The fallacy of private health care efficiency

Eamon Gilmore was on Sean O'Rourke's News at One with another guest and he urged that the C&AG undertake a cost benefit analysis of the co-location project because it wasn't done originally and needed to be done.

The other person representing the Yes to Co-location said the NDFA had done a (benefit) analysis of it and he asserted that there would be a net financial benefit to the country.

Sean O'Rourke said "Who's the NDFA?"

Why hasn't the office of the C&AG more powers instead of authorities getting set up willy-nilly to do ... what?

Stage II of the NDFA Bill in January 2007 in the Seanad

seinfeld wrote:

Great.

Another thread drown in an avalanche of rubbish from posters who seem more interested in idealogical chest-thumping than mature discussion.

Is it so hard to understand that discussion involves a little bit more than dumping the contents of your bookmarks folder and your spleen onto a thread and annoucing that the debate is over?

"avalanche of rubbish" Is that what you think you the above is? I'm afraid that's not a rebutal, there, seinfeld.

"idealogical chest-thumping than mature discussion."

What is idealogical about my two previous posts?

Oh and I quoted you here. I see you've failed to respond.

Pax wrote:

seinfeld wrote:

Great.

Another thread drown in an avalanche of rubbish from posters who seem more interested in idealogical chest-thumping than mature discussion.

Is it so hard to understand that discussion involves a little bit more than dumping the contents of your bookmarks folder and your spleen onto a thread and annoucing that the debate is over?

"avalanche of rubbish" Is that what you think you the above is? I'm afraid that's not a rebutal, there, seinfeld.

"idealogical chest-thumping than mature discussion."

What is idealogical about my two previous posts?

Oh and I quoted you here. I see you've failed to respond.

Well said Pax. Im tired of this 'Seinfeld' resorting to empty, fact-free insult and sarcastic denigration of factual arguments. He has no answers to what you've said. Intelligent readers will not have failed to notice the strategy.

Aragon wrote:

Pax wrote:

seinfeld wrote:

Great.

Another thread drown in an avalanche of rubbish from posters who seem more interested in idealogical chest-thumping than mature discussion.

Is it so hard to understand that discussion involves a little bit more than dumping the contents of your bookmarks folder and your spleen onto a thread and annoucing that the debate is over?

"avalanche of rubbish" Is that what you think you the above is? I'm afraid that's not a rebutal, there, seinfeld.

"idealogical chest-thumping than mature discussion."

What is idealogical about my two previous posts?

Oh and I quoted you here. I see you've failed to respond.

Well said Pax. Im tired of this 'Seinfeld' resorting to empty, fact-free insult and sarcastic denigration of factual arguments. He has no answers to what you've said. Intelligent readers will not have failed to notice the strategy.

Mods? Constructive, informative input?

Pax wrote:

seinfeld wrote:

Great.

Another thread drown in an avalanche of rubbish from posters who seem more interested in idealogical chest-thumping than mature discussion.

Is it so hard to understand that discussion involves a little bit more than dumping the contents of your bookmarks folder and your spleen onto a thread and annoucing that the debate is over?

"avalanche of rubbish" Is that what you think you the above is? I'm afraid that's not a rebutal, there, seinfeld.

"idealogical chest-thumping than mature discussion."

What is idealogical about my two previous posts?

Oh and I quoted you here. I see you've failed to respond.

Pax, I accept the bona fides of your post. I am not challenging your view that public health care is more efficient that private.

What I am challenging is your modus operandi.

Posting a stream of URLs and extracts from academic articles in support of your view that all peer-reviewed research suggests a particular conclusion isn't really discussion. Its more like something you'd find in a sworn affadavit in a court case.

If you want to use a piece of research to back up a particular point, go ahead, but dumping everything you know onto a thread feels a little bit more like propaganda than discussion.

Personally, I don't know how you can arrive at the conclusion that the efficiency of the public system is beyond doubt, given that there is no universally accepted measure of health care efficiency. What is that measure in your view? Cost? Outcomes? Equity?

seinfeld wrote:

Pax wrote:

seinfeld wrote:

Great.

