Irish Healthcare – time to adopt the Singaporean model?
There are many parallels between Ireland and Singapore, both small countries with populations of the order of 4.5 million, both open export focused economies, both competing for foreign direct investment. One area where Singapore is streets ahead of Ireland is in health care. With Ireland experiencing a fiscal crisis that threatens the economic sovereignty of the state, is it time to consider a different model for health care that could drastically reduce the cost of health care provision (€15.5bn this year in Ireland compared with a 2008 average of $381 per person or $1.5bn in Singapore) to the state while improving the standard of care. It is not only the cost to the state that is lower in Singapore, but also the total cost of health care provision. Health care in Singapore costs Singaporeans only 3.7% of GDP compared with 7.5% of GDP in Ireland (this underestimates the amount the Irish pay relative to their income as GDP overstates Irish income by 10-20%).
What do the Singaporeans get for they’re much reduced spend? Well, life expectancy at birth in Ireland is 78.07 years; in Singapore, it’s 82 years; In the UK it is 78.85. The Singaporean infant mortality rate is a mere 2.3 deaths in Ireland it is 5.14, in the UK it is 4.93.The Singaporean model works by mixing public and private health care in an optimally efficient manner. The current Irish system also mixes public and private health care, but does so in a much less efficient manner. Singaporean citizens, like Irish citizens, but unlike British citizens are responsible for selecting and paying for their own health care. This means that the market and not a bureaucracy determines the provisioning of health care services and ensures that citizens have an incentive to become informed, and unwasteful, consumers fostering competition among service providers to drive costs lower and service levels higher. The Singaporean model is based on a system of 3Ms – Medisave, Medisheild, and Medifund.
Unlike Ireland, however the market distorting insurance companies are not involved in paying day to day medical expenses. The state ensures citizens have enough cash to pay for health care via a mandatory health savings scheme (Medisave), funds are automatically deducted from citizens pay each month, supplemented by employer contributions and accumulated in personal health care accounts. These accounts remain the citizens property but are boxed off for meeting healthcare costs while the citizen is alive. The state provides for cover for serious (and expensive) health problems via a public health insurance scheme (Medisheild), but citizens are free to choose private alternatives if they wish. Medifund is a government run fund for meeting the costs of those Singaporeans who are unable to contribute to Medisave and Medisheild.
While a market based system may gall those used to the public health care provision provided by the NHS, it does seem to produce positive changes over time by allowing innovation by entreprenuers and competition on price and service levels. For example, in the last five years in Ireland a small startup company has enjoyed enormous success with their VHI branded Swift Care clinics. The clinics which promise to see every patient in under one hour specialise in dealing with non-life threatening accidents and emergencies. Not only do these clinics reduce inconvenience for their customers they also help to take the pressure of busy public A&E wards which deal with the real emergencies (car crashes, heart attacks etc). Another innovation helping to create an informed citizenry and reduce doctor and hospital visits is VHI’s Nurse Line service. Complementary to VHI policy holders Nurse Line is a 24 hour service providing remote diagnosis and first level medical advice.
It’s important to note that the Singaporean approach leverages the market as a means-to-an-end, that is quality affordable health care for all, rather than an ideological (free market) end in itself. To ensure that service providers do not price gouge or take advantage of vulnerable patients a health care regulator regulates service levels and costs.
Perhaps the biggest advantage of public health service is that the same quality health care is provided to all. However without a market pricing mechanism to allocate the finite resources (or funds) available to the service decisions on what health care services are available must be taken by a committee. For example in the UK, Tim Harford pointed out in his book “Undercover Economist” that treatments for some ailments that cause blindness aren’t provided under the NHS until they are well advanced and will only be performed to save one eye! The Singaporean model appears to solve this dilemma, patients can choose which treatments they spend their money on – and the government ensures that all patients have enough money to purchase services (and that no patient can duck out of the system by avoding making contributions to their own health care fund)
Is there a downside to such a system? Drastically reduced cost to the government (up to 90% cheaper) and quality market based health care solutions available to all. It certainly sounds better than the inefficient public / private mix we have in Ireland today, and givien the scale of our fiscal imbalances it is imperative we find innovative ways not only to reduce costs but to actually improve services available while doing so.
harry flashman ,
Thanks for pointing out my error . The sentence should of course have read
‘The US has the highest rate of infant mortality in the DEVELOPED world’
Thanks for agreeing with the rest of my post
Dave ,
‘Private healthcare clinics, on the other hand, are akin to hotels with the staff trained to offer top-rated service, and all run and ruthlessly efficient business lines that keeps costs under control.’
