If everyone got everything they wanted, how much would it cost to run the Public Health Service?

Noble Guardian

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I was having a chat with a colleague recently, who told me that the cost ofd new drugs is havoing a seriious effect on the healthcare budget in their specialirtty. In particular, they said that the cost of providinf Spinraza, the new medicine for the treatment (or perhaps, long-term palliation) of Spinal muscular Atrophy in children was such that other treatment areas might need to be curtailed or delayed.


It got me thinking a little. It's often said that we don't have enough consultants, nurses, Speech & Language therapists, mental health specialists, acute hospital beds, long term stepdown care beds, drug abuse treatment facilities, post treatment convalescence beds, public nursing home places, etc., etc., etc. Add to this, he cost of medicines for all treatments from the common cold to cancers of various forms and rare genetic conditions (such as SMA).

Has there ever been an economic analysis of how much it would cost to provide all the things we say we need? We currently budget over 17 billion euros per year, but this doesn’t seem to be enough, so what is the figure?
 


Dame_Enda

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I was having a chat with a colleague recently, who told me that the cost ofd new drugs is havoing a seriious effect on the healthcare budget in their specialirtty. In particular, they said that the cost of providinf Spinraza, the new medicine for the treatment (or perhaps, long-term palliation) of Spinal muscular Atrophy in children was such that other treatment areas might need to be curtailed or delayed.


It got me thinking a little. It's often said that we don't have enough consultants, nurses, Speech & Language therapists, mental health specialists, acute hospital beds, long term stepdown care beds, drug abuse treatment facilities, post treatment convalescence beds, public nursing home places, etc., etc., etc. Add to this, he cost of medicines for all treatments from the common cold to cancers of various forms and rare genetic conditions (such as SMA).

Has there ever been an economic analysis of how much it would cost to provide all the things we say we need? We currently budget over 17 billion euros per year, but this doesn’t seem to be enough, so what is the figure?
I think the health budget should be index linked at minimum to the medical inflation where it is a positive number. It should take account of an ageing population, and take account of projected migration.
 

Noble Guardian

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I think the health budget should be indexed linked at minimum to the medical inflation where it is a positive number.
Sure, but today, absent inflation, how much would it cost?
 

Dame_Enda

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Well I think we need to make greater use of donations from the public. The MRI scanner in Wexford General Hospital was acquired in this way. In theory I think the taxpayer should pay for this kind of thing, but FG have proven incompetent at delivering health improvements on budget. Look at the explosion in the cost of the National Children's Hospital.

As for the cost, it would depend on the model we are aiming for. Is it the current model but funded for the task, or is it the NHS model (which itself has problems but maybe less so in GB than NI)?
 

Noble Guardian

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Well I think we need to make greater use of donations from the public. The MRI scanner in Wexford General Hospital was acquired in this way. In theory I think the taxpayer should pay for this kind of thing, but FG have proven incompetent at delivering health improvements on budget. Look at the explosion in the cost of the National Children's Hospital.

As for the cost, it would depend on the model we are aiming for. Is it the current model but funded for the task, or is it the NHS model (which itself has problems but maybe less so in GB than NI)?
Alright, let's start here. There's a waiting list for MRI scans, so that implies we either need more MRI scanners (at a certain cost and rate of depreciation) or we need the current machines to work for longer each day (so more staff). The scan itself takes a certain length of time and can't really be shortened without affecting clinical accuracy, although as machines get older scan times take longer. There's also a greater risk of expected breakdowns and machine down-time as they age.


Does anyone know if this sort of analysis has been done? This might give an idea of the real cost of our current model, and so determine whether we can afford to provide all people want using this model, whether we need to change to a different model, or whether we need to tell the population that healthcare rationing is just a fact of life, with resources going to where they will do the most societal (rather than individualistic) good
 

Uganda

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I was having a chat with a colleague recently, who told me that the cost ofd new drugs is havoing a seriious effect on the healthcare budget in their specialirtty. In particular, they said that the cost of providinf Spinraza, the new medicine for the treatment (or perhaps, long-term palliation) of Spinal muscular Atrophy in children was such that other treatment areas might need to be curtailed or delayed.


It got me thinking a little. It's often said that we don't have enough consultants, nurses, Speech & Language therapists, mental health specialists, acute hospital beds, long term stepdown care beds, drug abuse treatment facilities, post treatment convalescence beds, public nursing home places, etc., etc., etc. Add to this, he cost of medicines for all treatments from the common cold to cancers of various forms and rare genetic conditions (such as SMA).

Has there ever been an economic analysis of how much it would cost to provide all the things we say we need? We currently budget over 17 billion euros per year, but this doesn’t seem to be enough, so what is the figure?
17bn isn’t enough

but if every cent were spent properly how much would it deliver?

a lot more than we are getting

but who knows?
 

Uganda

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I was having a chat with a colleague recently, who told me that the cost ofd new drugs is havoing a seriious effect on the healthcare budget in their specialirtty. In particular, they said that the cost of providinf Spinraza, the new medicine for the treatment (or perhaps, long-term palliation) of Spinal muscular Atrophy in children was such that other treatment areas might need to be curtailed or delayed.


It got me thinking a little. It's often said that we don't have enough consultants, nurses, Speech & Language therapists, mental health specialists, acute hospital beds, long term stepdown care beds, drug abuse treatment facilities, post treatment convalescence beds, public nursing home places, etc., etc., etc. Add to this, he cost of medicines for all treatments from the common cold to cancers of various forms and rare genetic conditions (such as SMA).

