Contrast between UK's tought cost control of health care and Ireland's wasteful spending

patslatt

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See https://www.theguardian.com/politics/2016/oct/14/no-extra-money-for-nhs-theresa-may-tells-health-chief?utm_source=esp&utm_medium=Email&utm_campaign=GU+Today+main+NEW+H+categories&utm_term=194936&subid=19970607&CMP=EMCNEWEML6619I2

The UK's parsimonious spending of 9% of the economy on health care contrasts with Ireland's wasteful spending of 12.5%. Yet the UK government believes further efficiencies are achievable in its tough attitude on budgets, whereas the Irish Health Minister continues the tradition of holding out the begging bowl to pay for chronic cost overruns on hospital budgets.

The obvious remedies to Ireland's health care costs are not rocket science:
[]Consolidate the 29 acute care hospitals into about half that number.
Health services would improve as many hospitals are kept as a source of local employment which prevents doctors from getting sufficient patient volumes for maintaining their skills.
[]Keep a tight grip on pay so that more hospital workers can be recruited for the available budgets.
There is a grave danger that trade union militancy will achieve big pay increases despite the fact that public sector pay is way out of line with the private sector average at about half as high again. Excessive pay leads to understaffing which in turn leads to stressful working conditions on the front line, leading to high staff turnover. So paradoxically, excessive pay leads to high staff turnover.
[]Train more hospital consultants.
High staff turnover needs to be addressed as mentioned above to improve working conditions for trainee consultants.
[]Abolish equal pay for all salaried hospital consultants.
THeir pay is influenced by the international market for their skills in the anglosaxon countries. Equal pay makes it difficult to recruit those in the scarcest specialties such as anesthetics. The result is that the very high pay needed to recruit the scarcest specialty must be paid to all specialties, an absurd privilege.
[]Computerise hospital operations.
How many nurses are still stuck in the pen and ink files prior to the computer age? Good off the shelf computer systems are available for use.
[]Experiment with clinical team management of hospitals.
Spain's Valentia hospital run by clinicians is maybe the best hospital in Europe and has attracted delegations from all over the world including the NHS to learn from their best practices. The hospital has to be cost efficient because as a private hospital it receives lower payments for services than government hospitals.

Ultimately, the solution to Ireland's health service inefficiencies requires political courage, a scarce commodity in the present coalition government with silly footloose independents acting like local councillors.
 
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Craggyjack

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There is a grave danger that trade union militancy will achieve big pay increases despite the fact that public sector pay is way out of line with the private sector average at about half as high again. Excessive pay leads to understaffing which in turn leads to stressful working conditions on the front line, leading to high staff turnover. So paradoxically, excessive pay leads to high staff turnover/
This is likely to become key driver for cost increases in the HSE for 2017/2018..............
 

Prester Jim

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Some good points there but you have two big problems with your analysis:
1. the govt have already "kept a grip on pay" and it has meant that the nurses have just gone abroad for better pay to, among others, the UK that you are saying we should emulate on spending, they pay better than us.
2. The UK is cutting spending and refusing to spend more because they are in the midst of an attempt that everyone knows is to privatise the NHS despite it still being at the top of the leagues worldwide for healthcare.
Just like their branch party here FG, the Tories are driven by thoughtless, non-fact based ideology and the greed of their already fabulously wealthy masters.
3.Yes we need to train more consultants and doctors generally but we have to put great thought into complete reform of the training and advancement opportunities for those doctors or they will just leave.
Personally I think we should expect them to stay (after such a reform makes it palatable) and make that happen through a carrot and stick system linked to their having been educated for 200,000 for free, we should do the same with the graduate training too, they are just as excellent as the ones trained after the 600 points in the LC and should be given a chance to leave that debt if they stay here.
4. Consolidation is a no-brainer and requires politicians with balls and the national interest in their hearts, we will have to fire 98% of the current crop so.
5. Computerisation is also a no-brainer but I had assumed that was already well under way, my experience of Tallaght suggests that anyway.
6. I am very suspicious of your suggestion about the private hospital in Spain, you are an ideologically driven poster and you 100% favour privatisation because it makes people rich not because it provides better services, do you have links to show that this hospital in Spain is generally better or is it just better because Spain is in massive debt and cannot properly fund its usually excellent health system?

