The fallacy of private health care efficiency

cactus flower wrote:

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

With all due respect, this unfortunate woman died of a massive brain haemorage after being seen by a Doctor and while waiting to be admitted. She was fully conscious when she was admitted and the triage found that she was suffering a stroke.

The inquest found that there was nothing that could have been done for her such was the extent of the bleed.

Obviously, this isn't acceptable, and people who present with strokes should be treated promptly, but very, very few patients actually die from their triage conditions will waiting for admitance to acute beds, contrary to what sensationalists would have you believe. In fact, I think this is the only case in the last 10 years.

Recent letter of protest from Dr James O' Reilly TD about conditions in Galway:

"We enclose the figures for the number of patients waiting on trolleys for an inpatient bed in the ED at UHG for the month of April 2008. You will see that this month we have had a total of 444 patients on trolleys at 9am. This compares to a total of 188 for the same period in 2007. This is an increase of 136 % at a time when the HSE is meant to be moving towards a zero tolerance for trolley waits in Emergency Departments, as recommended by the Task Force Report.
"There is no doubt that this continued overcrowding in the Emergency Department is adversely affecting patient care. Recent independent research from Australia suggests that this persistent overcrowding is resulting in anywhere between 10 to 20 unnecessary deaths per year for a population the size of Galway (assuming 2300,000 [sic]). The implication that there are one or more unnecessary deaths per month in Galway University Hospitals as a result of the persistent overcrowding is a very worrying one.
"The staff in the Emergency Department at University Hospital Galway are continually highlighting the risks associated with overcrowding. However, despite their efforts to highlight the issue, there appears to be no meaningful plan to address this issue, which is now spiralling out of control. By the end of April 2008 there were 1,283 patients on trolleys at 9am waiting for a bed, compared to 891 patients for the same period in 2007, an increase of 44%."

And that's just in Galway.

There are two Irish health service issues I am concerned about. One is the overall effectiveness of health care and the other is the equity of access to it, no matter who you are, what your income is or where you live.

This thread is about the effectiveness of private care. The impression I have that private care in Ireland secures you earlier treatment and fancier accommodation, not better treatment. The fancier accommodation is not important and I don't mind if people want to pay for it. The timeliness of care impacts on quality of life and mortality.
It is time that we changed our system to one that looks after everyone's health equally.

I asked above how having co-located hospitals would help consultants achieve the critical mass of patients needed to reach best practice standards, when they are offering separate and duplicate public and private services in one location. It would appear that it would have a negative effect and cut across the "centres of excellence" strategy. I still don't know the answer, and I still don't understand the purpose of separating public and private consultants.

What is the scheme for GP services in very large centralised clinics about - is there any model or research that shows them to be the right solution for Ireland? Or are they another wheeze for making money out of ill health. Even the GPs don't seem to know what is happening and have not been consulted.

I agree with proper centres of excellence provided they are excellent and have the capacity for their enlarged catchments, and provided people are provided with free, convenient transport to them, but this is a necessary reform of the public sector and has nothing to do with privatisation.

cactus flower wrote:

I asked above how having co-located hospitals would help consultants achieve the critical mass of patients needed to reach best practice standards, when they are offering separate and duplicate public and private services in one location. It would appear that it would have a negative effect and cut across the "centres of excellence" strategy. I still don't know the answer, and I still don't understand the purpose of separating public and private consultants.

Consultants will continue to do both private and public practice, and the co-lo hospitals will constitute only a fraction of overall capacity, but yes, it won't be the same as all consultants working in public facilities and building up expertise through shared experience.

Nobody is arguing that there are significant downsides to co-location. The problem is that we have a very urgent acute capacity problem, that is costing lives, and co-location is the just one of the solutions being applied to address this.

seinfeld wrote:

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?

Your opinion that it's grandiose is not a rebuttal or a valid argument against its content. Either deal with it or stop ducking and diving.

seinfeld wrote:

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?

The HSE is not independent it is quite clearly a politically orientated body created by Harney.

