that the Department of health must regulate the manner in which Private Hospitals conduct their activities. I do not believe the providers of private hospitals should get any favourable treatment in tax breaks, land concessions etc. because if it such a great idea, it should be able to stand on its own two feet. I would be very much against the misuse of public money or public facilities to facilitate private gain.

Why are you so opposed to tax breaks?

There are lots of forms of private enterprise that are good ideas that have benefited from tax breaks, because without the tax breaks, their economic viability is less clear.

Do you believe in tax breaks for R&D? What about Third-Level Accommodation schemes? What about alternative energy projects?

All of these are engaged in by private companies who want to make money.
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 7:49 pm

Slim Buddha wrote:
I agree that private hospitals should be built to get private patients out of public hospitals. I believe that the Department of health must regulate the manner in which Private Hospitals conduct their activities. I do not believe the providers of private hospitals should get any favourable treatment in tax breaks, land concessions etc. because if it such a great idea, it should be able to stand on its own two feet. I would be very much against the misuse of public money or public facilities to facilitate private gain.
Ah..

it sounds good in theory alright - the private patients get moved out of the public hospitals so the public queue moves faster. The question is how the private hospital will be funded - where will the money come from? Only the patients? Some will come from the HSE buying services as has already been said [and tax breaks] and I'm sure the initial saving on the cost of the land gets factored in as well of course as the €40million we're giving to have a hospital built.. but a hospital will cost a lot more than that to run... Will people's health insurance contribute to or cover the remaining private hospital running bill? How does the Beacon work?
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 7:54 pm

Auditor #9 wrote:
Slim Buddha wrote:
I agree that private hospitals should be built to get private patients out of public hospitals. I believe that the Department of health must regulate the manner in which Private Hospitals conduct their activities. I do not believe the providers of private hospitals should get any favourable treatment in tax breaks, land concessions etc. because if it such a great idea, it should be able to stand on its own two feet. I would be very much against the misuse of public money or public facilities to facilitate private gain.
Ah..

it sounds good in theory alright - the private patients get moved out of the public hospitals so the public queue moves faster. The question is how the private hospital will be funded - where will the money come from? Only the patients? Some will come from the HSE buying services as has already been said [and tax breaks] and I'm sure the initial saving on the cost of the land gets factored in as well of course as the €40million we're giving to have a hospital built.. but a hospital will cost a lot more than that to run... Will people's health insurance contribute to or cover the remaining private hospital running bill? How does the Beacon work?

The hospital will be run in the same way that every other private for-profit hospital will be run: the users will pay for the full cost of the care provided.

However, the question is: how do you provide private capacity other than with co-location?
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 8:01 pm

The Beacon isn't co-located and neither is the new hospital on the dock road in Limerick... can't private investors build private hospitals, the state gives tax breaks (I have no problem with that at the moment) because there will be an unloading from the public system and a number of jobs created. The public health system works alongside it as it seems to always have done in certain areas.

The idea of for-profit might be an incentive for professionals to move from public to private... is that an issue at all?
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 8:11 pm

Auditor #9 wrote:
The Beacon isn't co-located and neither is the new hospital on the dock road in Limerick... can't private investors build private hospitals, the state gives tax breaks (I have no problem with that at the moment) because there will be an unloading from the public system and a number of jobs created. The public health system works alongside it as it seems to always have done in certain areas.

The idea of for-profit might be an incentive for professionals to move from public to private... is that an issue at all?

I'm not sure what the incentive is re. public land, given that the private operator has to pay market value for the lease. Maybe its because they can share certain costs with the public hospital.

However, I have no problem with the private hospital being on public land. The land is sitting there doing nothing, so the state might as well be getting a return from it.
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 9:08 pm

So what about the non co-located private hospitals seinfeld - do you know anything about them? Bons Secours in Tralee/Cork elsewhere and the ones I mentioned above including the mental home I spent last year in. How do these places get funded because I believe the Bons in Tralee is doing pretty well - is it because the nuns made a killing via the land and run a highly organised hospital?

I'm kinda getting the argument now and I wonder if co-location would prod the HSE into more efficiency? When one system working alongside the other shows the other up then maybe they'd be embarrassed into getting their act together... Is that any reason for harney to have establised co-location at all?
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 9:18 pm

The HSE is subsidising private healthcare through the NTPF. Basically if a consultant keps a public patient waiting long enough he/she can then be paid for treatring that patient privately.. Often the patient isn't fully informed of this fact and often the patient may have vhi but not enough money to pay for the initial consultant fee.
co-location is flawed, it will take up land that could be used for step down care which is desperately neded and will suck the best of our healthcare staff into the private sector.

There is another option. We need to change the healthcare system from top to bottom. The way hospitals are paid to treat patients needs to be changed. They need to operate as business entities and bill the state for use. This system is in operation in the UK with the NHS Trust and it actually finished the year with a surplus last year!!! Co-location may work in larger countries but it is the wrong option for Ireland and it smacks of someone (or many investors) with friends in high places. There was no green paper or white paper on this policy. There were no other options examined.