Of course the HSE is a dreadful mess and needs deep reform at many levels.
 

Disillusioned democrat

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See https://www.theguardian.com/politics/2016/oct/14/no-extra-money-for-nhs-theresa-may-tells-health-chief?utm_source=esp&utm_medium=Email&utm_campaign=GU+Today+main+NEW+H+categories&utm_term=194936&subid=19970607&CMP=EMCNEWEML6619I2

The UK's parsimonious spending of 9% of the economy on health care contrasts with Ireland's wasteful spending of 12.5%. Yet the UK government believes further efficiencies are achievable in its tough attitude on budgets, whereas the Irish Health Minister continues the tradition of holding out the begging bowl to pay for chronic cost overruns on hospital budgets.

The obvious remedies to Ireland's health care costs are not rocket science:
[]Consolidate the 29 acute care hospitals into about half that number.
Health services would improve as many hospitals are kept as a source of local employment which prevents doctors from getting sufficient patient volumes for maintaining their skills.
[]Keep a tight grip on pay so that more hospital workers can be recruited for the available budgets.
There is a grave danger that trade union militancy will achieve big pay increases despite the fact that public sector pay is way out of line with the private sector average at about half as high again. Excessive pay leads to understaffing which in turn leads to stressful working conditions on the front line, leading to high staff turnover. So paradoxically, excessive pay leads to high staff turnover.
[]Train more hospital consultants.
High staff turnover needs to be addressed as mentioned above to improve working conditions for trainee consultants.
[]Abolish equal pay for all salaried hospital consultants.
THeir pay is influenced by the international market for their skills in the anglosaxon countries. Equal pay makes it difficult to recruit those in the scarcest specialties such as anesthetics. The result is that the very high pay needed to recruit the scarcest specialty must be paid to all specialties, an absurd privilege.
[]Computerise hospital operations.
How many nurses are still stuck in the pen and ink files prior to the computer age? Good off the shelf computer systems are available for use.
[]Experiment with clinical team management of hospitals.
Spain's Valentia hospital run by clinicians is maybe the best hospital in Europe and has attracted delegations from all over the world including the NHS to learn from their best practices. The hospital has to be cost efficient because as a private hospital it receives lower payments for services than government hospitals.

Ultimately, the solution to Ireland's health service inefficiencies requires political courage, a scarce commodity in the present coalition government with silly footloose independents acting like local councillors.

Okay - so this isn't going to get anywhere fast.

Politicians have already dismantled the HSE as a "national" system and quickly restored HQs east, south, north and east.

I think you might me confusing the UK's NHS - a system designed to provide excellent healthcare to the citizens of the UK with the HSE, a system designed to provide excellent careers and political cover for the networks of political cronies.
 

Nemesiscorporation

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See https://www.theguardian.com/politics/2016/oct/14/no-extra-money-for-nhs-theresa-may-tells-health-chief?utm_source=esp&utm_medium=Email&utm_campaign=GU+Today+main+NEW+H+categories&utm_term=194936&subid=19970607&CMP=EMCNEWEML6619I2

The UK's parsimonious spending of 9% of the economy on health care contrasts with Ireland's wasteful spending of 12.5%. Yet the UK government believes further efficiencies are achievable in its tough attitude on budgets, whereas the Irish Health Minister continues the tradition of holding out the begging bowl to pay for chronic cost overruns on hospital budgets.

The obvious remedies to Ireland's health care costs are not rocket science:
[]Consolidate the 29 acute care hospitals into about half that number.
Health services would improve as many hospitals are kept as a source of local employment which prevents doctors from getting sufficient patient volumes for maintaining their skills.
[]Keep a tight grip on pay so that more hospital workers can be recruited for the available budgets.
There is a grave danger that trade union militancy will achieve big pay increases despite the fact that public sector pay is way out of line with the private sector average at about half as high again. Excessive pay leads to understaffing which in turn leads to stressful working conditions on the front line, leading to high staff turnover. So paradoxically, excessive pay leads to high staff turnover.
[]Train more hospital consultants.
High staff turnover needs to be addressed as mentioned above to improve working conditions for trainee consultants.
[]Abolish equal pay for all salaried hospital consultants.
THeir pay is influenced by the international market for their skills in the anglosaxon countries. Equal pay makes it difficult to recruit those in the scarcest specialties such as anesthetics. The result is that the very high pay needed to recruit the scarcest specialty must be paid to all specialties, an absurd privilege.
[]Computerise hospital operations.
How many nurses are still stuck in the pen and ink files prior to the computer age? Good off the shelf computer systems are available for use.
[]Experiment with clinical team management of hospitals.
Spain's Valentia hospital run by clinicians is maybe the best hospital in Europe and has attracted delegations from all over the world including the NHS to learn from their best practices. The hospital has to be cost efficient because as a private hospital it receives lower payments for services than government hospitals.