It is a part of the ongoing outsourcing of government - a neoliberal and intimately political project. To suggest otherwise is to have your head in the sand.

The Prospectus report advocated the formation of a Health Services Executive, (HSE), modelled on a corporate board, to take charge of all executive functions pertaining to the health system. The report was carried out by Prospectus Consultancy, it's chairperson is Sean Donelly, who was a former director of the IDA and is a board member of several other companies. The managing director is David Duffy, who is a member of the Dublin regional committee of IBEC. Prior to this report it had done a major report on the opportunities for private health care for a private health care insurer. Its particular corporate ethos meant there was little likelihood that it would recommend universal free health care or any extension of democratic decision-making.

One of the recommendations of the report was the creation of a divisional structure for the HSE with a National Hospital Office being responsible for allocation funding to hospitals and, significantly, 'managing the interface with private acute providers'.

After Harney became minister for health in 2004 she named Kevin Kelly, a former Managing director of AIB and President of the Irish Bankers Federation, as interim head of the HSE. PWC were then hired at the cost of 36000 euros to recruit the permanent CEO of the new body. The HSE board was dominated by people from a business background. Its chairperson was Liam Downey, the former chief executive of Becton Dickson, a medical technology company and a member of the National Executive of IBEC. It also included Joe Macri, the managing director of Microsoft Ireland and also a member of the National Executive of IBEC; Eugen McCague, a partner with the solicitors firm Arthur Cox and council member of Dublin Chamber of Commerce; Donal de Buitleir, a General Manager with AIB; Professor John Murray, President of the Marketing Institute of Irelan and Niamh Brennan, a chartered accountant and academic director of the Institute of Directors Centre for Corporate Governance in UCD, among others.

It's no wonder they supported co-location contrary to the recommendations of the Department of Health.

As regards colocation, we don't need to scratch our heads in wonder as to how it will turn out, or even worse, rely on the plainly false argument that it will free up beds as research into similar schemes as co-location have shown they will not free up beds. This is obviously the case as the money will follow the beds and the for-profit element will cherry-pick and/or lead to duplication. Something very similar was tried in Australia and it was a failure. In the US when Medicare uses for-profits to provide the same care as before (the same outcome level) it increases costs dramatically. The same is the case in the UK.
Your argument about people paying insurance so we should then have private for-profit healthcare makes no sense whatsoever.
The money would be better spent on increasing the public system capacity. I'd ideally also like to see more local democracy and nurse and doctor 'shop-floor' input coupled with health-consumer say. But that's only a bonus.

seinfeld wrote:

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.

Wait a sec. You just said upthread that you accepted my point that for-profit healthcare is less efficient? You now turn that around? You've also yet to back any argument up as far as I can see. You've sniped, and bitched, oh and then used a yawn smilie. That aint backing up an argument on a board.

Basically health care is different, it's not selling baked beans, it's a public good which is poorly provided by a market and for-profit mechanisms as shown by international statitistics (oecd etc) comparing national systems and meta-analyses going back decades. The principles and pre-requisites of a free-market, described in economic textbooks, are absent in the area of health care. This is why I feel we shouldn't be wasting money on an ideological project to privatise as much of the system as we can.

I agree that the State needs to improve on it's capacity which it has not done, and it would get more health provision for it's money if it directly funded the public system as opposed to engaging in a hiring freeze and funding corporate healthcare providers via co-location and the NTPF.

seinfeld wrote:

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.

Jeez, you either don't get it or you're being purposefully naive. I'm not saying that equity is not an issue! And of course those costs and outcomes are included. You can't compare like with like without having the same outcome level or making those adjustments. It's obvious you've failed to even click on one of those links.
My point about equity is obviously that systems with a higher private for-profit element are more inequitable than ones with less. There's a direct correlation there.

Either way, you'd save yourself a lot of time if you clicked on one of those links and read how the studies were carried out. You appear to be suggesting that decades of studies into health care provision, and published in the worlds most respected medical journals, are actually rubbish.

seinfeld wrote:

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..