As your alter ego Harry is prone to say -complete and utter bollocks . The USA is now being bankrupted by it’s private healthcare system and it’s thieving private insurance companies . As for keeping costs under control I urge you to read Kensei’s link to Dr Gwande’s New Yorker article to see how ‘efficently’ private health care delivers ‘cost control’ in the neighbouring counties of McAllen and El Paso in Texas . Sad news for the pro free marketeers uber alles . It doesn’t . It provides the same level of service at twice the price per capita with the demographics of both counties being equal in respect of those factors which matter in health care .
‘This is a completely ridiculous argument that is underpinned by nothing more substantial than socialist paranoia about the free market system.’
More simplistic bollocksology from the school of Milton Friedman , Maggie Thatcher and Ronald Bush Reagan Rumsfeld and of course our anti EU Dave .
Have you noticed by any chance the current world economic crisis ? and the role of the unregulated shadow banking private sector in looting billions from taxpayers? Did it strike you as somewhat ironical that the ‘free market ‘ ran cap in hand to Government to help bail them out from their self engendered financial collapse which they ‘built ‘ on free market foundations ?
These are the self same idiots who wanted to ‘privatise ‘ American social security which fortunately despite Bush’s wishes did not happen . Had it done so the ‘retirement ‘funding of some 200 million americans would have done a disappearing trick as per the Madoff method
‘The free market system works perfectly when the government allow it to work’
More nonsense at least in respect of health care and education . Every country in Europe had to rely on government to provide basic education and health care for it’s people . In the middle ages these needs were provided by the monastries and the church up to the Reformation. It was only during and after the industrial revolutions in the UK and Germany that Government ‘interfered’ in the market to provide education and health care . They had to . The ‘free market’ was not interested . When you can make a huge profit by allowing 1 million Irish to die in famine or 27 million in India or allow dysentery and cholera to reduce life expectancy in Manchester to 19 years why would you want to reduce your profits by providing health or education services to people who can’t afford them anyway ?. Best to let them die in poverty and ignorance after all it’s their own fault anyway !
Spare us from your anti socialist paranoia . Your ideological committment to the ‘free market’ is passe . Health care and education for all according to their need is a fundamental right in modern democracy. If the market cannot provide that then the State MUST intervene to ensure that these services are provided .
Greenflag, Kensei -
I am pretty much convinced that you can’t have a free market in health. You are both absolutely correct about that.
Asymmetric information (insurance customers have a better idea of their health, doctors have a better idea of the efficacy of treatments) causes adverse selection problems (e.g. insurers attempt to reduce their risk by overcharging and selecting customers). Kenneth Arrow proved that an unregulated market in health care will not efficiently allocate resources 45 years ago.
http://www.scielosp.org/scielo.php?pid=S0042-96862004000200012&script=sci_arttext
That’s not what we’re discussing here though.
The Singaporean model attempts to address the problems highlighted by Arrow, via public health insurance (which can undercut any price gouging by private insurers) and regulation (which prevents price gouging by practitioners) while still retaining the advantages of choice provided by a market system.
The system was purposely designed by economists to be as efficient as possible. Where a totally efficient system is one in which no change can be affected that raises the outcome for all participants without harming one other participant (by this definition the US healthcare system is highly inefficient as is the British NHS).
Kensei
Does the Obama plan to involve introducing Public Health Insurance – possibly backed up by public funds for those unable to pay? Does this sound like a partial migration towards the Singaporean system? (Still missing the part that would help pay day to day expenses – GP fees, X-rays, prescriptions etc).
Kensei – (Further to the above)
President Obama has made his own preferences clear. In a letter to Senators Edward M. Kennedy of Massachusetts and Max Baucus of Montana, the chairmen of two key Senate committees, he wrote: “I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.”
http://www.nytimes.com/2009/06/28/business/economy/28view.html?_r=1
The Singapore health system is great for those that can afford it. It is not as financially unachievable as the US system but it has limits … and critical ones at that.
The critically ill youth who eventually run out of medisave, insurance, income and support cant access health care. Singapore hospitals regularly take to court and bankrupt individuals who can’t pay the bills.
What do you think is the primary requirement of health care – availability or efficiency. Personally I put them in that order or priority.
