Would spending more money on the health service do any good?

[Early Riser]

The Irish health service offers the worst value in the world. (source OECD)

I think the OECD report was ever so slightly more subtle than your summary might suggest. Cormac Lucey is quoted in the OP. I believe he is considered one of the more "fiscally reliable" right of centre economists ? Here is a link to his analysis and musings on some of the data:

https://brianmlucey.wordpress.com/2016/04/05/health-care-spending-ireland-v-oecd/ .

I understand that cross-national health expenditure comparisons are very tricky, as what is included in Health Budgets varies considerably. Care in the community, disability supports and aging supports may or may not be included in health budgets. Here is a link to the Central Statistics Office presentation of an analysis in this area: http://www.cso.ie/en/media/csoie/ne...in_Health_The_Evidence_A_User_Perspective.pdf

I refer especially to the conclusions in the final slide and this one particularly : Deriving lessons (or worse, policy) “at a glance”from international comparisons is potentially misleading. However, I expect it will be fully ignored.

Links to summaries from OECD reports:

https://www.oecd.org/ireland/Health-at-a-Glance-2015-Key-Findings-IRELAND.pdf

http://www.oecd.org/ireland/Health-Policy-in-Ireland-February-2016.pdf

The simple fact is that the public sector is grossly overpaid, over pensioned and over protected.

Another simple fact is that we have a manpower crisis at professional level in the Health Service. I refer to doctors, nurses and mental health professionals. There have been ongoing difficulties in trying to bring mental health community care teams up to strength. I believe some are barely functioning. We are producing graduates. There would seem to be some contradiction, then, between these two "simple facts". Partly this might be because we we may appear well paid relative to other EU countries but our competition for manpower is from other English speaking countries - who offer better terms and conditions (free market forces?).

"The share of generic drugs in the market is low in Ireland in both in volume (29% compared with an OECD average of 48%) and in value (16% compared with an OECD average of 24%)."

Clearly the HSE already has too much budget.

I am not sure how clear this conclusion is. Do you really reckon that the HSE is willingly or negligently paying excessively when they could do otherwise. I think the only thing clear is that there is an issue and it needs to be answered. Could it be in any way related to the fact that we have a high concentration of Pharma companies in Ireland who provide well paid jobs and who might, therefore, have a certain leverage at Government level? I don't know the answer. But in trying to reach one I would refer again to to the underlined quote from the CSO above.

Just to note in general - I do not know the answer to the question about increased health spending (I don't think I would find it so difficult, though, if I was an aging parent with an adult child who was desperately waiting for disability or mental health services). I recognise that we pay a lot for our health services and I do think that they are poorly configured and need drastic (but difficult) reform. I don't think that some of the cheap points about staff being lazy, overpaid, etc provide an insight in what is needed or how reform might take place.

And I think that resistance to reform might come as much from outside the health sector as within. What politician will support reform when it comes to some perceived loss in their own constituency? - Because we the voters will reward him/her accordingly at the next election. Notice who is involved with some of the "save our services" type groups - members of the local business community, primarily concerned with loss of "well-paid" jobs located locally and, thus, "spending power".

Or perhaps the nub of the problem is lazy nurses.

 

[cremeegg]

Or perhaps the nub of the problem is lazy nurses.

Or nurses working in a poorly organised system, becoming demoralised by that system.

Nurses cannot get pay rises because of the differentials operated across the health sector. If the nurses got 10% the porters, cleaners, office boys etc would all have to get 10%. The market economy doesn't operate in healthland.

 

[Purple]

Another simple fact is that we have a manpower crisis at professional level in the Health Service.

Is that due to a shortage of manpower or the inefficient allocation and use of manpower? If it is the latter then the solution is not more manpower.

There have been ongoing difficulties in trying to bring mental health community care teams up to strength. I believe some are barely functioning.

See above. The involvement of a very fractured private sector and massive duplication of service as well as an almost complete lack of oversight is also an issue here. I speak from personal experience.

We are producing graduates. There would seem to be some contradiction, then, between these two "simple facts". Partly this might be because we we may appear well paid relative to other EU countries but our competition for manpower is from other English speaking countries - who offer better terms and conditions (free market forces?).

About a third of Trinity medical graduates are overseas students. I'd say the figure for the RCSI is higher. Those guys were never going to stay here.

Could it be in any way related to the fact that we have a high concentration of Pharma companies in Ireland who provide well paid jobs and who might, therefore, have a certain leverage at Government level?

