The Financing of Healthcare

In addition to the acute problems caused by the economic crisis,  Ireland (along with all other countries) must also resolve chronic policy challenges, with the financing of healthcare near the top of that list.

This article in The Economist provides an interesting cross-country survey of the pros and cons of private insurance.

16 thoughts on “The Financing of Healthcare”

  1. Homeopathy is extremely cheap, effective despite “scientific” skepticism, and as it is not poisonous, has few blowbacks! Where the patient is not satisfied, then the allotropic/pharmaceutical expense fest is in reserve.

    Financing the system is the cart before the horse. Luckily we have a “crisis” that will last a decade or so and enable a review of medical options that are less cosly and more effective, such as teetree oil instead of anti-biotics.

    Given that Ireland will lose doctors and nurses etc to Queensland, nurse practitioners might also be instituted. Yes! Women with authority!

  2. @Pat Donnelly

    I hope you’re joking Pat because homeopathy is complete rubbish. The “scientific” scepticism that you’re speaking of is fact and to suggest that the way to cut down on health care costs is to use solutions containing nothing is ridiculous.
    Although I think what you meant to say was herbal medicine, which has shown some positive effects, of which the vast majority have already been turned into far more effective pharmaceutical medicines.
    As a final point all medicines that have an effect have a limit of dosage above which they become poisonous e.g. Pharmaceutical drugs, vitamins and (yes!) herbal medicines.

  3. Health care is a bottomless pit and will remain so despite struggles to contain costs.

    VHI reported last month that over the last five years the total number of medical procedures which it paid for on behalf of its customers in private facilities increased from 293,000 procedures to 507,000 procedures which is an increase of 73% and it expects this to increase by a further 9% in the year ahead.

    It will generate losses of over €170m in meeting the healthcare needs of its 280,000 customers who are sixty years and older.

  4. I also really hope you are joking @Pat!

    There is no (respectable) proof that Homeopathy performs better than placebo. And, while taking this route might reduce the cost of people demanding antibiotics for flu (a virus), it is not something that would make a dent in heathcare costs.

    As for herbal medicine, that comes with a whole range of serious issues which would need to be addressed before they could be utilized in mainstream healthcare.

    For a quick example read –

    http://uk.reuters.com/article/idUKTRE61G3N420100217

    Basically a woman was given pills to cure her acne (they were described as safe as Coca cola…) and the only real side effects she experienced were that she needed to have her kidneys removed, contracted urinary tract cancer and later had a heart attack. And now she needs to go to hospital for dialysis three times a week. So quite safe….

  5. @All

    Health and Pensions are real BIG ones. Hence my continuing focus on the National Pension Reserve Fund, carefully built up by an astute, world class, and very professional NTMA, and my absolute horror at it being raided to prop up Zombies as the fruits will be lost in the great black hole. We may have to wait 30 years to read ‘Blind Panic Revisited’ (the joycean tome set in an afternoon in late Sept of 2008) but The Greatest Heist in Irish History is imminent – the manuscript is, allegedly, with the publisher: This is one publication I do not want to see the light of day. How does one, or many, stop it?

  6. Anyone in any doubt about homeopathy should read: Trick or Treatment: The Undeniable Facts about Alternative Medicine, Simon Singh & Edzard Ernst. Singh is currently being sued by chiropractors in an attempt to shut him up.
    Alternatively visit http://www.senseaboutscience.org.uk

    And if you still want homeopathic remedies, I suggest turning on the tap: its just water.

  7. I was interviewing a director of a ‘well known private insurer’ just before Christmas and he told me that new business had dropped 35% in a year and was predicted to drop another 35% in the coming year.

    That may explain the ridiculous hike in premium printed on the renewal letter I received last month. Sadly, I am unable to take them up on it as it has become unaffordable for me (and the benefits of the next plan down are a joke not worth bothering with) and I have to join the 35% heading for the door.

    I just hope that I don’t get ill. I’ve got my European health card. I will just have to get on the ferry to France if I do. G*d forbid I end up in an Irish hospital.

  8. @All

    On health – the key distinction is between ‘universal’ [+higher tax] … and my preferance … or ‘wealthy-insured [insured live – poor die; low tax]. The Scandinavian model follows the former – the neo-liberal largely follows the latter. Over ten years ago the neo-con anyeen-randish PD ideology, and its fellow travellers within FF, ensured the latter and the privatisation of the Irish health system. Health, no longer viewed as a public good, is commoditised and commercialised to the benefit of PharmaChem MNCs and the Health Insurance INDUSTRY, and the Consultant vested interest group – the profit imperative: Joe and Joan citizen better have health insurance or ‘tough sh1te’ is the basic policy and philosophy. & look at regulatory capture by the profession itself – in barriers to entry and in power of negotiaton with Gov. Look to the crass GOP attacks on public health care in the US at the mo ……… bought by the vested interests …. and the base propaganda by Sharah Phelan, F0x Newz, Newtz, and co as they try to keep millions of other Jose and Juanitas in their place …….

    In a Republic one would expect the citizen to take priority – not in this one. Time for the relevant Minister, notwithstanding certain admirable personal qualities) to find some ‘error of judgment’ somewhere and go. The strategic decision was not only the wrong one – it has cost, is costing, and will cost lives of those in the working poor, the unemployed (many now cannor afford h. insurance), and the underclass.

