The Economist Slams Irish Health Service

ruman

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The Economist calling out vested interest groups, disapointing that the subservient Irish media refuses to do so.

"In Ireland in the 1940s private medical practitioners were worried about a reduction in their income from what they saw as “socialised medicine”, and they brought the Catholic church on board, saying that if the state extended its reach it might start looking at contraception and things like that,” he says. “The church has declined in influence, but the power of the consultants has not.”


 


Ireniall

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I would not really question their interpretation but it does seem a little pointed right now. Their argument would have been better made without the dubious political point scoring in the background. Health care leaves much to be desired mainly because of the lost decade. What we pay our consultants is disgraceful compared to what they are paid in Germany but we have to live in the Anglo-sphere where unbridled market economics is allowed to dictate these things unhindered. In any case my understanding is that the NHS is not what it was either. Frankly -if a united Ireland is going to come down to this then lets not worry too much.
 

General Urko

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A lad who drafted the legalesse in general contracts for one of the health insurers told me the last thing we will ever see here is a universal healthcare system, the European Norm!
 

Lumpy Talbot

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Had an elderly relative go to see her doc recently. The doc sent her in for tests and set up an appointment with a consultant. The relative told me she received a bill for 160 euros and a letter a couple of days later saying that further appointments had been set up 'as requested' with another specialist/consultant.

The relative informed them that she hadn't requested any further appointments. After best part of a day in hospital being run through various machines and so on.

Turns out she had a small cyst behind the knee which was taken care of by a simple course of anti-biotics/anti-inflammatories. Her take on it was that the consultants involved were just recommending patients to each other on a money-spinner exercise. The proposed appointments she told them she never requested would have come in at about 460 odd euro.

And she has private medical cover which inevitably doesn't cover such treatments or referrals unless she has an overnight stay in hospital. I absolutely agree that this system of GPs referring constantly to consultants needs to be looked at because the system now seems almost entirely captured by these medical privateers.

And the GPs are propping it up.
 

ruman

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I would not really question their interpretation but it does seem a little pointed right now. Their argument would have been better made without the dubious political point scoring in the background. Health care leaves much to be desired mainly because of the lost decade. What we pay our consultants is disgraceful compared to what they are paid in Germany but we have to live in the Anglo-sphere where unbridled market economics is allowed to dictate these things unhindered. In any case my understanding is that the NHS is not what it was either. Frankly -if a united Ireland is going to come down to this then lets not worry too much.
Hardly " political point scoring". Allowing consultants to work part time in the public sector leaving public patients to be seen by inadequately vetted doctors is unacceptable.

Only issue i have with the article is that an Irish media outlet has failed to highlight these issues. We are an EU country and should aim to copy successful EU health services rather than blindly following the EU/UK.
If it takes further EU integration and a pan european health service to achieve this i am all for it. Certainly i would prefer my taxes go directly to Germany then allow the HSE to squander it.
 

Ireniall

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Hardly " political point scoring". Allowing consultants to work part time in the public sector leaving public patients to be seen by inadequately vetted doctors is unacceptable.

Only issue i have with the article is that an Irish media outlet has failed to highlight these issues. We are an EU country and should aim to copy successful EU health services rather than blindly following the EU/UK.
If it takes further EU integration and a pan european health service to achieve this i am all for it. Certainly i would prefer my taxes go directly to Germany then allow the HSE to squander it.
I strongly suspect that the real problem with the Irish health service is the result of successive governments lack of the necessary level of bottle to stand up to civil service unions pay demands. In a very labour intensive field and with quite a few highly qualified people who can up sticks and earn fortunes in Canada or Australia the combination is particularly unsuited to an Irish health service and whatever we are paying now -the main solution would involve more money being spent until this basic situation changes.
 

owedtojoy

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The Economist calling out vested interest groups, disapointing that the subservient Irish media refuses to do so.

"In Ireland in the 1940s private medical practitioners were worried about a reduction in their income from what they saw as “socialised medicine”, and they brought the Catholic church on board, saying that if the state extended its reach it might start looking at contraception and things like that,” he says. “The church has declined in influence, but the power of the consultants has not.”


I think the article is wrong. The Health Boards of the 1980s did a good job, though they were probably a bit top heavy and inefficient.

