NERI seminar" Unwinding the state subsidy of private health insurance"

We shouldn't forget that in the long run, there are advantages accruing to all members of society from this.

The problem in Ireland isn't the benefits that some people get from private medical insurance, it's that the public service is so dysfunctional. Look at A&E.

There are disadvantages, as non-insured patients must wait while the consultant prioritises the cash income that they can earn from private patients.

This is well-known, and to be expected.

If you pay consultants a PAYE wage for public work, and also allow them to have private patients, it's obvious that the incentives facing them will lead to delays for the public patients.

Yes, the public system is too slow, that's true as well.
 
Hi Protocol

I think that the public system and private system should be completely separated.

I don't think that the consultants are abusing the system in the way you suggest, but I fully agree that it could happen.

But do you have a problem with completely separate public and private systems?

Brendan
 
I read a very interesting article in the Sunday Independent recently by Stephen Donnelly TD, giving an insight into the public system and the sheer
dysfunctional, waste of money on a daily basis. Link as follows;
http://www.independent.ie/opinion/comment/twoyear-hip-op-wait-is-unacceptable-34793003.html

One often hears about problems in the public hospital system and it is difficult to get a handle on what exactly is wrong.

However, this is article by Stephen Donnelly TD vividly illustrates the sheer lack of common sense when it comes to governmental funding of public hospitals. This is a quote from the article:

"Believe it or not, the 15-month waiting list for the operation is actually the HSE target - and Cappagh's about to start missing even that. The hospital has been put in an impossible situation. In 2014, its funding was cut. It had the staff, but no longer had the money. So it cut back - costs were reduced, staff were let go - and the waiting lists grew longer. In fact, it did 700 fewer procedures in 2014 than in the previous year. So in 2015 it got more money, but no longer had the staff. So it scaled up again.

By the start of this year it had the staff, but didn't know how much money it was going to get for the year. It worked on the assumption that it would get the same as last year. It started making inroads into the waiting times. But then it learned its funding was being cut again. So it has closed operating theatres, told surgeons to stop working full days in theatre, and is scaling down - again."

Dr. Brian Turner has pointed out several times that the only way to gradually eliminate the multi-tiered health system is to improve the public health service.
 
There are disadvantages, as non-insured patients must wait while the consultant prioritises the cash income that they can earn from private patients. This is well-known, and to be expected. If you pay consultants a PAYE wage for public work, and also allow them to have private patients, it's obvious that the incentives facing them will lead to delays for the public patients. Yes, the public system is too slow, that's true as well.

One wonders how many consultants we would have if they were just getting a PAYE wage, and of what quality.
Already we have lots of newly qualified doctors from Ireland going off to Australia, Canada, UK et al

So private insurance is acting as subsidy to make more consultants and of better quality available to the public sector.
 
Hi Protocol

I think that the public system and private system should be completely separated.

I don't think that the consultants are abusing the system in the way you suggest, but I fully agree that it could happen.

But do you have a problem with completely separate public and private systems?

Brendan

No, I don't have a problem with that.

But, is there enough work in some specialities so that each sector could have separate consultants?

In a city like, say Waterford, there probably isn't enough work for two dermatologists, one public and one private..........


Instead of separating the systems, why not ignore who owns each hosp, and make that not relevant?

Why not let all patients have access to all hosps?

Either by universal insurance, or by a single payer.

Why not pay all hosps to receive all patients?
 
Hi Protocol

I think that the public system and private system should be completely separated.

I don't think that the consultants are abusing the system in the way you suggest, but I fully agree that it could happen.

But do you have a problem with completely separate public and private systems?

Brendan

Who owns the hospitals that are classed as "public"? Are most of them not owned by religious trusts? Ergo, to fully take control of them, similar to the school system, would the state not have to buy them (the properties) off the Trusts?
 
Instead of separating the systems, why not ignore who owns each hosp, and make that not relevant?

Why not let all patients have access to all hosps?

Because there is no reason to do so.

I don't have faith in the public hospital system to meet the needs of every illness of every patient in the country.

I am happy to use my money to pay for a standard of healthcare which the public service has shown itself unable to provide.

There is no reason why I should be condemned to the public health service.

If I choose to spend my money on private health care, or a bigger car, or nicer restaurants, I should be allowed to do so. If someone else chooses to spend their money on holidays, cigarettes, clothes and alcohol, let them do so as well.

Or should we make all restaurants charge the same price to all customers? In fact, make them free to everyone?

Brendan
 
Why not let all patients have access to all hosps?

While this sounds right, one of the problems with this is that private hospitals often do not have the multi-disciplinary teams to deal with patients with complex co-morbidity.
 
I am happy to use my money to pay for a standard of healthcare which the public service has shown itself unable to provide.

It is not that public hospitals do not provide a good standard of care. Indeed, if you have a complexity of health issues, you would most likely be better off to be in a public hospital.

The problem is access rather than the healthcare standard and that is not always the fault of the public hospital concerned.
 
Anyone going along to this seminar next Wednesday?

I am still confused by the ideological opposition to the state subsidy of private healthcare or private insurance.

A private patient gets no special treatment or quicker treatment in a "private" bed in a public hospital. The only thing is that they pay €813 per night instead of €75 per night.

If we didn't pay this through our health insurance, the state would pay it on our behalf.

If I have a problem, I have a choice of Blackrock Clinic of St Vincent's. If I go to St Vincent's I will be just adding to the queue. Doesn't going to Blackrock simply reduce the queue in St. Vincent's? Isn't that good for everyone?
 
The ideological position seems to be that there should be no private medical treatment and that you should be treated according to medical need and not your ability to pay. Why not extend that to housing. All housing should be nationalised and allocated according to need and not ability to pay. It seems like madness to me.

Brendan
 
Interesting paper yesterday evening.

The main point seemed to be that the changes to the system have not caused the death of private health insurance or a huge increase in premiums. In fact, the numbers with insurance have increased, although he did acknowledge that other factors such as increased employment and the introduction of lifetime community rating contributed to the increase.

I challenged the assumption that private health insurance was in some way inequitable. The assumption throughout the paper was that a person with private health insurance gets faster treatment in a public hospital. I said that I thought that was not correct but Brian admitted that he did not know. Bizarrely, neither did anyone else at the paper, which included at least one person from the Department of Health.

I frantically searched for this thread, but could not find it at the time:

"Can I see a consultant privately, and then go public for the procedure?"

I argued that charging someone €800 for a public bed which would otherwise be charged at €75 was not a subsidy.
Someone else went further and called it a reverse subsidy.
Then another speaker classified it as theft from the state.

Brendan
 
Back
Top