Another thread drown in an avalanche of rubbish from posters who seem more interested in idealogical chest-thumping than mature discussion.

Is it so hard to understand that discussion involves a little bit more than dumping the contents of your bookmarks folder and your spleen onto a thread and annoucing that the debate is over?

"avalanche of rubbish" Is that what you think you the above is? I'm afraid that's not a rebutal, there, seinfeld.

"idealogical chest-thumping than mature discussion."

What is idealogical about my two previous posts?

Oh and I quoted you here. I see you've failed to respond.

Pax, I accept the bona fides of your post. I am not challenging your view that public health care is more efficient that private.

What I am challenging is your modus operandi.

Posting a stream of URLs and extracts from academic articles in support of your view that all peer-reviewed research suggests a particular conclusion isn't really discussion. Its more like something you'd find in a sworn affadavit in a court case.

If you want to use a piece of research to back up a particular point, go ahead, but dumping everything you know onto a thread feels a little bit more like propaganda than discussion.

That's a mis-characterisation. In my first post I quoted you without any "'stream' of URLs and extracts from academic articles". I posted, about how all peer-reviewed studies of health systems in developed nations (since the end of WWII as far as I'm aware) have shown public not-for-profit health care to be more efficient. I thought somehow that was, you know, relevant to the thread and to your comment.

Pax wrote:

seinfeld wrote:

The focus should be on the quality and cost of the care provided, not who owns the assets.

All (not just a majority) of peer-reviewed studies, --published in the most respected journals and going back decades,-- have shown for-profit privatised health care to be less efficient (to cost more), to deliver lower quality care with higher mortality rates (mainly due to perverse profit based incentives) and to be much more bureaucratic than publicly provided non-profit health care.

The ideology here is with those who are working 24/7 to privatise the Irish health system. Most specifically that's Harney, and the corporate-loaded HSE she created.

In response to cactus flower's request for some links of that evidence I included some of that research,

cactus flower wrote:

Whilst on an intuitive level I agree it seems probable Pax, do you have any links to any of these studies?

Now, given what appears to be your politics, and your own modus operandi of a wilful refusal to back up your arguments, I can understand how all of that might be an uncomfortable truth for you. But you're not the only one discussing the subject on this thread. The subject being -The fallacy of private health care efficiency

Basically don't expect me to apologise for answering another poster's suggestion for some research links.

seinfeld wrote:

Personally, I don't know how you can arrive at the conclusion that the efficiency of the public system is beyond doubt, given that there is no universally accepted measure of health care efficiency. What is that measure in your view? Cost? Outcomes? Equity?

Efficiency is based on cost comparisons between the differing forms of delivery. You would of course have to compare like with like as regards outcomes (and they are compared) and equity doesn't come into it. But there's certainly separate studies about equity – the conclusions are unsurprising.

The question of how we judge efficiency is central. Average life expectancy is a very real measure, but many other things affect it other than health care - diet, housing, peaceful society, road safety and so on. A good average could also mask serious deficiencies in some specialised areas or population segments. Cost, in terms of the ability of a society to sustain a level of care, has got to matter. Fairness also - that bears on the issue of a good average not being the whole story.

Private care, if there is no universal insurance, surely fails the equity test and is also unlikely to do well on average. The US really performs pretty poorly, does it not?

Pax wrote:

All (not just a majority) of peer-reviewed studies, --published in the most respected journals and going back decades,-- have shown for-profit privatised health care to be less efficient (to cost more), to deliver lower quality care with higher mortality rates (mainly due to perverse profit based incentives) and to be much more bureaucratic than publicly provided non-profit health care.

Do you not see how totally grandiose that statement is?

Pax wrote:

The ideology here is with those who are working 24/7 to privatise the Irish health system. Most specifically that's Harney, and the corporate-loaded HSE she created.

How do you explain the IHCA contract which for the first time has created Public Only Consultants and which limits to 20% the amount of private practice other consultants can carry on in public hospitals?

You keep promoting this idea that the Government is selling off the public health system, when in fact, no part of the health service has been transferred from public to private ownership. What has happened is that the Government has incentivised the development of private health care, because 52% of the adult population have private health insurance and are currently using that health insurance to displace public patients in public hospitals. Why should the State be using its funds to build public facilities to treat patients with private health insurance?

