Health expenditure

[Mikefromcork]

Just wondering given the cut in health expenditure compared to last year, rising healthcare costs with inflation and the deficit the HSE is running, no new programmes approved.

1 where are the new beds promised going to come from.
2 Surely our health system is going to even get worst this winter?

 

[Purple]

I am delighted that spending hasn't increased on healthcare. Those working in the sector have to start to act like adults and accept the majority of the responsibility for the shocking state of the health service, especially considering that it's one of the best funded healthcare systems in the world with amongst the best paid employees and has very high staffing levels.

 

[T McGibney]

Budgeted spending on healthcare hasn't increased for 2023.

But there's not a doubt in the world that actual healthcare spending next year will increase.

 

[arbitron]

People are very focused on the DoH/HSE spend but relatively little is mentioned about the huge money we pay for private insurance. It all comes out of our pockets one way or another, so we should be looking at our overall health spend per capita.

The public system props up the private in many ways, so those who have no/low insurance are effectively subsidising both the well-heeled with VHI MegaPlan Z as well as those with medical cards, etc.

 

[Mikefromcork]

I am delighted that spending hasn't increased on healthcare. Those working in the sector have to start to act like adults and accept the majority of the responsibility for the shocking state of the health service, especially considering that it's one of the best funded healthcare systems in the world with amongst the best paid employees and has very high staffing levels.

I agree but they have increased the cost of consultant contracts in the last year with no added benefit to wait times from what I can see.

I am wondering where the joined up thinking is? What will they do with healthcare. Waiting lists aren’t getting shorter and wait times in EDs are chronic. Maybe I just don’t get a feeling it is being sorted.

 

[Sophrosyne]

People are very focused on the DoH/HSE spend but relatively little is mentioned about the huge money we pay for private insurance. It all comes out of our pockets one way or another, so we should be looking at our overall health spend per capita.

Yes.

This is the Annual Market Report 2022 from the Health Insurance Authority.

It doesn’t show the total premiums paid in 2022 – not that could I see.

 

[Purple]

People are very focused on the DoH/HSE spend but relatively little is mentioned about the huge money we pay for private insurance. It all comes out of our pockets one way or another, so we should be looking at our overall health spend per capita.

The public system props up the private in many ways, so those who have no/low insurance are effectively subsidising both the well-heeled with VHI MegaPlan Z as well as those with medical cards, etc.

No, the Private System props up the Public System. I pay for healthcare through my taxes and I pay for again with private health insurance.

 

[arbitron]

No, the Private System props up the Public System.

In what way?

I pay for healthcare through my taxes and I pay for again with private health insurance.

Yes, that's the exact point being made.

 

[thedaddyman]

From a budgetry perspective, the HSE is completely and utterly out of control. I get there will be issues, unexpected spikes etc but the scale of forecasting failure is just shocking. In addition, the sheer amount of money wasted on nonsense. Finally they have a hiring freeze on managers for example.

Until they sort themselves out, throwing money at them is throwing it down the drain

 

[arbitron]

Yes.

This is the Annual Market Report 2022 from the Health Insurance Authority.

It doesn’t show the total premiums paid in 2022 – not that could I see.

€2.93 billion which equates to about 12% of national health spending for 2022. That is signficant. Then you have all of the out-of-pocket expenses which are not covered by either HSE or private insurance, e.g. any meds below threshold of Drugs Payment Scheme. The total cost of health is very high.

 

[Purple]

In what way?

If there was no private system the State would have to provide the services it currently provides.

Yes, that's the exact point being made.

Okay, so that's the point. What don't you get? Sorry if that sounds curt but I don't see how anyone other than a teenaged socialist could possibly think that the private system is being propped up by the public system.

 

[WizardDr]

But for the Corporate Taxes windfall, our overruns with the HSE would be worse than UK NHS. When the CT bounty evaporates we will have major problems that we should be addressing now. Isn't your man a former McKinsey consultant?
We don't get VFM and its nothing new and not tackled.
People take out private insurance as they don't believe they will get treated on a timely basis.
That said once in the system people seem satisfied.

 

[Sophrosyne]

Agreed.

Most people agree that the public system is generally good if one could access it.

We’ve had an access problem for years – hence the main reason for private health insurance.

I have been closely watching the Dail Committees on Health and also Public Expenditure & Reform & the PAC in relation to health.

The number of times there has been either no or most unsatisfactory answers to pertinent questions as to why major programmes or required changes to existing programmes were not implemented is shocking. Expenditure is not properly accounted for. The economic cost of disease is unknown. It shouts incompetence & irresponsibility.

 

[arbitron]

If there was no private system the State would have to provide the services it currently provides.

The private system largely cherry picks the high-margin, lower-cost, lower-risk activity. The HSE is the provider of last resort, so when insurance runs out (and it often does) then the HSE picks up the tab. For example, patients who have private cosmetic procedures and end up in ICU costing 6 figures. The cost of delivering care privately is not always cheaper either, so there are hidden costs to the individual, the insured as a whole, and to the exchequer.

Okay, so that's the point. What don't you get? Sorry if that sounds curt but I don't see how anyone other than a teenaged socialist could possibly think that the private system is being propped up by the public system.

There is no point in discussing further if you can't be civil. No-one else here is personalising it or using ad hominems.

 

[valery]

the Private System props up the Public System.

Agree with Purple. Was told recently by an employee of Mater Public that the difference between it and the Private is shaded. HSE parients are regularly referred to Private for treatment,
Had a scan some months ago in Mater Private late in the evening. staff in X-ray told me they would be working until midnight mainly seeing HSE patients.

 

[Purple]

The private system largely cherry picks the high-margin, lower-cost, lower-risk activity. The HSE is the provider of last resort, so when insurance runs out (and it often does) then the HSE picks up the tab.

Yes, when the subsidy runs out the HSE covers the rest of the cost.

For example, patients who have private cosmetic procedures and end up in ICU costing 6 figures.

That's a tiny sum in the overall context of the billions spent on private healthcare.

The cost of delivering care privately is not always cheaper either, so there are hidden costs to the individual, the insured as a whole, and to the exchequer.

I agree. Healthcare is extremely bad value for money.

There is no point in discussing further if you can't be civil. No-one else here is personalising it or using ad hominems.

I apologise. I was asking an honest question. I don't see how a private system which gives billions of additional funding on top of the public system can be seen as anything other than a subsidy of that public system.

 

[Sophrosyne]

Are we not talking about the greater dependency?

Across the board, does the private health sector have a greater dependency on the public health sector or vice versa?

 

[Purple]

Are we not talking about the greater dependency?

Across the board, does the private health sector have a greater dependency on the public health sector or vice versa?

If I have a lump or a heart attack and I use my private health insurance to receive treatment then there is no cost to the State. If I don't have private health insurance then I use the public system and there is a cost to the State. Ergo the private health service subsidises the public health service in that it reduces the amount of health services consumed within the public system.

 

[T McGibney]

If I have a lump or a heart attack and I use my private health insurance to receive treatment then there is no cost to the State. If I don't have private health insurance then I use the public system and there is a cost to the State. Ergo the private health service subsidises the public health service in that it reduces the amount of health services consumed within the public system.

Also, elective treatment covered by private health insurance in order to avert, resolve or ameliorate a particular condition will presumably lessen the burden on the public system that would have materialised in due course had that treatment not been undergone in the first instance.

 

[Protocol]

2021 expenditure