1. Availability
2. Efficiency
The Singapore system ends up excluding health care to long term critical care patients (and I have first hand experience of this). The universal systems in operation in the Ireland, UK and Australia to name a few are always available to everyone who is ill.
You may rail against some of their internal mechanisms and efficiencies and waiting lists can sometimes be high. but Availability must be first.
Dont forget that basic tenet before proposing alternatives (the article above doesnt do that and shows ignorance of the realities of a flawed system)
mack ,
Fair enough comment . Whatever Obama may prefer it looks like Max Baucus’s reelection campaign will be financed mainly by the private health insurance companies just as it has been in the past . Senator Kennedy is ailing as we speak and may not live to see a public option never mind universal health care . It will be interesting to see how far Obama gets his way . There are many Senators and Congressmen in both parties who are ‘beholden’ to the insurance industry for their financial support !
As for keeping insurance companies honest ? Good luck . As Kensei says above we can at least in theory remove governments which maladminister or make a botch of health care -we don’t have any say with ‘private health insurance ‘ companies .
Just like some of the US banks and AIG and sections of the shadow financial services sector who were allowed to become too big to be allowed to fail i.e fall on their ‘free market ‘ swords so it is that the entire US Health Care morass cannot be cleaned up or reformed or made into a USA equivalent of what France or the UK or Germany or Singapore or even Ireland has -overnight . Obama has already made the point that bad and all as the present mess is americans can probably not afford to turn the entire system upside down without risking the entire economy in the short term and it’s risky enough at present with rumours of increased numbers of foreclosures in the offing .
The Singapore model may well be worth investigating . My suspicion is that it works there not just because it was designed by a bunch of gypsy fortune tellers sorry economists but because of the local culture and a rather stringent (by western standards ) deterrents for those who would try to gouge the system for personal excessive gain .
My opposition to a free market only system is because it would end up as in the USA i.e gobbling up some 20% of the economy while delivering excellent 21st century care for the wealthy and insured and those lucky enough to be employed by the larger corporations while leaving everybody else at the mercy of ‘legalised ‘ gangsters , rip off merchants and white collar criminals .
Private health care only is also a major impediment to labour mobility and flexibility . Employees are not going to change jobs if it means that their ‘insurance ‘ with a future employer may not be as good as their present or if they have developed a health condition which would make their hiring more problematic.
Many young people don’t pay into health insurance because they are ‘eternal ‘ and not likely to become ill . At the other end of the scale 60 year olds who are too young to retire and don’t qualify for Medicare have taken to robbing banks in the hope that a three year jail sentence will provide them with food , clothing , and free health care until they reach the magic age of 65?
The Dutch system which is rich in preventative care strategies is presumably the main reason why the Dutch have become the ‘tallest ‘ people in the world over the past two generations . Not too long ago i.e the 19th century the Dutch were known for being ‘undersized ‘
Whatever system Ireland adopts ‘cost control’ will have to be a major factor given scarce tax resources . In addition while everybody should contribute as a percentage of earnings to any such system those consumers who deliberately neglect their own health should be penalised premium /contribution wise to encourage a change of behaviour . And while we can wax lyrical over the failure of a private health care system to regulate itself in the interest of the consumer it also is beholden on the state to ‘regulate ‘ the regulators of public services through strong longs and deterrents including confiscation of private property and in extreme cases the death penalty for those who abuse their position as financial trustees of the public health !
Error above second last line
‘through strong longs’
should read ‘through strong laws ‘
Yes I will try to take a look at the undercover economist some time. It is interesting to hear about a different system of healthcare as my own knowledge is limited to the UK the USA and a few major European systems.
Dave though, jeez where to begin?
[i]This is a completely ridiculous argument that is underpinned by nothing more substantial than socialist paranoia about the free market system.[/i]
Dave no its not it is a reflection of pretty widely held recognition of the problem of market failure in the healthcare system. It cannot be a perfect market because it violates so many of the necessary underlying assumptions of a properly functioning market e.g. asymmetric/imperfect information, positive externalities, barriers to entry etc. You on the other hand are an uncritical fanboy for the wonders of the market system in any and all walks of human endeavour. As for the discussion about Irish grannys the problem is that where doctors do have an incentive to inflate the cost or order extra treatment that is demonstrably what they do. It is a fact illustrated by a great deal of quantitative data in the USA not just a wild stab in the dark based on my assumptions about human nature. Where doctors have a financial stake the per patient cost can be increased by up to 50%. I would also recommend the New Yorker article listed above as it covers that point quite well.