Pax wrote:

Now, given what appears to be your politics, and your own modus operandi of a wilful refusal to back up your arguments

What argument have I not backed up? I don't know if private health care is more efficient than public health care, and given the myriad complexities of the provision of health care across 100s of different economic and fiscal regimes, I doubt if anyone does.

What I do know, for a fact, is that there is widespread popular discontent with the Irish public system, which arises largely due to capacity issues, and that the State is duty bound to address this.

Pax wrote:

Efficiency is based on cost comparisons between the differing forms of delivery.

That's a complete oversimplification. To suggest that you can isolate 'costs' in this way without reference to secondary and tertiary costs, term, outcomes and equity isn't tenable.

And equity should be a primary factor. The is a total absence of equity in a public system that springboards private patients to the top of the queue. An efficient public system that is inequitable is of little use to anyone.

Seinfeld, you obviously know a good bit about the health system. As an outsider / user neither the existing nor the proposed system makes sense to me. We have always had a dual public / private system, have we not, with a good proportion of the private hospital side provided by Church run bodies. Consultants were free to sell their services to both public and private. The hospitals weren't organised in any planned way across the country but had evolved in a fairly ad hoc way to provide most services locally with some more specialised services provided in Dublin and Cork.

G.P.s are I think private operators who are compensated for treating people who can't afford to pay?

We seem all to be agreed that the present system in which half the population pay a private "top up" insurance that does not cover the full costs of treatment, with "private" patients being shoved up the queue and in some cases overtreated and public patients waiting years for consultant appointments and in some cases dying untreated is a scandal and a misuse of resources.

The other big problem we are being told is that consultants/treatment centres are too small in terms of patient numbers per annum and therefore don't reach the best possible level of expertise, and that patients also die for that reason.

I can't for the life of me see how in a small country splitting public from private consultants in different hospitals sitting next to each other, but with no shared expertise between the two, can possibly do anything but make the latter problem (lack of sufficient patient numbers in a particular field) much worse.

In some areas, say pancreatic care, we have no national centre of any description. There would be no sense in Ireland in having more than one centre. If we divide our consultants between two different systems we would be even further away from having one.

What reason does Mary Harney give for dividing the consultants up in this way? I think it is plain nuts.

cactus flower wrote:

Seinfeld, you obviously know a good bit about the health system. As an outsider / user neither the existing nor the proposed system makes sense to me. We have always had a dual public / private system, have we not, with a good proportion of the private hospital side provided by Church run bodies. Consultants were free to sell their services to both public and private. The hospitals weren't organised in any planned way across the country but had evolved in a fairly ad hoc way to provide most services locally with some more specialised services provided in Dublin and Cork.

All true.

Over the last twenty years, primarily due to political pressure from Hospital Action Groups, very little reform of our acute in-patient services has occured. Hence, the vast bulk of our acute health care continues to be delivered on an in-patient basis, which means long hospital stays and bed shortages.

In tandem with this, our population has grown, people are living longer and we can now treat more conditions that before. All of this means that there is more pressure than ever on our supply of hospital beds, including pressure from private health insurance holders who are presenting in public hospitals and taking up beds in public wards ahead of public patients.

The Government has to do something about this. For instance, the new consultants contract requires weekend rostering, so that patients can be discharged on Saturdays on Sundays; the NTPF buys treatment in other jurisdictions, rather than having patients waiting around for treatment that will cost the HSE the same in this jurisdiction; centralisation of general surgery in a smaller number of hospitals means that beds aren't being taken up in County Hospitals by people waiting for elective surgery.

However, the use of the public system by private patients remains a critical issue. The Government could of course invest heavily in an expansion of public bed capacity, but why should the State be investing tax payers money in providing infrastructure for private patients when it already has enough beds to serve public patients?

An alternative solution would be for the State to introduce compulsory health insurance and make the entire system public, as in Canada, in the hope that people would be happy to pay this rather than private health insurance. That's hugely problematic from a political point of view, however, and there is no guarantee that the State could afford to run a entirely public system on this basis.