Ultimately, the solution to Ireland's health service inefficiencies requires political courage, a scarce commodity in the present coalition government with silly footloose independents acting like local councillors.
This is a good idea OP in principle with some good ideas worth exploring.

The only part I would disagree with is comparing it to the NHS. The UK's 9% is not worth looking at. DDeveloped countries are usually a few points above that. The problem in Ireland is inefficiency and fraud.

Comparison with the best from UK (Scotland), Singapore, Denmark, Netherlands, Czech Republic, Austria, Switzerland, Finland, etc, etc, who have significantly better healthcare systems would be a good idea so as to pull in the best ideas from all over the world.

We need to stop comparing ourselves to the failures of UK(England) and USA.
 

captain obvious

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PBP voter

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See https://www.theguardian.com/politics/2016/oct/14/no-extra-money-for-nhs-theresa-may-tells-health-chief?utm_source=esp&utm_medium=Email&utm_campaign=GU+Today+main+NEW+H+categories&utm_term=194936&subid=19970607&CMP=EMCNEWEML6619I2

The UK's parsimonious spending of 9% of the economy on health care contrasts with Ireland's wasteful spending of 12.5%. Yet the UK government believes further efficiencies are achievable in its tough attitude on budgets, whereas the Irish Health Minister continues the tradition of holding out the begging bowl to pay for chronic cost overruns on hospital budgets.

The obvious remedies to Ireland's health care costs are not rocket science:
[]Consolidate the 29 acute care hospitals into about half that number.
Health services would improve as many hospitals are kept as a source of local employment which prevents doctors from getting sufficient patient volumes for maintaining their skills.
[]Keep a tight grip on pay so that more hospital workers can be recruited for the available budgets.
There is a grave danger that trade union militancy will achieve big pay increases despite the fact that public sector pay is way out of line with the private sector average at about half as high again. Excessive pay leads to understaffing which in turn leads to stressful working conditions on the front line, leading to high staff turnover. So paradoxically, excessive pay leads to high staff turnover.
[]Train more hospital consultants.
High staff turnover needs to be addressed as mentioned above to improve working conditions for trainee consultants.
[]Abolish equal pay for all salaried hospital consultants.
THeir pay is influenced by the international market for their skills in the anglosaxon countries. Equal pay makes it difficult to recruit those in the scarcest specialties such as anesthetics. The result is that the very high pay needed to recruit the scarcest specialty must be paid to all specialties, an absurd privilege.
[]Computerise hospital operations.
How many nurses are still stuck in the pen and ink files prior to the computer age? Good off the shelf computer systems are available for use.
[]Experiment with clinical team management of hospitals.
Spain's Valentia hospital run by clinicians is maybe the best hospital in Europe and has attracted delegations from all over the world including the NHS to learn from their best practices. The hospital has to be cost efficient because as a private hospital it receives lower payments for services than government hospitals.

Ultimately, the solution to Ireland's health service inefficiencies requires political courage, a scarce commodity in the present coalition government with silly footloose independents acting like local councillors.
This will never happen.

Can you imagine the roars and the protests? No government TD would stand a chance of re-election in the areas where closures happen.
 

Nemesiscorporation

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This will never happen.

Can you imagine the roars and the protests? No government TD would stand a chance of re-election in the areas where closures happen.
Strange coming from a PBP voter. You people apparently want a major hospital in every village, a motorway to every house and a mansion for every immigrant.
 