  9. I haven’t read the Economist article yet. When I look at the large new private hospital being built in St Vincents in Dublin I wonder will it have enough patients to be profitable? Will it perform acute care procedures that are costly or only those procedures that are profit making? Will the reduction in private insurance members jeopardise Harney’s plan for private hospitals? Will there come a time when Ireland will nationalise private hospitals to provide care for its people through the public health system? I’m only beginning to get my head around these issues, all I have are questions, no answers yet.

  10. Its sad to see this has been taken over by the money men looking to take their percentage…. Not alone have they taken over the health ‘industry’; they have taken over the thinking behind it…

    One would hope that people would start to realize that when you have lawyers, bankers, traders and brokers, all you are ever going to get are ‘trading platforms’, ‘insurance vehicles’ and more nonsense.
    If left to their own devices, these class of people are never going to do anything useful… make a bed, clean up a mess, let alone help a patient.. They are like cockroaches; they will just multiple and create filth for themselves to thrive in.

    A return to basics is needed. We have an opportunity in this crisis to thin out the cockroaches; not create another steaming pile of **** for them to feed off.

    True healthcare aint what it used to be…. Technology has moved on, made some health problems survivable, some manageable, some curable. And for every new breakthrough; it unfortunately means more cost if that treatment is to become available. And decisions have to be made; the only thing certain is everyone will shuffle off at some stage, no matter how much money is spent on us.

    We pay taxes; we have a public health system. Imperfect, but how do we improve it? A few basic principals

    1) Remove subsidies for private.
    2) Stop this medical card nonsense where stuff is either free for card holders or people a little bit richer pay through the nose. Have it so there is some payment; even if its the price of a pint for medical card people.
    3) If you pay taxes; you are eligibe for the public health system. Youre paying in to the system; you should be able to get its benefits… doesnt matter if you are an unemployed student or a multi millionaire.
    4) If you work in the system; you should use it. Very hard to enforce, but if you work in the system particularly at the higher end; those making the decisions need to be in the position where they will be lying on their back in a pubic ward and experiencing the consequences of their work later on.

    What we have is a second class public system; with lots of people making a first class living from it. Most of them have private health insurance and worse, practically all those making the decisions are private… The pseudo socialists among them salve their consciences by making the medical card free. (but not putting in basic checks to stop abuse) while the rest just collect their paycheck secure in the knowledge the private hospital with tax breaks will look after them.

    Its like the old stories about workers in Detroit turning up at the factory driving a toyota. Something is fundamentally wrong, it make take years but eventually if even those earning their living from the system arent using it, it will fail.

  11. Just today, I had cause to go through the P+L’s of two hospitals. There appears to be a fundamental lack of accountability that is basically the HSE’s fault. The money the hospitals get is not given in return for services to public patients – it is given as a big amorphous block grant. This is a stupid way to pay money to the hospitals.

  12. @Antoin O Lachtnain – “the money follows the patient” would seem to be a sensible way to relate funding to services. Provided patients are able to voted with their feet (or trollies) bad performance would be exposed pretty quickly.

  13. Health care has a lot in common with pensions.

    It’s ironic that politicians who have arranged a system for lifetime pensions that could never be funded for the private sector worker who is lucky to have an occupational pension, see the virtue in private health care provision.

    Their public pensions give them the security of always having an excellent standard of private care while the control of the wealthy consultants of both public and private provision, could hardly be termed an example of a free market..

    Mary Harney told us we were closer to Boston than Berlin, when the delusion of inventing the free lunch gave us the notion we would never again be caught rattling the tin ponny towards the East.

    In the US, the Republicans also want to have their cake and eat it.

    Senate Minority Leader Mitch McConnell (R-Ky.), has warned that “a government takeover of health care” would “take away the care that people already have [and] are perfectly satisfied with.” In its place, the senator said, would be “a system in which care and treatment will be either delayed or denied.”

    Of course that disdain for a public hospital did not stop him having a heart operation in one in 2003 – – at the Bethesda Naval Hospital.

  14. @Garry

    Stop this medical card nonsense where stuff is either free for card holders or people a little bit richer pay through the nose. Have it so there is some payment; even if its the price of a pint for medical card people.

    A reform such as this would be absolutely key to discourage over-consumption.

    But imagine the beating of chests that would ensue if this was introduced (particularly the chests of well-heeled over-70s).

  15. Healthcare reform too often degenerates into a discussion of the possible in political economy terms given the relative power of various entrenched actors. Ireland, no less than other countries in a similar conversation, requires a clearer sense of the appropriate destination toward which a functioning health care system should be heading, before then engaging in the necessary discussion about the path and the political economy of reform.

    The two best people to read on healthcare reform as a general concept rather than a country-specific political economy discussion are Michael Porter and Clay Christensen. Both have written important books in the last few years – Redefining Healthcare and the Innovator’s Prescription respectively – but the following links provide a good short introduction to their works:
    Porter:
    http://www.hbs.edu/rhc/speaking.html
    Christensen:
    http://www.hpcgg.org/PM/presentations/2007_Christensen_Health_Care_Main.pdf

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