The next option is co-location. Incentivise the creation of private facilities that will serve private patients so that public capacity can be used for public patients. This solution is not without problems. It undermines critical mass; it will increase the cost of health insurance, driving people back to the public system, and its impact on the public system remains unclear.

However, it is a solution that can be delivered quickly, at a known cost and which is consistent with the development of our health service to date.

Personally, I would prefer if Irish people were inclined to go for a public system financed by compulsory health insurance, but to date, they have shown no inclination to do so. The problem is that we can't just wait around for them to see the light; we have a public capacity problem and something needs to be done about it. At this juncture, I don't see any option other than co-location.

Seinfeld

Irish people have never seriously been offered the possibility of mandatory public helath insurance. There is no doubt that this would be an infinitely preferable option for the majority - so long as there is equal provision for the minority who cannot afford it. All that is lacking is the political will to recommend it as the most responsible and effective solution. Of course IBEC wouldnt like it one little bit, nor the PD ideologues who are behind privatisation. It would mean an increase in taxation for the common good - a notion that brings IBEC people out in hives.

That said, what are we paying our taxes for now if not, among other things, to provide a decent health service? The inefficiency in Ireland is almost entirely a matter of atrocious management - something that can far more easily be dealt with by making people accountable for the way they do their jobs than by resorting to 'incentivising' the private health care service (i.e. throwing good taxpayers money after bad, with zero benefit to the taxpayer, in order to line the pockets of those who want to make a profit of the present catastrophe.)

It's perverse, in the face of the overwhelming evidence to the contrary to pretend that privatisation results in improved services or value for money. The exact opposite is manifestly the case - as has been proven several times over in examples given on this thread alone.

Aragon wrote:

Seinfeld

Irish people have never seriously been offered the possibility of mandatory public helath insurance.

It was a central feature of the Labour Party's General Election Manifesto in 2002, in which they won 20 seats. The sitting FF/PD Government of the day, who do not support Universal Health Insurance, increased its seat total from 81 to 89.

seinfeld wrote:

Aragon wrote:

Seinfeld

Irish people have never seriously been offered the possibility of mandatory public helath insurance.

It was a central feature of the Labour Party's General Election Manifesto in 2002, in which they won 20 seats. The sitting FF/PD Government of the day, who do not support Universal Health Insurance, increased its seat total from 81 to 89.

Pathetic Seinfeld!!! Labour Party pre-election campaining is not a serious attempt to advance mandatory health insurance to the electorate - especially not from a party that has shown itself willing to abandon any and all principle if it thinks it will make it more likely to curry favour with the post electoral power-brokers. Nobody believes Labour anymore since the Dick Spring/FF sell out and their so called 'modernising' calamity. The Labour Party is to politics what MOR is to rock and roll: devoid of personality, talent and appeal.

This is a task that was the responsibility of government and successive administrations have been seriously derelict in thier duty to the country by their failure to engage in proper discussion and consultation with the electorate over this issue. None of that is an accident of course because the profiteers never wanted anything as remotely democratic as that ever to be allowed to happen. Cf, the sell of our gas and oil resources and about a milllion other equally disgraceful examples of how profit has been put ahead of the common good and the electorate deliberately kept ignorant of the realities.

Aragon wrote:

seinfeld wrote:

Aragon wrote:

Seinfeld

Irish people have never seriously been offered the possibility of mandatory public helath insurance.

It was a central feature of the Labour Party's General Election Manifesto in 2002, in which they won 20 seats. The sitting FF/PD Government of the day, who do not support Universal Health Insurance, increased its seat total from 81 to 89.

Pathetic Seinfeld!!! Labour Party pre-election campaining is not a serious attempt to advance mandatory health insurance to the electorate - especially not from a party that has shown itself willing to abandon any and all principle if it thinks it will make it more likely to curry favour with the post electoral power-brokers. Nobody believes Labour anymore since the Dick Spring/FF sell out and their so called 'modernising' calamity. The Labour Party is to politics what MOR is to rock and roll: devoid of personality, talent and appeal.

