cactus flower wrote:

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

cactus flower wrote:

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

tonys wrote:

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

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

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

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

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

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

There are many ways to improve the provision of services for everyone, to decide exactly what the mix of private & public will be, but in my opinion none will work long term unless the vested interests can be brought to accept & work with the necessary change in the provision of those services. If any other road is chosen, we will simply be throwing good money after bad.

seinfeld wrote:

cactus flower wrote:

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

Is building capacity in the public system free?

EvotingMachine0197 wrote:

The motorway network in Ireland is one example. It's class..except for the privately run bits (aka toll bridges)

The M50 would be close on superb if it wasn't for that pricks 650 Million stake on a Liffey Bridge.

Paris: Best public transport system in Europe if you ask me.

New York: Best public transport system in Europe if you ask me.

Spot the error ! Point is tonys, public built is better built.

Or maybe the point is that we should not be comparing the health system to any other system....Like maybe health is different ??

cactus flower wrote:

seinfeld wrote:

cactus flower wrote:

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

Is building capacity in the public system free?

The public own the building in the public system.
In the Harney system the public pay for the building, but they don't own it.

cactus flower wrote:

seinfeld wrote:

cactus flower wrote:

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

Is building capacity in the public system free?

The public own the building in the public system.

cactus flower wrote:

To reiterate: in both public and private systems the public/users pay for the building. In the private system, the public pay for it but don't own it. In the public system they do own it.

seinfeld wrote:

cactus flower wrote:

To reiterate: in both public and private systems the public/users pay for the building. In the private system, the public pay for it but don't own it. In the public system they do own it.

Who cares who owns it?

We don't invest in healthcare as sort of speculative property development deal.

cactus flower wrote:

seinfeld wrote:

cactus flower wrote:

To reiterate: in both public and private systems the public/users pay for the building. In the private system, the public pay for it but don't own it. In the public system they do own it.

Who cares who owns it?

We don't invest in healthcare as sort of speculative property development deal.

That will be bad news for Mary. That is entirely what she is depending on in terms of 'co-location' investment. Do you think Barringtons and the Beacon were built for the good of someone's health? and I thought you were a fine upstanding capitalist Seinfeld.

cactus flower wrote:

If the public patient has paid for the asset, and then has to pay again to use it, or indeed may be excluded from using it if not in funds, it would be a matter of some interest to the patient.

Auditor #9 wrote:

The private hospitals will be out of control of the state so I'm wondering if it could eventually end up like the Eircom network - an infrastructure in need of an upgrade but the private sector won't have the interest in doing that and the state won't have the control.

Many of the 158 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be — often because of some combination of higher premiums, less extensive coverage, and bigger out-of-pocket deductibles and co-payments.
With medical costs soaring, the coverage many people have may not adequately protect them from the financial shock of an emergency room visit or a major surgery. For some, even routine doctor visits might now take a back seat to basic expenses like food and gasoline.
“It just keeps eating into people’s income,” said James Corbin, a former union official who works for the local utility in Tucson.
Mr. Corbin said that under their employer’s health plan, he and his co-workers are now obliged to pay up to $4,000 of their families’ annual medical bills, on top of about $1,600 a year in premiums. Five years ago, they paid no premiums and were responsible for only about $2,000 of their families’ medical bills.
“That’s a big jump,” Mr. Corbin said. “You’ve just lost a month’s pay.”

Companies and policy makers have yet to focus on what the faltering economy means for employees’ medical care, said Helen Darling, president of the National Business Group on Health, a Washington association of about 200 large employers.
“It’s a bad-news situation when an individual or household has to pay out-of-pocket three, four or five times as much for their health plan as they would have at the time of the last recession,” she said. “Americans have been giving their pay raise to the health care system.”

In 2006, the nation’s six biggest private health insurers collectively earned almost $11 billion in profits.

Quote :

But when Raymond had his medical problems, Ms. Giarde discovered that her insurance would cover only $22,000, leaving them with about $100,000 in unpaid hospital bills.

Even though the hospital agreed to reduce that debt to about $50,000, Ms. Giarde is still struggling to pay it — in part because the poor economy has meant slumping sales at the Purple Parasol. Her husband, now disabled and unable to work, will not qualify for Medicare for another year, and she cannot afford the $758 a month it would cost to enroll him in a state-run insurance plan for individuals who cannot find private insurance.