All evidence suggests that a public system would cost less. The Canadian public system costs less per-person than the US system and one of the developed world's most efficient systems is the UK's NHS. There is certainly "a guarantee that the State could afford to run a entirely public system on this basis."

Pax wrote:

seinfeld wrote:

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?

Your opinion that it's grandiose is not a rebuttal or a valid argument against its content. Either deal with it or stop ducking and diving.

Its grandiose because you're claiming to have read every study on health care efficiency ever written.

I'm not going to reply to the rest of your post. You can claim that you've 'won' if you like. I don't post here to win arguments with idealogues.

seinfeld wrote:

Pax wrote:

seinfeld wrote:

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?

Your opinion that it's grandiose is not a rebuttal or a valid argument against its content. Either deal with it or stop ducking and diving.

Its grandiose because you're claiming to have read every study on health care efficiency ever written.

Pathetic. I said no such thing, I said as far as I'm aware I've read of no study which has shown that to be the case.

I also highlighted, in bold, one particular meta-analyses which shows that to the case. Like all of the other studies you avoided them
and continued in your pathetic posting style berating me for the fact that I'd posted them. You then childishly call it a grandiose claim. You're a troll.

I wrote:

When Money is the Mission — The High Costs of Investor-Owned Care
http://content.nejm.org/cgi/content/short/341/6/444

Quote :

"Market
medicine's dogma, that the profit motive optimizes care and minimizes
costs, seems impervious to evidence that contradicts it. For decades,
studies have shown that for-profit hospitals are 3 to 11 percent more
expensive than not-for-profit hospitals2,3,4,5,6,7; no peer-reviewed study has found that for-profit hospitals are less expensive.... "

seinfeld wrote:

I'm not going to reply to the rest of your post. You can claim that you've 'won' if you like. I don't post here to win arguments with idealogues.

Yes I will claim that I've won. I also don't claim to not be motivate by ideology. However, in the area of health it just so happens that real-world evidence concurs with my ideology.

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.

Pray tell seinfeld - Do they pay more, or less than the Americans?

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. 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.

They certainly are happy with it. No party there can touch it.

One interesting point here though is that the PDs were the party most associated with privatisation policies at the last election. They were also the most decimated.

The first step on the rung to an Irish NHS was tried under Noel Browne but the Church and consultants/doctors prevented it. Since then it has never, seriously been proposed as an implementable policy within government.

I'd imagine polls would show most people to be in favour of free at the point of delivery health care? Certainly in developed democracies? I think this is unsurprising and comes with, well, democracy. Now why the Labour Party have been perenially afraid to sell this policy is up to them...

Pax wrote:

seinfeld wrote:

Pax wrote:

seinfeld wrote:

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?

Your opinion that it's grandiose is not a rebuttal or a valid argument against its content. Either deal with it or stop ducking and diving.

Its grandiose because you're claiming to have read every study on health care efficiency ever written.

Pathetic. I said no such thing, I said as far as I'm aware I've read of no study which has shown that to be the case.

Yes you have!

I'm quoting you here:

"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"

That implicity implies that you've read *every* study on the subject.

Pax wrote:

You're a troll.

That sort of language doesn't belong here. You might want to read the Charter.

cactus flower wrote:

I asked above how having co-located hospitals would help consultants achieve the critical mass of patients needed to reach best practice standards, when they are offering separate and duplicate public and private services in one location. It would appear that it would have a negative effect and cut across the "centres of excellence" strategy. I still don't know the answer, and I still don't understand the purpose of separating public and private consultants.

What is the scheme for GP services in very large centralised clinics about - is there any model or research that shows them to be the right solution for Ireland? Or are they another wheeze for making money out of ill health. Even the GPs don't seem to know what is happening and have not been consulted.

Here's an interesting article on that subject CF, it may highlight an answer.

The Great Consolidation

Quote :

Everything is getting bigger and further away. Hospitals, post offices, schools and prisons are being “rationalised” and “consolidated”. The government says that this process improves efficiency. Instead, it outsources inefficiency: we must travel further to use public services. This is bad for the environment, bad for community life, bad for universal provision. But we haven’t seen anything yet. We are about to be confronted with the biggest shutdown of all: the government has started the process of closing England’s network of doctors’ surgeries...