Uganda

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Some good points there but you have two big problems with your analysis:
1. the govt have already "kept a grip on pay" and it has meant that the nurses have just gone abroad for better pay to, among others, the UK that you are saying we should emulate on spending, they pay better than us.
2. The UK is cutting spending and refusing to spend more because they are in the midst of an attempt that everyone knows is to privatise the NHS despite it still being at the top of the leagues worldwide for healthcare.
Just like their branch party here FG, the Tories are driven by thoughtless, non-fact based ideology and the greed of their already fabulously wealthy masters.
3.Yes we need to train more consultants and doctors generally but we have to put great thought into complete reform of the training and advancement opportunities for those doctors or they will just leave.
Personally I think we should expect them to stay (after such a reform makes it palatable) and make that happen through a carrot and stick system linked to their having been educated for 200,000 for free, we should do the same with the graduate training too, they are just as excellent as the ones trained after the 600 points in the LC and should be given a chance to leave that debt if they stay here.
4. Consolidation is a no-brainer and requires politicians with balls and the national interest in their hearts, we will have to fire 98% of the current crop so.
5. Computerisation is also a no-brainer but I had assumed that was already well under way, my experience of Tallaght suggests that anyway.
6. I am very suspicious of your suggestion about the private hospital in Spain, you are an ideologically driven poster and you 100% favour privatisation because it makes people rich not because it provides better services, do you have links to show that this hospital in Spain is generally better or is it just better because Spain is in massive debt and cannot properly fund its usually excellent health system?

Of course the HSE is a dreadful mess and needs deep reform at many levels.
1. If you talk to nurses who have emigrated you may find that the management of the facilities in which they work is as big an issue as pay. But, then we are bereft of managers (while awash with individuals describing themselves as managers).

2. "Everyone knows" that the agenda in the uk is to privatise the nhs. "Everyone", really?

3. If we are to oblige consultants to stay here because we have invested in them, why not apply the same principle to nurses?

4. Agree with your point 4.

5. God bless your optimism where IT progress is concerned. To take an analogy, if they were involved in transport it would be rather like them making progress from having a person with a red flag walking in front of every car. They are antediluvian. I was part of a (non-profit) delegation to the hse presenting it concepts to the hse 10 years ago, which showed clearly how, with the right it, mega savings could be made, and patient safety increased. After the session, one of our delegation made the point that the more savings the less likelihood of adoption. Why? Because the savings were sitting across the table.

6. You are arguing that private healthcare makes profit, but isn't necessarily better healthcare. Who in their right mind would pay for inferior private care, if there is free, superior, care down the road?

The reality is that private healthcare is better. And it is no coincidence that private healthcare is not dominated by the trade unions.
 

PeaceGoalie

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Strange coming from a PBP voter. You people apparently want a major hospital in every village, a motorway to every house and a mansion for every immigrant.
The Trots have posters up over Dublin: Wage Increases for all.
Economics is not their strong point. Waffle is.
 

Uganda

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The Trots have posters up over Dublin: Wage Increases for all.
Economics is not their strong point. Waffle is.
Can't figure this out.

Why would workshy freeloaders who never earn any wages want an increase?
 

patslatt

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Messages
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Okay - so this isn't going to get anywhere fast.

Politicians have already dismantled the HSE as a "national" system and quickly restored HQs east, south, north and east.

I think you might me confusing the UK's NHS - a system designed to provide excellent healthcare to the citizens of the UK with the HSE, a system designed to provide excellent careers and political cover for the networks of political cronies.
Centralisation at the top resulted in huge layers of bureaucrats needed to communicate up and down the chain of command. Decentralisation is better, with lean management and few layers using advanced computer systems to manage. How are cronies infiltrating the jobs?
 

patslatt

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Apr 11, 2007
Messages
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This is a good idea OP in principle with some good ideas worth exploring.

The only part I would disagree with is comparing it to the NHS. The UK's 9% is not worth looking at. DDeveloped countries are usually a few points above that. The problem in Ireland is inefficiency and fraud.

Comparison with the best from UK (Scotland), Singapore, Denmark, Netherlands, Czech Republic, Austria, Switzerland, Finland, etc, etc, who have significantly better healthcare systems would be a good idea so as to pull in the best ideas from all over the world.

We need to stop comparing ourselves to the failures of UK(England) and USA.
POLITICAL WILL LACKING

Ireland's extreme version of PR voting undermines the political will to take unpopular political measures. Only in a severe crisis can our extremely centralised government act decisively. When A&Es put up signs "F off and die", maybe the government will act.