She recently refinanced her car, a 2002 Toyota Highlander, to help pay for her husband’s heart medicines, which cost some $400 a month.

Auditor #9 wrote:

from the above

Quote :

But when Raymond had his medical problems, Ms. Giarde discovered that her insurance would cover only $22,000, leaving them with about $100,000 in unpaid hospital bills.

Even though the hospital agreed to reduce that debt to about $50,000, Ms. Giarde is still struggling to pay it — in part because the poor economy has meant slumping sales at the Purple Parasol. Her husband, now disabled and unable to work, will not qualify for Medicare for another year, and she cannot afford the $758 a month it would cost to enroll him in a state-run insurance plan for individuals who cannot find private insurance.

She recently refinanced her car, a 2002 Toyota Highlander, to help pay for her husband’s heart medicines, which cost some $400 a month.

mother of god are those costs normal? $700 a month for health insurance? With stories like that you'd be sick with worry as to what would happen you if you did get sick...

it must be a rare case though ... Time to post a question on Boards.USA or JoeDuffy.America and find out how much and how often this type of story happens in the states - maybe we could try to learn from it. Prevention is better than cure in case it gets to that stage here.

seinfeld wrote:

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

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 bureacratic than publicly provided non-profit health care.

The idealogy 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.

cactus flower wrote:

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 bureacratic than publicly provided non-profit health care.

The idealogy 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.

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

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.... "

Quote :

“Conclusions Administrative costs as a percentage of total hospital costs increased in the United States between 1990 and 1994 and were particularly high at for-profit hospitals. Overall costs of care were also higher at for-profit hospitals.”

Quote :

Conclusions: In the United States, for-profit ownership of dialysis facilities, as compared with not-for-profit ownership, is associated with increased mortality and decreased rates of placement on the waiting list for a renal transplant.

Quote :

Conclusions: Both the rates of per capita Medicare spending and the increases in spending rates were greater in areas served by for-profit hospitals than in areas served by not-for-profit hospitals.

Quote :

Dialysis Centers

Eighty-five percent of dialysis centers in the US are for-profit, and they compare poorly with their not-for-profit counterparts—death rates are 30% higher with 26% less use of transplants in 1 study reported in 1999.81 A more recent systematic review and meta-analysis estimated that there are 2500 excessive premature deaths each year in US for-profit dialysis centers.82

Emphasis on bottom-line profits leads to cutbacks of staff and the use of shorter dialysis periods (average of 10 hours per week in the United States compared with 12 in Germany and 14 in Japan).12, pp137–8 Frensenius Medical Care North America (a German firm) is the largest provider of kidney dialysis products in the world, with more than 800 dialysis facilities in the US. After pleading guilty to charges of conspiracy and fraud, it paid $486 million in fines and settlements to the government in 2000.83

[...]

It would be one thing if investor-owned, corporate health care brought increased efficiency and value to the market, but just the opposite is the case. Instead, for example, the huge for-profit health insurance industry takes one quarter of the health care dollar while separating the relatively healthy from the sick and fragmenting the risk pool.90 For-profit plans and facilities are consistently found to have lower quality of care than their not-for-profit counterparts, whether HMOs32 hospitals,15–18 dialysis centers,81,82 or nursing homes.86 Table 1 *summarizes some of the evidence documenting increased costs and lower quality of care in investor-owned facilities.

Quote :

Table 1. Investor-Owned Care: Comparative Examples versus Not-For-Profit Care

Hospitals: Costs 3% to 13% higher, with higher overhead, fewer nurses, and death rates 6% to 13% higher.11,17,88

HMOs: Higher overhead (25% to 33% for some of the largest HMOs), worse scores on 14 of 14 quality indicators reported to National Committee for Quality Assurance32,33

Dialysis centers: Death rates 30% higher, with 26% less use of transplants81,82

Nursing homes: More citations for poor quality of care (30% committed violations which caused death or life-threatening harm to patients)85


Mental health centers: Medicare expelled 80 programs after investigations found that 91% of claims were fraudulent89

Quote :

"Bureaucracy costs jumped sharply when non-profit and public hospitals were purchased by for-profits. If all U.S. hospitals became for-profit, hospital paperwork would rise by $14.8 billion annually," noted Woolhandler. She continued: "It's a myth that for-profit hospitals are efficient. They save money by laying off nurses, then hire consultants and bureaucrats to figure out how to avoid unprofitable patients and maximize revenues. For-profits increase costs, decrease care, and generate windfall profits, like the $359.5 million pocketed by Rick Scott of Columbia/HCA in 1996. They're fat and mean." [New England Journal of Medicine, March 1997]