[i]Private healthcare clinics, on the other hand, are akin to hotels with the staff trained to offer top-rated service, and all run and ruthlessly efficient business lines that keeps costs under control. That is the level that we should be aiming for, not state-controlled backwardness.[/i]
Just complete and utter bollocks. Ok here is one problem to consider. Teaching hospitals. To be a teaching hospital is to add a cost to every transaction in that hospital. Their overall costs and thus prices will be necessarily higher to facilitate the process of teaching the next generation of doctors. If all hospitals have to compete ruthlessly on a lowest price basis for business then the teaching hospital will be driven out of business. The problem here is that teaching new doctors is a positive externality. It has a wider public good but the value of that cannot be captured by the teaching institution thus it makes it uncompetitive in a perfect market. You see a market failure. Are you getting that concept yet?
In fact the experience of the USA suggests that rather than being super efficient the opposite has happened. Stays in the super efficient private US hospitals are the most expensive in the industrialized world. Thus the length of stay in them is the lowest in the industrialized world. Does it deliver the best care in the world? Well the broader indicators would suggest not.
[i]The only future for healthcare is privatisation of hospitals and healthcare insurance. There should be no public healthcare whatsoever. [/i]
Well as pointed out before healthcare has positive public benefits that cannot be captured by the market (these are called positive externalities in economics). In a mad capitalist world it may sound great to ignore those who can’t pay for their treatment but it is not so good when the great unwashed masses get sick and spread that illness to everyone else regardless of their social status. Inoculation is great example of this. It is cheap and extremely effective but it requires a critical mass of the populace to be inoculated before it will effectively wipe out a particular disease threat thus achieving the best result. Interestingly it is something the US system is very bad at doing as the cost is higher there than in other countries and a larger number of people go without basic lifesaving inoculations. But hopefully you see the point that in healthcare often times a wider public good is served by everyone getting access to it and that is beneficial to wider society and to individuals as well. There is of course the not inconsiderable argument that in a modern wealthy society no one should have to go without basic medical care as a positive political choice but I was trying to stick more to the economic arguments.
[i]That free market system works perfectly when the government allow it to work.[/i]
Just utter bollocks. There is no market anywhere that works perfectly. If they did there would never be anything in the shops because a perfect market clears itself i.e. the last bit of supply is taken up by the last demander at the clearance price of that market since that pretty much never happens no market is ever perfect is it? Economics is riddled with inconsistencies and with unsustainable assumptions about the behaviour of economic man that in my view render much of it half baked and it is very unsafe to so blithely assume that the free market system works perfectly and then build your whole political and moral outlook on top of that very shaky edifice.
“Dave no its not it is a reflection of pretty widely held recognition of the problem of market failure in the healthcare system. It cannot be a perfect market because it violates so many of the necessary underlying assumptions of a properly functioning market e.g. asymmetric/imperfect information, positive externalities, barriers to entry etc.”
As I pointed out to you, law and architecture are two of a plethora of examples that operate successfully under the same criteria. Why stop at healthcare if you deem it better for the user that the State should provide the service? Your flawed argument would mean that all services where the client relies on the expertise and integrity of the service-provider should be provided by the State (which, presumably, is the purveyor of all that is good).
Yet where is the compelling evidence that the State can successfully run a newspaper stand, never mind a highly complex business like healthcare? Totally absent, of course.
“You on the other hand are an uncritical fanboy for the wonders of the market system in any and all walks of human endeavour.”
Fan, certainly. Uncritical, never. Boy, 25 years ago.
“As for the discussion about Irish grannys the problem is that where doctors do have an incentive to inflate the cost or order extra treatment that is demonstrably what they do. It is a fact illustrated by a great deal of quantitative data in the USA not just a wild stab in the dark based on my assumptions about human nature. Where doctors have a financial stake the per patient cost can be increased by up to 50%. I would also recommend the New Yorker article listed above as it covers that point quite well.”
I haven’t read the New Yorker article and I’m not bothered with magazines and their assorted agendas. However, I’m not disputing that the business of business is maximising profits. Prices are usually determined, not by the cost of providing the service, but by what the market will pay for it.