Has there ever been an economic analysis of how much it would cost to provide all the things we say we need? We currently budget over 17 billion euros per year, but this doesn’t seem to be enough, so what is the figure?
The problem with many of these new drugs is that they are intrinsically uneconomic.

for example - the drug orkambi could never be justified on economic grounds. It only works for a very small number of people, and the opportunity cost is huge.

which is all very well until you’re the one of a few who needs orkambi to survive
 

Noble Guardian

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17bn isn’t enough

but if every cent were spent properly how much would it deliver?

a lot more than we are getting

but who knows?
I don't know about your experience, but certainly everytime i visit a hospital i don't see a lot of staff sitting around playing Candy Crush. So staff are probably worknig at a reasonable level of efficiency. Whether they're doing the right things is probably relates to the "aer we providing the right model of care?" question which Dame Enda alluded to earlier.
 

Noble Guardian

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The problem with many of these new drugs is that they are intrinsically uneconomic.

for example - the drug orkambi could never be justified on economic grounds. It only works for a very small number of people, and the opportunity cost is huge.

which is all very well until you’re the one of a few who needs orkambi to survive
So maybe, as a society, we cant afford Orkambi. If people who need Orkambi want it, they will need to find a way for themselves to provide it.
 

Orbit v2

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Surely, the answer is obvious from the anecdote in the OP? The demand for highly expensive specialist drugs and treatments is unlimited. There is no way any health system can fulfill the demand for them.
 

Dame_Enda

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If you reduce charges to NHS levels, you will have to replace it with either taxation or private finance. I understand that in the UK system, all GP visits are free. In Ireland the govt is still trying to working on this for children, and has only managed to bring it to all 6 yr olds so far.
 

Uganda

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Surely, the answer is obvious from the anecdote in the OP? The demand for highly expensive specialist drugs and treatments is unlimited. There is no way any health system can fulfill the demand for them.
So some sort of rationing may be necessary - financial or otherwise

but good luck with that one. First time it happens RTÉ will find some poor sod and broadcast it morning noon and night
 

Uganda

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If you reduce charges to NHS levels, you will have to replace it with either taxation or private finance. I understand that in the UK system, all GP visits are free. In Ireland the govt is still trying to working on this for children, and has only managed to bring it to all 6 yr olds so far.
But this is part of the problem. Free gp care for all 6 year olds regardless of their parents means

GPs i know are brassed off with this as their waiting rooms are suddenly filled with children who are now ill (and weren’t before). Parents who can pay are grassed off becuse the queues to see the doc are now much longer

Where this might end is that some GPs in better off areas may decide to do private only.
 

Uganda

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So maybe, as a society, we cant afford Orkambi. If people who need Orkambi want it, they will need to find a way for themselves to provide it.
You just try telling that to those who need orkambi! The politicians will be put under extreme pressure. And they will buckle.
 

Dame_Enda

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But this is part of the problem. Free gp care for all 6 year olds regardless of their parents means

GPs i know are brassed off with this as their waiting rooms are suddenly filled with children who are now ill (and weren’t before). Parents who can pay are grassed off becuse the queues to see the doc are now much longer

Where this might end is that some GPs in better off areas may decide to do private only.
I agree but FG, FF and Labour are looking for middle class votes by promising freebies. It was the same with free third level fees, despite the continuation of the registration fees.
 

Orbit v2

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So some sort of rationing may be necessary - financial or otherwise

but good luck with that one. First time it happens RTÉ will find some poor sod and broadcast it morning noon and night
It happens already. There is some not terribly well known branch of the health service which evaluates these treatments and sets the conditions where they can be used. No doubt there are already cases where people are refused treatment because they are outside the criteria.

But, there's no doubting, from the OP's post that the pressure is on to spend more and more. So, maybe they are finding it hard to hold the line.
 
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Noble Guardian

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You just try telling that to those who need orkambi! The politicians will be put under extreme pressure. And they will buckle.
THey might have a beter chance if they hd a "here's what it will cost overall" figure like i originally posted. Probably not, but at least it will be a more informed discussion. At the momen, all people see is, it only costs x amount, and sure we've tons of money!"
 

Uganda

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I don't know about your experience, but certainly everytime i visit a hospital i don't see a lot of staff sitting around playing Candy Crush. So staff are probably worknig at a reasonable level of efficiency. Whether they're doing the right things is probably relates to the "aer we providing the right model of care?" question which Dame Enda alluded to earlier.
I would question this hypothesis.

as an example i would question a system where case notes have to handwritten and then later typed by someone else. So neither the caseworker nor the typist are playing candy crush. But the typist should be.
 

Noble Guardian

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It happens already. There is some not terribly well known branch of the health service which evaluates these treatments and sets the conditions where they can be used. No doubt there are already cases where people are refused treatment because they are outside the criteria.
Not quite. THeres the NCPE who perform cost benefit analyses, but their recommendations are only ever that. tHe ultimate decision is for the HSE, which can be pursuaded to provide the intervention by the minister (who is "accountable to the people").
 

Uganda

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THey might have a beter chance if they hd a "here's what it will cost overall" figure like i originally posted. Probably not, but at least it will be a more informed discussion. At the momen, all people see is, it only costs x amount, and sure we've tons of money!"
In my experience those who shout loudest get the most.
 


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