Also not only will co-location be a bad deal for Irish patients but it may be bad for existing private hospitals, as there will be a surplus of private hospitals and a static demand. These hospitals have made significant investments in the past and this seems somehow unfair to them....

There are no easy solutions to the Irish healthcare problem but one thing is sure co-location is not the answer.
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 9:31 pm

irishbeergirl wrote:
The HSE is subsidising private healthcare through the NTPF.

Whats the difference in buying the service from a private provider and paying a consultant to provide the service in a public hospital? Market forces apply in both cases, but at least in the former, the patient doesn't have to wait.

irishbeergirl wrote:

Basically if a consultant keps a public patient waiting long enough he/she can then be paid for treatring that patient privately.. Often the patient isn't fully informed of this fact and often the patient may have vhi but not enough money to pay for the initial consultant fee.

Notwithstanding that such behaviour would be repugnant to the Hypocratic Oath, the consultant gets paid regardless of whether or not they treat the patient on a public list or a private list, so I fail to see the incentive for making a patient wait.

irishbeergirl wrote:

co-location is flawed, it will take up land that could be used for step down care which is desperately neded and will suck the best of our healthcare staff into the private sector.

The State gets paid full market value for the use of the land, which it can then invest in step down facilities where they need to go, rather than on a fixed point on the map. Public patients can use colocated hospitals, and very few consultants operate on a private only basis, so the transfer of expertise argument is tenuous at best. Other countries, like France, have significant for-profit capacity, and it doesn't appear to affect their outcomes.

irishbeergirl wrote:

There is another option. We need to change the healthcare system from top to bottom. The way hospitals are paid to treat patients needs to be changed. They need to operate as business entities and bill the state for use. This system is in operation in the UK with the NHS Trust and it actually finished the year with a surplus last year!!! Co-location may work in larger countries but it is the wrong option for Ireland and it smacks of someone (or many investors) with friends in high places. There was no green paper or white paper on this policy. There were no other options examined.

I wouldn't rule out the whole 'Internal Market' approach either, but this was greeted with a hail of criticism when it was introduced in the UK.

irishbeergirl wrote:

Also not only will co-location be a bad deal for Irish patients but it may be bad for existing private hospitals, as there will be a surplus of private hospitals and a static demand. These hospitals have made significant investments in the past and this seems somehow unfair to them....

In what way will there be static demand? Demand for in-patient capacity in the health system is increasing exponentially.


Anyway, the question was: how do you create sufficient private capacity without co-location?


Last edited by seinfeld on Sun May 25, 2008 10:51 pm; edited 1 time in total
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PostSubject: Re: Alternatives to co-location   Sun May 25, 2008 9:34 pm

Auditor #9 wrote:
So what about the non co-located private hospitals seinfeld - do you know anything about them? Bons Secours in Tralee/Cork elsewhere and the ones I mentioned above including the mental home I spent last year in. How do these places get funded because I believe the Bons in Tralee is doing pretty well - is it because the nuns made a killing via the land and run a highly organised hospital?

They are private non-profit institutions. They charge what they need to charge to break even, mainly to private insurance companies. They're costs are also considerably lower, in that the buildings and lands are owned outright by the religious orders.

Auditor #9 wrote:

I'm kinda getting the argument now and I wonder if co-location would prod the HSE into more efficiency? When one system working alongside the other shows the other up then maybe they'd be embarrassed into getting their act together... Is that any reason for harney to have establised co-location at all?

I don't think thats' the reason. Ireland has pretty low for-profit capacity comparred to our neighbours, which was impacting on the public system. Something had to be done.
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PostSubject: Re: Alternatives to co-location   Mon May 26, 2008 2:04 am

seinfeld wrote:
lostexpectation wrote:
well they say col-location gets rid of the private beds from public hospitals but why give the opportunity to build on public land?

Fair point.

One argument would be that the public land isn't actually producing any return for the State while it is lying idle, so why not develop private health care capacity on it.

Prior to the public land becoming available, there was very little development activity in the for-profit sector.

and how are the public hospital going to expand in the future?
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PostSubject: Re: Alternatives to co-location   Mon May 26, 2008 2:07 am

seinfeld wrote:
Slim Buddha wrote:
I agree that private hospitals should be built to get private patients out of public hospitals. I believe that the Department of health must regulate the manner in which Private Hospitals conduct their activities. I do not believe the providers of private hospitals should get any favourable treatment in tax breaks, land concessions etc. because if it such a great idea, it should be able to stand on its own two feet. I would be very much against the misuse of public money or public facilities to facilitate private gain.

Why are you so opposed to tax breaks?

There are lots of forms of private enterprise that are good ideas that have benefited from tax breaks, because without the tax breaks, their economic viability is less clear.

are private hospitals somehow uneconomic, i doubt it?
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PostSubject: Re: Alternatives to co-location   Mon May 26, 2008 2:43 am

http://archives.tcm.ie/businesspost/2006/06/11/story14938.asp

This 2006 Business Post story sets out the Co Location plan quite clearly.
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