Most of the necessary reforms are reasonably well known.
 

patslatt

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Strange coming from a PBP voter. You people apparently want a major hospital in every village, a motorway to every house and a mansion for every immigrant.
CONSPIRACY THEORY!
Didn't you know PBP was financed by an establishment political party to soak up Sinn Fein votes in contests of lefty populism?
 

patslatt

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1. If you talk to nurses who have emigrated you may find that the management of the facilities in which they work is as big an issue as pay. But, then we are bereft of managers (while awash with individuals describing themselves as managers).

2. "Everyone knows" that the agenda in the uk is to privatise the nhs. "Everyone", really?

3. If we are to oblige consultants to stay here because we have invested in them, why not apply the same principle to nurses?

4. Agree with your point 4.

5. God bless your optimism where IT progress is concerned. To take an analogy, if they were involved in transport it would be rather like them making progress from having a person with a red flag walking in front of every car. They are antediluvian. I was part of a (non-profit) delegation to the hse presenting it concepts to the hse 10 years ago, which showed clearly how, with the right it, mega savings could be made, and patient safety increased. After the session, one of our delegation made the point that the more savings the less likelihood of adoption. Why? Because the savings were sitting across the table.

6. You are arguing that private healthcare makes profit, but isn't necessarily better healthcare. Who in their right mind would pay for inferior private care, if there is free, superior, care down the road?

The reality is that private healthcare is better. And it is no coincidence that private healthcare is not dominated by the trade unions.
BLAIR

On your last point above, Blair's comment on public sector unions is insightful: "I hate those f*****s".
 

patslatt

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Some good points there but you have two big problems with your analysis:
1. the govt have already "kept a grip on pay" and it has meant that the nurses have just gone abroad for better pay to, among others, the UK that you are saying we should emulate on spending, they pay better than us.
2. The UK is cutting spending and refusing to spend more because they are in the midst of an attempt that everyone knows is to privatise the NHS despite it still being at the top of the leagues worldwide for healthcare.
Just like their branch party here FG, the Tories are driven by thoughtless, non-fact based ideology and the greed of their already fabulously wealthy masters.
3.Yes we need to train more consultants and doctors generally but we have to put great thought into complete reform of the training and advancement opportunities for those doctors or they will just leave.
Personally I think we should expect them to stay (after such a reform makes it palatable) and make that happen through a carrot and stick system linked to their having been educated for 200,000 for free, we should do the same with the graduate training too, they are just as excellent as the ones trained after the 600 points in the LC and should be given a chance to leave that debt if they stay here.
4. Consolidation is a no-brainer and requires politicians with balls and the national interest in their hearts, we will have to fire 98% of the current crop so.
5. Computerisation is also a no-brainer but I had assumed that was already well under way, my experience of Tallaght suggests that anyway.
6. I am very suspicious of your suggestion about the private hospital in Spain, you are an ideologically driven poster and you 100% favour privatisation because it makes people rich not because it provides better services, do you have links to show that this hospital in Spain is generally better or is it just better because Spain is in massive debt and cannot properly fund its usually excellent health system?

Of course the HSE is a dreadful mess and needs deep reform at many levels.
RE. points:

1. Public sector pay is where it should be in the year 2030 since it is half as high again as the private sector average. Nurses pay was 30% higher than the UK in 2011 based on the OECD study "Health at a glance". So you are spoofing.Only young nurses on the reduced pay scale since 2009 can afford to emigrate to the UK.
2. PM May successfully took draconian measures to control policing costs and wrongfully thinks the same tough measures should apply in health care.
5. What IT changes in Tallaght?
6. In France and Germany, considerable health care is delivered in private hospitals. In France, the chronic or very expensive care that can't be a profitable model is done in public hospitals. Both France and Germany rank highly for excellent care.
 

nakatomi

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RE. points:

1. Public sector pay is where it should be in the year 2030 since it is half as high again as the private sector average. Nurses pay was 30% higher than the UK in 2011 based on the OECD study "Health at a glance". So you are spoofing.Only young nurses on the reduced pay scale since 2009 can afford to emigrate to the UK.
2. PM May successfully took draconian measures to control policing costs and wrongfully thinks the same tough measures should apply in health care.
5. What IT changes in Tallaght?
6. In France and Germany, considerable health care is delivered in private hospitals. In France, the chronic or very expensive care that can't be a profitable model is done in public hospitals. Both France and Germany rank highly for excellent care.
Pat , do you think we should cut nurses pay again, given the shortage of nurses?
 

captain obvious

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1. If you talk to nurses who have emigrated you may find that the management of the facilities in which they work is as big an issue as pay. But, then we are bereft of managers (while awash with individuals describing themselves as managers).