Yes.

And I think that resistance to reform might come as much from outside the health sector as within. What politician will support reform when it comes to some perceived loss in their own constituency? - Because we the voters will reward him/her accordingly at the next election. Notice who is involved with some of the "save our services" type groups - members of the local business community, primarily concerned with loss of "well-paid" jobs located locally and, thus, "spending power".

I agree completely. That is a major part of the problem.

Or perhaps the nub of the problem is lazy nurses.

No, but lets not pretend that they are not part of the problem. We need to get away from the emotional presumption that front line = good, clerical/managerial = bad.

 

[Purple]

I understand that cross-national health expenditure comparisons are very tricky, as what is included in Health Budgets varies considerably. Care in the community, disability supports and aging supports may or may not be included in health budgets. Here is a link to the Central Statistics Office presentation of an analysis in this area: http://www.cso.ie/en/media/csoie/ne...in_Health_The_Evidence_A_User_Perspective.pdf

I notice that one of the charts shows expenditure for Ireland in both GDP and GNI. GNI is a much more meaningful figure for us to use when expressing expenditure as a percentage as out GDP figure is bloated due to multinationals. When you see a expenditure expressed as a percentage of GDP you need to multiply it by about 1.2 to get the real figure (GNI).

 

[odyssey06]

I am not sure how clear this conclusion is. Do you really reckon that the HSE is willingly or negligently paying excessively when they could do otherwise.

Yes. I reckon this is the case. And not just on generic medicines. I don't see evidence from the HSE of the kind of concern for costs that a private company has.

 

[Early Riser]

No, but lets not pretend that they are not part of the problem. We need to get away from the emotional presumption that front line = good, clerical/managerial = bad.

I actually completely agree with this, so clearly I phrased myself badly. No one should be beyond scrutiny. For "nurses" feel free to substitute clerical, admin or whatever. My point is that it is lazy and counter-productive to reduce the issues to a simplistic blame-game (whether from within or without the health service).

Is that due to a shortage of manpower or the inefficient allocation and use of manpower? If it is the latter then the solution is not more manpower.

Or perhaps, a bit of both? They are not mutually exclusive. Also manpower mix and make-up. Nurses are highly trained and consequently relatively expensive to employ. Could some of their current tasks be undertaken by less extensively trained personnel ? And the nurses expertise more appropriately applied where it is most beneficial and necessary?

My broader point though, is that despite ongoing recruitment campaigns, there are widespread vacancies that remain unfilled in the Health Service. That would seem to give the lie to the other claim that staff are overpaid. Many see the pay and conditions elsewhere as more attractive.

About a third of Trinity medical graduates are overseas students. I'd say the figure for the RCSI is higher. Those guys were never going to stay here.

Fair point. How many Irish graduates, doctors-in-training or trained doctors are leaving though? I don't know the answer to this. Perhaps, the reports are wrong?

Nurses cannot get pay rises because of the differentials operated across the health sector. If the nurses got 10% the porters, cleaners, office boys etc would all have to get 10%. The market economy doesn't operate in healthland.

I am not going to comment on the relative merits and value of porters, cleaners and "office boys" (because I do not know) but I agree that the pay linkages are a big problem in the public sector.

 

[Purple]

My broader point though, is that despite ongoing recruitment campaigns, there are widespread vacancies that remain unfilled in the Health Service. That would seem to give the lie to the other claim that staff are overpaid. Many see the pay and conditions elsewhere as more attractive.

Okay, but we have to work with what we can afford and we can't even afford what we currently have so, in light of your previous point, employ lower paid people to do some of the work currently done by nurses. How'd little Liam like that one?

 

[Purple]

Perhaps, the reports are wrong?

Sensational headlines are the stock and trade of the Irish media. Just think of the reports on radio or current affairs programs on TV. It is the same format every time. Take a story about a school; background noise from the yard/ classroom then a teacher/parent frames the issue in an emotive "Will someone please think of the children!" context, then the reporter discusses the issue without any reference to the root cause, then the parent again, then the yard/children background noise. There is no attempt at a contextual cost benefit analysis or any good reason why the issue is still an issue. The solution is always more money.

 

[Early Riser]

Yes. I reckon this is the case. And not just on generic medicines. I don't see evidence from the HSE of the kind of concern for costs that a private company has.