Quote :

Several prerequisites for the competitive free market described in textbooks are absent in health care.19,20

First, it is absurd to think that frail elderly and seriously ill patients, who consume most care, can act as informed consumers (i.e., comparison-shop, reduce demand when suppliers raise prices or accurately appraise quality). Even less vulnerable patients can have difficulty gauging whether a hospital's luxurious appurtenances bespeak good care.

Second, the "product" of health care is notoriously difficult to evaluate, even for sophisticated buyers like government. Physicians and hospitals create the data used to monitor them; self-interest puts the accuracy of such data into question. By labelling minor chest discomfort "angina" rather than "chest pain," a US hospital can garner both higher Medicare payments and a factitiously improved track record for angina treatment. It is easier and more profitable to exploit such loopholes than to improve efficiency or quality...

Quote :

Dozens of patients allege unnecessary heart surgery
25, 91

A lawsuit brought on behalf of 82 patients who were allegedly subjected to unnecessary cardiac surgery at Redding Medical Center, Redding, northern California, has been filed in a Californian county superior court.

Nine of the 82 patients later died, and some of the deaths have been attributed to the unnecessary surgery, the lawsuit says. It further contends that a deliberate push for high profits prompted the hospital and doctors to perform inordinate numbers of highly profitable heart procedures, whether they were necessary or not.

Last October the Federal Bureau of Investigation raided the offices at the Redding Medical Center of cardiovascular surgeon Dr Chae Hyun Moon and director of cardiovascular surgery Dr Fidel Realyvasquez Jr, but no charges have yet been filed (BMJ 2002;325:1130). With Dr Moon performing 10-12 cardiac catheterisations a day, about 2400 cardiac catheterisations were done at the Redding Medical Center last year, earning $94m (£59m; €82m) last year for its owners Tenet Healthcare Corporation. Dr Moon, 55, who stopped his practice in February, because he could not get malpractice insurance, has said that he was saving lives. Fred Charatan Florida

seinfeld wrote:

Auditor #9 wrote:

The private hospitals will be out of control of the state so I'm wondering if it could eventually end up like the Eircom network - an infrastructure in need of an upgrade but the private sector won't have the interest in doing that and the state won't have the control.

The comparison with Eircom doesn't stand.

Eircom owns the entire residential leased line infrastructure in the country, whereas private health care operators will own only a fraction of our health care infratructure.

Eircom has a total monopoly on the residential leased line market, so it doesn't need to invest in it for competitiveness. All private hospitals have to compete with other private hospitals, and the entire public system.

Underinvestment in the private sector will only arise through declining demand, which can only result from increased capacity in the public systemor a more health population, both of which are welcome alternatives in my book.

Again, private healthcare is being painted as some sort of evil based on a perception that it is only available to people with money.

The reality is that private health care facilities will be available to everyone through the NTPF. The State is simply taking the view that it should provide for public patients by shopping around for the best quality care rather than investing tax payers money in public systems that clearly don't work.

cactus flower wrote:

seinfeld wrote:

Auditor #9 wrote:

The private hospitals will be out of control of the state so I'm wondering if it could eventually end up like the Eircom network - an infrastructure in need of an upgrade but the private sector won't have the interest in doing that and the state won't have the control.

The comparison with Eircom doesn't stand.

Eircom owns the entire residential leased line infrastructure in the country, whereas private health care operators will own only a fraction of our health care infratructure.

Eircom has a total monopoly on the residential leased line market, so it doesn't need to invest in it for competitiveness. All private hospitals have to compete with other private hospitals, and the entire public system.

Underinvestment in the private sector will only arise through declining demand, which can only result from increased capacity in the public systemor a more health population, both of which are welcome alternatives in my book.

Again, private healthcare is being painted as some sort of evil based on a perception that it is only available to people with money.

The reality is that private health care facilities will be available to everyone through the NTPF. The State is simply taking the view that it should provide for public patients by shopping around for the best quality care rather than investing tax payers money in public systems that clearly don't work.

People have to be able to get near a consultant in order to have anything to do with the NTPF