[....]

Quote :

Lord Darzi insists that polyclinics will offer “a more personalised service”(9). This is nonsense: in the huge new centres we are less likely to be able to see the same GP and more likely to get lost in the system. A recent paper in the British Medical Journal reveals that “patients in small practices rate their care more highly in terms of both access and continuity” and that small practices “achieved slightly higher levels of clinical quality than larger practices”(10). The new centres will be built not where they are most convenient for patients but – as Darzi revealed to the Commons health committee - where the NHS happens to own land(11). If you live in a village or a distant suburb and depend on public transport – as many elderly and sick people do - visiting the doctor could take all day. Ara Darzi is the new Dr Beeching, shutting down the branch lines of our primary health service.

So why is this happening? In seeking surreptitiously to privatise healthcare, the government has a problem. Primary care is already in private hands: GPs run their own practices. But they are the wrong hands: the corporations demanding guaranteed streams of income from the taxpayer can’t play. Polyclinics are perfectly designed to let them in, while preventing doctors from competing.

[...]

Quote :

Do I need to explain the implications? The US health system, which the
British government seems determined to emulate, is both more expensive
and less efficient than ours; those who can’t afford to pay are either
excluded or treated like battery pigs(13). The independent sector
treatment centres (ISTCs) – private clinics performing routine
operations for the NHS - that the government introduced in England in
2003 have been a costly disaster. Private companies receive their money
whether or not they carry out the work they are contracted to do. The
government refuses to release comparative figures, but the little
evidence we have suggests that their costs are much higher than the
public sector’s(14). The risks have been transferred back to the
taxpayer and in some cases the standards of treatment are appalling. In
2006 Angus Wallace, professor of orthopaedic and accident surgery at
Nottingham University, told the Guardian, “We expect failures of hip
replacements at approximately 1% a year and knees at about 1.5% a year.
But we have got some of the ISTCs that are looking at 20% failure
rates.”(15) Because they put profits first, companies that run these
centres have generated a stack of litigation claims and a huge NHS bill
for repairing the damage they have caused(16). Far from reversing its
policy in the light of this evidence, the government is setting up a
competition panel, to ensure that the health service never
discriminates in favour of the public sector when awarding
contracts(17).

[...]

Quote :

Why, after the 60-odd consecutive quarters of growth that Gordon
Brown keeps boasting about, can he not maintain a public service
founded in the midst of poverty and rationing?

One interesting point that is not often brought up in talks on costs and efficiencies is the impact on the environment of not providing public goods in an efficient manner. It can all add up when calculating how many planet's resources we need to achieve a certain human development level.....

(ETA: missing words/quotes)

I'd rather that form of address wasn't used here Pax - remember the words of Winston Churchill - "In Victory, Magnanimity".

That's if you won. Can you counter Pax now, Seinfeld, with similar for-profit studies which indicate private efficiency? Or criticise the studies he has posted?

seinfeld wrote:

Pax wrote:

seinfeld wrote:

Pax wrote:

seinfeld wrote:

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?

Your opinion that it's grandiose is not a rebuttal or a valid argument against its content. Either deal with it or stop ducking and diving.

Its grandiose because you're claiming to have read every study on health care efficiency ever written.

Pathetic. I said no such thing, I said as far as I'm aware I've read of no study which has shown that to be the case.

Yes you have!

I'm quoting you here:

"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"

That implicity implies that you've read *every* study on the subject.

I don't claim to have read every study. Which is why I posted, in the very next post, (the one that you criticised) meta-analyses of studies going back decades which showed that that was the case.

seinfeld wrote:

Pax wrote:

You're a troll.

That sort of language doesn't belong here. You might want to read the Charter.

Hmm. I wasn't aware you couldn't call a troll a troll here. Seems pretty mild 'language ' to me I have to say. Are you aware what a Troll is in forum terminology seinfeld?
Anyways, good for it to be pointed out.