This is a task that was the responsibility of government and successive administrations have been seriously derelict in thier duty to the country by their failure to engage in proper discussion and consultation with the electorate over this issue. None of that is an accident of course because the profiteers never wanted anything as remotely democratic as that ever to be allowed to happen. Cf, the sell of our gas and oil resources and about a milllion other equally disgraceful examples of how profit has been put ahead of the common good and the electorate deliberately kept ignorant of the realities.

I see. So the problem is that the policies the people have voted for are not the right policies.

Germany seems to get pretty good outcomes, and I think has a system of universal health insurance. They have far more GPs than we do - do we not have the highest per capita patient lists per GP in europe?

Does anyone have any experience of the German system?

seinfeld wrote:

Aragon wrote:

seinfeld wrote:

Aragon wrote:

Seinfeld

Irish people have never seriously been offered the possibility of mandatory public helath insurance.

It was a central feature of the Labour Party's General Election Manifesto in 2002, in which they won 20 seats. The sitting FF/PD Government of the day, who do not support Universal Health Insurance, increased its seat total from 81 to 89.

Pathetic Seinfeld!!! Labour Party pre-election campaining is not a serious attempt to advance mandatory health insurance to the electorate - especially not from a party that has shown itself willing to abandon any and all principle if it thinks it will make it more likely to curry favour with the post electoral power-brokers. Nobody believes Labour anymore since the Dick Spring/FF sell out and their so called 'modernising' calamity. The Labour Party is to politics what MOR is to rock and roll: devoid of personality, talent and appeal.

This is a task that was the responsibility of government and successive administrations have been seriously derelict in thier duty to the country by their failure to engage in proper discussion and consultation with the electorate over this issue. None of that is an accident of course because the profiteers never wanted anything as remotely democratic as that ever to be allowed to happen. Cf, the sell of our gas and oil resources and about a milllion other equally disgraceful examples of how profit has been put ahead of the common good and the electorate deliberately kept ignorant of the realities.

I see. So the problem is that the policies the people have voted for are not the right policies.

Eh, no Seinfeld. That the electorate have never trusted the Labour Party in sufficient numbers since Dick Spring and his modernisers is an entirely different matter.

Health policy is a matter for responsible government - of which there has been none where health is concerned for decades.

Aragon wrote:

seinfeld wrote:

Aragon wrote:

seinfeld wrote:

Aragon wrote:

Seinfeld

Irish people have never seriously been offered the possibility of mandatory public helath insurance.

It was a central feature of the Labour Party's General Election Manifesto in 2002, in which they won 20 seats. The sitting FF/PD Government of the day, who do not support Universal Health Insurance, increased its seat total from 81 to 89.

Pathetic Seinfeld!!! Labour Party pre-election campaining is not a serious attempt to advance mandatory health insurance to the electorate - especially not from a party that has shown itself willing to abandon any and all principle if it thinks it will make it more likely to curry favour with the post electoral power-brokers. Nobody believes Labour anymore since the Dick Spring/FF sell out and their so called 'modernising' calamity. The Labour Party is to politics what MOR is to rock and roll: devoid of personality, talent and appeal.

This is a task that was the responsibility of government and successive administrations have been seriously derelict in thier duty to the country by their failure to engage in proper discussion and consultation with the electorate over this issue. None of that is an accident of course because the profiteers never wanted anything as remotely democratic as that ever to be allowed to happen. Cf, the sell of our gas and oil resources and about a milllion other equally disgraceful examples of how profit has been put ahead of the common good and the electorate deliberately kept ignorant of the realities.

I see. So the problem is that the policies the people have voted for are not the right policies.

Eh, no Seinfeld. That the electorate have never trusted the Labour Party in sufficient numbers since Dick Spring and his modernisers is an entirely different matter.

So the electorate want Universal Health Insurance, but are prepared to vote in their droves for parties who don't want to give it to them, because they'd sooner not vote for a Party who wants to give it to them, because Dick Spring went into coalition with FF 16 years ago?

And it has nothing to do with Universal Health Insurance involving the mandatory payment of Health Insurance premia?

cactus flower wrote:

Germany seems to get pretty good outcomes, and I think has a system of universal health insurance.