The 1980s economic crisis started the rot. Haughey ran on a slogan of "Health Curs hurt the Old, the Poor and the Handicapped", and then proceeded to make swingeing Thatcherite cuts. Later, Mary Harney merged the Health Boards, but Bertie Ahern took fright and mandated there would be no redundancies, so there were no cost savings. Successive Government threw money at the problem, and pressure groups like unions and consultants are able to get their way.
 

ruman

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I strongly suspect that the real problem with the Irish health service is the result of successive governments lack of the necessary level of bottle to stand up to civil service unions pay demands. In a very labour intensive field and with quite a few highly qualified people who can up sticks and earn fortunes in Canada or Australia the combination is particularly unsuited to an Irish health service and whatever we are paying now -the main solution would involve more money being spent until this basic situation changes.
As far as i can tell the main driver of medical staff leaving Ireland is not pay but poor working conditions. I may be way off here but i'd strongly suspect many medics would accept european salaries for reasonable working hours and conditions.
 
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ruman

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I think the article is wrong. The Health Boards of the 1980s did a good job, though they were probably a bit top heavy and inefficient.

The 1980s economic crisis started the rot. Haughey ran on a slogan of "Health Curs hurt the Old, the Poor and the Handicapped", and then proceeded to make swingeing Thatcherite cuts. Later, Mary Harney merged the Health Boards, but Bertie Ahern took fright and mandated there would be no redundancies, so there were no cost savings. Successive Government threw money at the problem, and pressure groups like unions and consultants are able to get their way.
With respect I fear you have a rose tinted view of our health service in the past. Despite all its faults now our Health Service is still vastly superior to what it was in the past. The difference now is Irish people justifiably have higher standards and are more willing to complain.
Additionally their complaints are more likely to be listened to wheras in the past anyone complaining about service in an Irish hospital was as likely to be listened to as a child complaining about being abused by a priest.

As the article i posted alludes to we still have a very long way to go to get to a stage where our health service exists for patients rather than consultants benefit.

Our political parties here appear to believe our health service is unreformable which begs the question why are we paying them. Personally i would favour a pan european health service.
 

Patslatt1

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Had an elderly relative go to see her doc recently. The doc sent her in for tests and set up an appointment with a consultant. The relative told me she received a bill for 160 euros and a letter a couple of days later saying that further appointments had been set up 'as requested' with another specialist/consultant.

The relative informed them that she hadn't requested any further appointments. After best part of a day in hospital being run through various machines and so on.

Turns out she had a small cyst behind the knee which was taken care of by a simple course of anti-biotics/anti-inflammatories. Her take on it was that the consultants involved were just recommending patients to each other on a money-spinner exercise. The proposed appointments she told them she never requested would have come in at about 460 odd euro.

And she has private medical cover which inevitably doesn't cover such treatments or referrals unless she has an overnight stay in hospital. I absolutely agree that this system of GPs referring constantly to consultants needs to be looked at because the system now seems almost entirely captured by these medical privateers.

And the GPs are propping it up.
Medical litigation makes GPs risk averse. As generalists, they can't defend themselves by claiming specialist expertise in a particular medical case, unlike consultants. The excessively bureaucratic Irish system of hospital and HSE directed health care is better for the threats of medical litigation which at least forces some reforms. Basically, health care is an unmanagable workers co-op for heavily unionised workers and consultants.
A medical specialist on Newstalk yesterday who worked in a Boston hospital mentioned a system typical in the US where enough doctors are available on weekends to discharge patients and free up lots of beds. Here, the beds are blocked while patients lie on trolleys.
An indication of ineptness in the HSE is the failure to provide relatively simple cataract surgery to prevent blindness. This was publicised by the news that busloads of cataract patients on waiting lists went from Cork to Northern Ireland for treatment.
 
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Patslatt1

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I think the article is wrong. The Health Boards of the 1980s did a good job, though they were probably a bit top heavy and inefficient.

The 1980s economic crisis started the rot. Haughey ran on a slogan of "Health Curs hurt the Old, the Poor and the Handicapped", and then proceeded to make swingeing Thatcherite cuts. Later, Mary Harney merged the Health Boards, but Bertie Ahern took fright and mandated there would be no redundancies, so there were no cost savings. Successive Government threw money at the problem, and pressure groups like unions and consultants are able to get their way.
Health boards couldn't achieve the economies of scale of centres of excellence for very expensive treatments such as cancers. Maybe a few regional health boards could have done so but the government decided to copy the NHS model. If properly run, the HSE in our small country wouldn't be bureaucratic like the NHS with its 1 million plus workers.
 