Now can you actually argue like Auditor #9 has suggested? I'll need to look at the Charter again but the place will be poorer if threads go round in circles because of the tactics you've employed here.

Auditor #9 wrote:

I'd rather that form of address wasn't used here Pax - remember the words of Winston Churchill - "In Victory, Magnanimity".

That's if you won. Can you counter Pax now, Seinfeld, with similar for-profit studies which indicate private efficiency? Or criticise the studies he has posted?

I haven't even disagreed with him/her.

Pax seems to have a bugbear about the HSE and the use of the private sector in the health service and has compiled a collection of references to support his/hers views which s/he uses to napalm threads like this.

I have no real opinion on the subject, other than its being illogical to transpose theories derived from studies of health services in one culture/economy into another without taking account of the peculiarities of that health service/culture/economy.

I prefer to discuss the merits/demerits of the Irish Health Service without feeling the need to arrive at absolute conclusions based on the opinions of people who have never studied the Irish health experience in any particular detail.

Pax it's a fair point he makes - your studies are all from Canada is that right? Can you outline a bit about how you came across them and their substance - I believe they consist (your links) of studies compiled which compare costs of care between public and private?

I had a look at the bibliography and it is extensive - any way we can make a constructive and instructive for Dummies out of this thread? Some of us are very slow readers you know.

These are the footnote in one of your links - all substantial articles in themselves

seinfeld wrote:

I haven't even disagreed with him/her.

It is now obvious you are not engaging honestly here.

seinfeld wrote:

I have no real opinion on the subject, other than its being illogical
to transpose theories derived from studies of health services in one
culture/economy into another without taking account of the
peculiarities of that health service/culture/economy.

Studies in other developed nations show the same result seinfeld, as do international statistics comparing systems. The difference between nations and cultures can, and are, accommodated.
I mean even in the US the right wing think tanks like Cato and Heritage have stopped alleging efficiencies from for-profit health care. They know they just can't win on it.

Auditor #9 wrote:

Pax it's a fair point he makes - your studies are all from Canada is that right? Can you outline a bit about how you came across them and their substance - I believe they consist (your links) of studies compiled which compare costs of care between public and private?

No they're not all from Canada Auditor #9. They're mainly from the US and Canada (for instance the one linked above is from the New England Journal of Medicine http://content.nejm.org/ )and are actually collections (or meta-analyses) of numerous studies going back decades comparing costs of systems, public and private. There are similar studies published for instance in British medical journals, Australian, and European. Also, international statistics (I have an oecd xls link somewhere...) show per-person costs are higher in nations with higher for-profit elements. I could include more of these links but I'd be accused of spamming the thread. I think it's fair to say that for the same level of care public systems are more efficient.

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.

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.

Ok, so we can take it that if studies from a few similar countries have concluded that public care is all round better than for-profit then it should apply here also?

It's a lot of information to assess of an evening so you might have to be patient with some of us ... I'd appreciate it if you could contribute that xls file though - I've quizzed people on p.ie in the past on similar threads for similar oecd and international studies but it seems you weren't around at the time Pax.

Seinfeld has just posted before me on co-location: I'm wondering if those systems in Canada and elsewhere may not for some reason apply in Ireland? Perhaps there is a geographic or infrastructural peculiarity to our country ... ?

If it's at all possible I wouldn't mind spending some time on those links you posted and I also wouldn't mind building up some data here on the HSE and other bodies to have here for this site. This might take a little time but I am willing to read those studies in detail and gather stats etc. on them. My own mind is not clear on the value of private health to Ireland and I'd like to have a clearer picture of that.

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.

Auditor #9 wrote:

Seinfeld has just posted before me on co-location: I'm wondering if those systems in Canada and elsewhere may not for some reason apply in Ireland? Perhaps there is a geographic or infrastructural peculiarity to our country ... ?

Our peculiarity is that we are hugely invested in politically sensitive in-patient care.

ie

We have lots of County Hospitals into which people are admitted for all manner of procedures that in other countries are dealt with in primary care clinics.

