Say No To A&E Closures!

by Noel - None Thu Apr 23, 2009 04:08 Dublin 018892052

Whether we like it or not , we will always have a two tier health system. People willing to pay for private health insurance expect to get better treatment, otherwise why would they pay the exorbitant private insurance premiums?

I have private health insurance for over 25 years. If I did'nt have it, I would'nt be writing this e-mail. Thats the price you have to pay.

by ex-HSE Tue Jul 31, 2007 11:00

Let me tell you one thing, a lot of what goes right in the administration is down to those grade 3 and grade 4 clerical officers keeping things patched together despite the indifference or incompetence of very well paid managers above them.

The PPARS project is a good example, cost a fortune, didn't work properly, end-user staff were given minimal training in its use. The consultants were paid a fortune (at taxpayer expense), one of the HSE managers who was paid a fortune to oversee it's implementation, was the most incompetent bully they could have picked to run it. Despite the huge costs, the end user staff, once they started using the system, started finding holes all over it, and pointing these out to the managers (where it was not well received)

In one old healthboard area, there are 10 payroll staff to pay over 12,000 staff (plus another 10 staff, who get over paid to stamp and sign it once the work has been done).
There have been some staff reductions from things like PPARS. And a lot of grade 3 clerical officers were on monthly contracts when I worked there, we got contracts at the start of each month, and had to take it on trust that it would be renewed the following month.

I'm sure there are other examples in the medical areas. where the people doing the real work, are crippled under a bunch of over paid bean counters, who rub shoulders with the politcally appointed sacred cows. The agenda gets done, and if that effects efficiency, even better, to hasten the demise of the public service.

I disagree with Andrew that too little responsibility is given to managers, it's too little accountability that is given to them. They get paid to make decisions, but they gon't get any penalties for screwing up.

Having seen how much some of these consultant doctors get paid, I think it's a disgrace that we allow them to carry out 'private practice' in public hospitals, while we are paying them to treat the public patients.

by Andrew Mon Jul 30, 2007 22:48

Too much bureaucracy in the HSE, from the HQ to the hospital offices. The old Healthboards were abolished and a new centralised HSE replaced them, but no staff reductions followed. This has led to a situation where, anecdotally, fourteen or fifteen office staff now do the work that ten did only a few years ago.
Too many consultants (not the consultant doctors, I hasten to add), and too much money spent on them.
Too many non-medical staff, especially the over-paid, unionised clerical administrators costing the HSE billions in salaries and pension contributions.
Too little responsibilty given to managers. They must be held accountable for failures.

by Asisc - blah Mon Jul 30, 2007 21:36

"The supposed ‘opposition’ of Fine Gael\Labour want even more market control of health and when last in government they too underfunded public health care and supported the development of the two-tier system."

Explain how?

by Jimbob Mon Jul 30, 2007 13:11

Mr. Novack wrote:
Those points and similar ones having been considered, how do you decide to what extent medical treatments not provided by the system should be prevented internally if they can't be prevented internally.

Jimbob replies,
Hello Mr. Novack,
I don't see what angle you're coming from. The idea of stopping a two tier health system is not to stop millionaires from flying off to the best private clinics in Geneva, Gemany or the US.
The idea is to stop the government and their 'private healthcare buddies' from ripping out the guts (metaphorically) of the existing public system, thereby forcing us to go private to get speedy treatment, when we already pay for the public system.
Sometimes, this even involves the private treatment being carried out in the public hospital, using public staff, so paying over the odds, and subsidisig the greed of the two tier system.
That public /private system is illegal in other countries.

The PD's are following an agenda that has been used elsewhere, screw up the public system, allow it to then screw itself up further, and then 'rescue' it with the shinging knights of private investors.

by Cian P - Sp Sat Jul 28, 2007 22:31

This is done by having a top-qulity, free public system, eliminating the need for people to get private care. Also, stop all privatisations and public money going into private hospitals. No need for complex laws etc. Simple. :-)

by Mike Novack Sat Jul 28, 2007 11:53

Not easy to do, but I think you have to separate into two rather different questions.

The first -- full and adequate funding of the publicily provided health care system.

The second -- the "two tier" problem.
That's a rather difficult subject, and you need to argue against it with examples of what you mean, because this is a situation where the cure can easily be worse than the diesease. In other words, how do you propose to prevent the rich from access to health care not provided by the public system? How do you STOP "two tier" in practice?

Do you prevent all travel by the rich?
Make it illegal for them to have any medical treatment while abroad?
If so, to what does this apply? Obviously you want Irish (rich or poor) while travelling abroad to get medical care for problems that arise while travelling. Do you propose some reg like "travelling aborad requires prior medical exams and listing of "pre-existing" conditions" (which must NOT be treated).

Those points and similar ones having been considered, how do you decide to what extent medical treatments not provided by the system should be prevented internally if they can't be prevented internally.

Please note --- I can think of one very obvious medical treatment not available in Ireland, public system or not, which you get abroad (assuming you have enough money to get abroad) ---- what in my day would have been a D&C without a prior pregancy test showing not pregnant. THAT'S an exaple of "two tier", yes? (it was while I was growing up before abortions were legal here. I'm NOT talking about back room abortions, but a D&C performed in a hospital with either faked paperwork of the medical need sort or faked pregnancy test --- going rate back then about 1/4 a years tuition at an Ivy League "uni")