They have, and it costs 15% of your Gross monthly salary up to a ceiling of €534.00, of which your employer pays half. This is in addition to standard rates of income tax of between 15% and 42%, and a top rate of 45%.

Try selling that on the doorsteps at the next General Election.

seinfeld wrote:

cactus flower wrote:

Germany seems to get pretty good outcomes, and I think has a system of universal health insurance.

They have, and it costs 15% of your Gross monthly salary up to a ceiling of €534.00, of which your employer pays half. This is in addition to standard rates of income tax of between 15% and 42%, and a top rate of 45%.

Try selling that on the doorsteps at the next General Election.

And the German's are delighted with it. Nobody is dying on trollies. Waiting lists are a fraction of what ours are. Cancer treatment is excellent in comparison. It's an excellent health service in comparison to ours and one which places the value of human health at the centre of its political life - as much for sound economic reasons as for social. Any woman who has given birth in both Germany and Ireland, to take just one example, will be able to attest to the drastic difference in the quality of service between both countries. Sell all that at the next election and your on to a winner.

Here is a comparison between the UK and German health care systems - both of which are much better than the Irish:

Full report: http://www.civitas.org.uk/pubs/bb3Germany.php

Excerpts:

Quote :

Not so in Germany, where queueing up in a hospital outpatient department to see a specialist is largely unknown. First, Germans are free to visit any doctor they like. They may either walk in off the street, or ring for an appointment that will invariably be booked for the same morning or afternoon. Consumers can and do penalise bad service. Our recent study of German consumers commonly produced reactions like this: 'I saw a long queue, so hopped on the tube and went to a different practice'; 'she was rather ill-tempered so I never went back'; 'the facilities were drab, so I went to a different one next to my office'; 'I felt rushed at his practice so didn't go back'.

Second, Germans do not have to see a GP before visiting a private specialist. GPs do act as gatekeepers to German hospitals, but about half of all specialists practice outside the hospitals. German hospitals provide few out-patient services. Instead, there are a large number of independent clinics, invariably with the most sophisticated diagnostic equipment. Most Germans have a favourite GP, although many maintain a relationship with more than one - just in case - but if they need to see a specialist they would not waste time seeing a GP first.

And

Quote :

What problems are there in Germany? The German media is not excited by the subject. There are no patients lying on trolleys in A&E. Germany suffers no real rationing. Yes, problems occur from time to time. Just at the moment, there is a shortage of nurses, and many Germans feel that care is expensive, but serious complaints are few. Nevertheless, reform is in the air. Since January 2004 members of the statutory insurance plan have had to pay 10 euros per quarter to see a GP. The reforms also saw the introduction of charges for non-prescription drugs, and an end to free treatments such as health farm visits and to free taxi rides to hospital. This is expected to allow for a reduction in premiums from an average of 14 to 13 per cent of annual gross wages.

Now it's good to get those studies and accounts from the likes of Germany there Aragon - thanks. It sounds like it's operating like a proper market there with competition coming in to play which brings the word 'geography' into mind when considering here. And 'population'. Then 'infrastructure' and 'transport'. Think of West Cork, West Clare, parts of Mayo, Galway and Donegal and you have a scenario where the free market mechanisms need to be nudged and stimulated in order to get the market lubrication flowing.

Are these considerations serious containing issues around the hospital issues do ye think? And are they given enough attention? Population, planning, development, markets, infrastructure. Looking at ourselves holistically might show up some dark corners.

Aragon wrote:

seinfeld wrote:

cactus flower wrote:

Germany seems to get pretty good outcomes, and I think has a system of universal health insurance.

They have, and it costs 15% of your Gross monthly salary up to a ceiling of €534.00, of which your employer pays half. This is in addition to standard rates of income tax of between 15% and 42%, and a top rate of 45%.

Try selling that on the doorsteps at the next General Election.

And the German's are delighted with it. Nobody is dying on trollies.

Nobody is dying on hospital trollies in the Irish Health System either. Get a grip.

This is not the only case. It is inevitable seeing as there are a lot of sick people spending a lot of time on them.

http://www.sligoweekender.ie/news/story/?trs=cwqlauidid