We also have a God-culture amongst our consultants, who up until now have been very rigid in terms of their work practices, meaning that we have very narrow discharge windows.

All of this has led to huge pressure on our acute bed capacity, particularly when private patients are being admitted to public facilities because there isn't enough private capacity to accommodate them.

Co-location is a tactical response to that specific issue, not some sort of grand conspiracy on the part of Mary Harney and corporate Ireland.

Pax would prefer to see a massive overhaul of health funding and the development of a single tier system therein. I imagine most people would, but its not a short term solution, and may not be a solution at all, given that there is no evidence that Irish people would accept mandatory health insurance.

Auditor #9 wrote:

Ok, so we can take it that if studies from a few similar countries have concluded that public care is all round better than for-profit then it should apply here also?

It's a lot of information to assess of an evening so you might have to be patient with some of us ... I'd appreciate it if you could contribute that xls file though - I've quizzed people on p.ie in the past on similar threads for similar oecd and international studies but it seems you weren't around at the time Pax.

No problem.

http://www.oecd.org/dataoecd/60/27/35529803.xls

Also the program below is very useful.
http://www.whc.ki.se/files/whydownload.php

Quote :

Some of the many questions for which World Health Chart can contribute to the answer:

• Which are the richest countries
  in the world?
  
• Which are the healthiest countries
  in the world?
  
• How does wealth relate to
  health today and in the past?
  
• Has the world become healthier
  over the past 50-100 years?
  
• 
  How has the differences in
  health between countries changed?
  
• How has each country developed over
  the past 50-100 years?
  

Auditor #9 wrote:

Seinfeld has just posted before me on co-location: I'm wondering if those systems in Canada and elsewhere may not for some reason apply in Ireland? Perhaps there is a geographic or infrastructural peculiarity to our country ... ?

Well they were mostly comparing American for-profits, but it's not really related to a region or geography or (probably infrastructure) its focusing more on the delivery mechanisms. Indeed, we now have the very same health care corporations over here.

Thanks for those links Pax, no idea why I couldn't find those stats ages ago when I was getting involved in a HSE debate over on p.ie.

I wrote a giant reply there but I think I was rambling a bit .. I don't know if your world health chart link is linking or is it me but the google page entry #1 for those very words was this

http://www.whc.ki.se/index.php

which looks like it's linking for me anyway.

Ye seem to be both in agreement that the HSE needs an overhaul anyway - is it possible to eject hundreds of consultants and bring in Polish and Pakistani ones instead as well as implement thousands of other cost-cutting measures I could think of given a bit of time and a small consultancy fee...

The consultants definitely seem to be a major part of the problem here. Are they?

seinfeld wrote:

Auditor #9 wrote:

Seinfeld has just posted before me on co-location: I'm wondering if those systems in Canada and elsewhere may not for some reason apply in Ireland? Perhaps there is a geographic or infrastructural peculiarity to our country ... ?

Our peculiarity is that we are hugely invested in politically sensitive in-patient care.

ie

We have lots of County Hospitals into which people are admitted for all manner of procedures that in other countries are dealt with in primary care clinics.

We also have a God-culture amongst our consultants, who up until now have been very rigid in terms of their work practices, meaning that we have very narrow discharge windows.

All of this has led to huge pressure on our acute bed capacity, particularly when private patients are being admitted to public facilities because there isn't enough private capacity to accommodate them.

Co-location is a tactical response to that specific issue, not some sort of grand conspiracy on the part of Mary Harney and corporate Ireland.
Pax would prefer to see a massive overhaul of health funding and the development of a single tier system therein. I imagine most people would, but its not a short term solution, and may not be a solution at all, given that there is no evidence that Irish people would accept mandatory health insurance.

From what I have read a lot of people do see it as the thin end of the wedge of privatisation. I think I agree with them. It is the worst of both worlds, as it involves public moneys in the form both of payment for treatment and tax subsidies for building up private assets (hospitals and clinics), with no proper public control and not as part of an overall strategic services plan. The arrogance of bringing in the mega clinics with no proper consultation with the GPs is unbelievable.