Perhaps you have some more knowledge of this than is reported in the media? There seems to be pretty intensive negotiations re drug pricing:

https://www.imt.ie/news/unilateral-drug-price-cuts-threatened-26-05-2016/

But it is never going to be like a bus company, because we the public will not accept the threat of loss of access. Of course, the companies won't just cut it off but there could be "supply chain issues" (Not to mention the threat of re-location).

Look also at the issue of the new designer drugs that have been forced through in recent years, whatever the outcome of the appraisal by the National Centre for Pharmacoeconomics. And the companies know they have the HSE/Government over a barrel :

http://www.independent.ie/sport/col...tter-pill-for-us-all-to-swallow-35284322.html

(I have no opinion on this specific drug - it is just one example of several).

 

[Early Riser]

Sensational headlines are the stock and trade of the Irish media. Just think of the reports on radio or current affairs programs on TV. It is the same format every time. Take a story about a school; background noise from the yard/ classroom then a teacher/parent frames the issue in an emotive "Will someone please think of the children!" context, then the reporter discusses the issue without any reference to the root cause, then the parent again, then the yard/children background noise. There is no attempt at a contextual cost benefit analysis or any good reason why the issue is still an issue. The solution is always more money.

That is interesting but I am not sure if specifically relevant. Do you have any figures on on the numbers of Irish doctors/doctors-in-training leaving?

 

[Early Riser]

Okay, but we have to work with what we can afford and we can't even afford what we currently have so, in light of your previous point, employ lower paid people to do some of the work currently done by nurses. How'd little Liam like that one?

I don't know what you are saying or asking here.

 

[Purple]

I don't know what you are saying or asking here.

You said that other countries may have lower skilled people doing work that nurses do here. Maybe we should do the same? If we do what will little Liam Doran have to say about it?

 

[Early Riser]

You said that other countries may have lower skilled people doing work that nurses do here. Maybe we should do the same? If we do what will little Liam Doran have to say about it?

Ah, Sorry, I didn't get the Liam reference. He probably won't be happy about it - Don't know and don't care.

Just to clarify: doing some of the work or some of the types of work that nurses are doing. There will still be plenty of demand for their skills.

 

[odyssey06]

But it is never going to be like a bus company, because we the public will not accept the threat of loss of access. Of course, the companies won't just cut it off but there could be "supply chain issues" (Not to mention the threat of re-location).

I would settle for them being as cost conscious as health providers in other EU states.
Relocation is not the HSE's concern. Getting the best deal on medicines is.

And to return to the main topic... I have seen differing opinions on why we are getting such poor return for health spending. Nothing solid to suggest the solution is increasing the budget.

 

[Early Riser]

I would settle for them being as cost conscious as health providers in other EU states.

So your suggestion is that medicines are relatively expensive in Ireland because the HSE couldn't be bothered enough to do something about it - a variation of the laziness explanation? I don't know enough about it to argue, but I suspect that it may be more complex - and that it is your simple explanation that is "lazy".

Here are a few reports that seem to suggest that there might be a bit more complexity about the issue:

[broken link removed]

https://www.esri.ie/pubs/RS32.pdf

Relocation is not the HSE's concern. Getting the best deal on medicines is.

You are not being a bit naive to suggest that the HSE can act in a political vacuum on this issue? Or faux naive?

 

[odyssey06]

So your suggestion is that medicines are relatively expensive in Ireland because the HSE couldn't be bothered enough to do something about it - a variation of the laziness explanation? I don't know enough about it to argue, but I suspect that it may be more complex - and that it is your simple explanation that is "lazy".

Where did I use the word lazy???
A lot of semi-state bodies, including the HSE, find it easier to get more money from the government than to try tackling their costs.

Sometimes explanations are simple. Sometimes they are complex. Sometimes simple explanations are right, sometimes they are wrong. Complexity is no indicator of "rightness".

You linked a 194 page report. I don't have time to wade through it all. If you have read it in full please point out the sections that justify Ireland paying over the odds for medicines, with page number reference.
I read the summary conclusion...
It dismisses concerns about re-location as a possible reason for why Ireland is paying over the odds for medicines (Ref pages 117-118).
So I'm not sure where you are going with that.

The state has been increasing its use of generics, but whatever it is doing, it is not doing it quickly enough - or else why are we still paying so much more than other EU member states?
If the earlier information is now out dated and in fact Ireland is paying average prices for medicines, please provide the latest information.

I'm sure everything always looks "more complex" to the HSE too. Yet other health services in the EU have found a way to pay less than we do for medicines and they don't work in a political vacuum either do they??? The HSE have not. It's entirely legitimate to criticise them for this.