Patslatt1

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With respect I fear you have a rose tinted view of our health service in the past. Despite all its faults now our Health Service is still vastly superior to what it was in the past. The difference now is Irish people justifiably have higher standards and are more willing to complain.
Additionally their complaints are more likely to be listened to wheras in the past anyone complaining about service in an Irish hospital was as likely to be listened to as a child complaining about being abused by a priest.

As the article i posted alludes to we still have a very long way to go to get to a stage where our health service exists for patients rather than consultants benefit.

Our political parties here appear to believe our health service is unreformable which begs the question why are we paying them. Personally i would favour a pan european health service.
It is unreformable as long as the Irish and their local TDs insist on a hospital in every town. There are about 29 acute care hospitals but maybe five would suffice with the completion of the motorways and provision of a good ambulance and helicopter service.
 

Massey

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It is unreformable as long as the Irish and their local TDs insist on a hospital in every town. There are about 29 acute care hospitals but maybe five would suffice with the completion of the motorways and provision of a good ambulance and helicopter service.
Like they did with the hospitals in Limerick and Clare?
How did that go?
 

Lumpy Talbot

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Medical litigation makes GPs risk averse. As generalists, they can't defend themselves by claiming specialist expertise in a particular medical case, unlike consultants. The excessively bureaucratic Irish system of hospital and HSE directed health care is better for the threats of medical litigation which at least forces some reforms. Basically, health care is an unmanagable workers co-op for heavily unionised workers and consultants.
A medical specialist on Newstalk yesterday who worked in a Boston hospital mentioned a system typical in the US where enough doctors are available on weekends to discharge patients and free up lots of beds. Here, the beds are blocked while patients lie on trolleys.
An indication of ineptness in the HSE is the failure to provide relatively simple cataract surgery to prevent blindness. This was publicised by the news that busloads of cataract patients on waiting lists went from Cork to Northern Ireland for treatment.
We are approaching a stage where GPs are beginning to look like the unnecessary middleman/woman. Either that or providing a secretarial service for consultants.

I find it difficult to believe that GP medical training has gone backwards so far that they are unable to treat anyone without referrals to specialists.

Unless humans have dramatically changed physiological format in recent decades.
 

Patslatt1

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Like they did with the hospitals in Limerick and Clare?
How did that go?
Limerick University Hospital was supposed to get a lot more financing for the consolidation of Ennis and Nenagh. It serves a far bigger population than acute care hospitals in Dublin,maybe 50% more, hence more patients on trolleys.
That consolidation was only two hospitals out of maybe 25 more that need consolidation.
 

Patslatt1

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We are approaching a stage where GPs are beginning to look like the unnecessary middleman/woman. Either that or providing a secretarial service for consultants.

I find it difficult to believe that GP medical training has gone backwards so far that they are unable to treat anyone without referrals to specialists.

Unless humans have dramatically changed physiological format in recent decades.
GPs find that consultants want to see only a limited number of public patients. With private patients, it's hard to restrain GPs from sending them to consultants.
 

Dame_Enda

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The government is not enforcing the public-private ratios in the consultants contract. Last year I saw a repeat of the Prime Time episode where it mentioned that the enforcement varied drastically around the country, with certain hospitals in the midlands and Dublin having over 50% of consultant time being spent in private practice.
 

Uganda

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The Economist calling out vested interest groups, disapointing that the subservient Irish media refuses to do so.

"In Ireland in the 1940s private medical practitioners were worried about a reduction in their income from what they saw as “socialised medicine”, and they brought the Catholic church on board, saying that if the state extended its reach it might start looking at contraception and things like that,” he says. “The church has declined in influence, but the power of the consultants has not.”


Seems to me that the article uncritically accepted the Roisin Shortall dogma line - I.e get rid of private medicine and all will be well.

Nothing whatsoever about featherbedding, poor (or complete absence of) management, system organised to suit employees first and patients second, utter inefficiencies.

But the politicians, like shortall, and certainly not Louise Reilly would not accept there is any problem there.
 

Northsideman

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Seems to me that the article uncritically accepted the Roisin Shortall dogma line - I.e get rid of private medicine and all will be well.

Nothing whatsoever about featherbedding, poor (or complete absence of) management, system organised to suit employees first and patients second, utter inefficiencies.

But the politicians, like shortall, and certainly not Louise Reilly would not accept there is any problem there.
It would be interesting to canvass all TDs to ask each do they have private medical insurance? I would guess the vast bulk have including most of the lefties.
 


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