2. "Everyone knows" that the agenda in the uk is to privatise the nhs. "Everyone", really?

3. If we are to oblige consultants to stay here because we have invested in them, why not apply the same principle to nurses?

4. Agree with your point 4.

5. God bless your optimism where IT progress is concerned. To take an analogy, if they were involved in transport it would be rather like them making progress from having a person with a red flag walking in front of every car. They are antediluvian. I was part of a (non-profit) delegation to the hse presenting it concepts to the hse 10 years ago, which showed clearly how, with the right it, mega savings could be made, and patient safety increased. After the session, one of our delegation made the point that the more savings the less likelihood of adoption. Why? Because the savings were sitting across the table.

6. You are arguing that private healthcare makes profit, but isn't necessarily better healthcare. Who in their right mind would pay for inferior private care, if there is free, superior, care down the road?

The reality is that private healthcare is better. And it is no coincidence that private healthcare is not dominated by the trade unions.
The problem with private healthcare is it cherry picks the procedures and patients. The remainder have to be processed by the public system. And because the public system also caters for private patients (public beds for private consultants) it creates a fast-track for private patients in the hospital (which to my mind is inherently wrong).

I think it is worth pointing out that this is a global phenomena. In the last 20 years health spend across the globe has increased by 2% (from 8% to 10%) of global GDP. In addition, the per-capita spend in adjusted dollars has doubled over that period. In my opinion that is not sustainable without creating a multi-tier system or we become more efficient.

IMHO IT is part of this solution. But it requires embracing not only paperless systems but automated diagnostics and machine-learning/artificial intelligence; some systems are already better than the average GP at diagnosis and the problem is well suited to this approach. But this sort of thing is going to be fought tooth and nail by vested interests, so I am not expecting any great changes in the near future.
 

patslatt

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Pat , do you think we should cut nurses pay again, given the shortage of nurses?
PARADOX OF HIGH NURSES PAY
An increase in wages in the free market would increase the workforce but paradoxically in health care it has reduced it. That's because excessive pay increases on fixed Irish government budgets reduce the number of hires. The result has been understaffing and stressful working conditions-especially on the front line of A&E-which cause high job turnover among young nurses. Their lower pay contracts since 2009 make it attractive for some to emigrate,yet Irish nurses on the old, generous contracts are close to the best paid internationally.
 

patslatt

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The problem with private healthcare is it cherry picks the procedures and patients. The remainder have to be processed by the public system. And because the public system also caters for private patients (public beds for private consultants) it creates a fast-track for private patients in the hospital (which to my mind is inherently wrong).

I think it is worth pointing out that this is a global phenomena. In the last 20 years health spend across the globe has increased by 2% (from 8% to 10%) of global GDP. In addition, the per-capita spend in adjusted dollars has doubled over that period. In my opinion that is not sustainable without creating a multi-tier system or we become more efficient.

IMHO IT is part of this solution. But it requires embracing not only paperless systems but automated diagnostics and machine-learning/artificial intelligence; some systems are already better than the average GP at diagnosis and the problem is well suited to this approach. But this sort of thing is going to be fought tooth and nail by vested interests, so I am not expecting any great changes in the near future.
CHERRY PICKING BY PRIVATE HEALTH SERVICES
This has big advantages if managed well. The high quality French health care system efficiently manages the pricing and procedures of private hospitals which contribute a substantial share of services. In the UK, hip and knee replacements were contracted out to a specialist private hospital some years ago. THe results in quick procedures that minimised hospital stays and cut hospital bacterial infections were so impressive that the NHS immediately contracted for a second hospital. In Valentia, Spain, a hospital managed by clinicians is visited by a stream of international medical practitioners including the NHS to study the hospital's best practices. THe hospital has to be cost efficient because it is paid less than public hospitals by the provincial government.
 


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