What I am disputing is that doctors will perform procedures that are not required and that cause undue distress to poor granny for profit. In order words, that the profit motive makes “everybody into an evil rogue.” In the US, for example, one third of American women will have a hysterectomy by age 60, which is four times the rate in most European countries. Yet there is no evidence whatsover that that extraordinary difference is due to US doctors performing unnecessary procedures in order to maximise profits. US doctors tend to err on the side of caution because it is much easier to sue them than it is to sue doctors in Europe. Nor, of course, is there any evidence that state-controlled hospitals are any better. The report of the Lourdes Hospital Inquiry showed that Dr. Neary was performing caesarean hysterectomies at the hospital at the rate of 1 for every 37 caesarean sections, compared to a European statistical norm of 1 per 304 caesarean sections. The State was performing unnecessary hysterectomies without any profit motive being applicable.
The best way of keep costs under control is by privatisation of hospitals and by the use of healthcare insurance, with the private insurers paying the private healthcare providers, thereby having the incentive and the power to keep the costs of services to a minimum. Likewise, the private healthcare providers are looking to maximise profits and they thereby have an incentive to keep costs under control.
If the State is paying the cost, no one gives a toss about the cost, since they view the State as a limitless source of free money.
“Just complete and utter bollocks.”
Not at all. My short stay in The Galway Clinic was a pure delight. Indeed, just step inside the door and you’re into an atrium that is indistinguishable from a plush hotel. Room service isn’t half bad either. And all it cost me was a modest annual subscription to health insurance.
“Ok here is one problem to consider. Teaching hospitals. To be a teaching hospital is to add a cost to every transaction in that hospital. Their overall costs and thus prices will be necessarily higher to facilitate the process of teaching the next generation of doctors. If all hospitals have to compete ruthlessly on a lowest price basis for business then the teaching hospital will be driven out of business. The problem here is that teaching new doctors is a positive externality. It has a wider public good but the value of that cannot be captured by the teaching institution thus it makes it uncompetitive in a perfect market. You see a market failure. Are you getting that concept yet?”
[b]Continued[/b]
Oh dear… do you regard the public as guinea pigs? We must have public hospitals so that doctors can learn? I don’t think so. Trainee doctors will be required respective of whether healthcare is private or public. Now, in case it escaped your attention, trainee doctors are paid less, so the hospital cuts costs by employing them. If it is college students that you are referring to, then they should not be allowed in hospitals as part of a teaching course.
In regard to the US, of course, it takes 8 years to college to qualify as a doctor, whereas in Europe, it only takes 6 years. They could save money simply by cutting the 2 years off the college course, thereby reducing the amount that doctors earn due to the length of time it takes to teach them. Also, doctors wages are subject to the law of supply and demand, so what do you do to keep the cost down? That’s right: increase the supply. Are you getting that concept yet?
Okay, I’m already over the post size limit, so rather than continue to point out how mistaken you are, I think I’ll just accept that you are committed to state-provision of healthcare on ideological grounds and that rationality has no part to play in that ideology. That sentence might be a little loaded in the expression, but you get the gist.
Mack
Does the Obama plan to involve introducing Public Health Insurance – possibly backed up by public funds for those unable to pay? Does this sound like a partial migration towards the Singaporean system? (Still missing the part that would help pay day to day expenses – GP fees, X-rays, prescriptions etc).
Obama is on record as saying he prefers single payer, but views it as unattainable. The public option is suggested because of several reasons; partly because the administration costs of Medicare are so much lower than private clinics, and partly because in many states there are effectively local monopolies. Note it is by no means guaranteed that the public option will escape Congress.
When it comes to what the Americans term social security – pensions, health care, unemployment etc- I much prefer these things to be in the hands of the government. That is because I am primarily interested in security over efficacy. Shifting things to the individuals does produce some advantages, but it ultimately represents a large shift in risk to the individual. Personal accounts do get depleted. Insurance fails to cover what is needed. We have already pulled a few issues here you glossed over in the original piece. I am not adverse to market based reforms, but I know where I want the buck to stop. With people I can kick out if they screw up.
Whatever ‘system’ is adopted, the allocation of resources will still have to deal with lifestyles.
Smokers, obese people and other selfish loafs should always be at the bottom of the list for treatment. Evolution takes no prisoners. Let it roll.
‘The US has the highest rate of infant mortality in the DEVELOPED world’
Still bollocks Greenie.
I presume you regard your beloved EU as part of the “developed” world in which case I count no fewer than nine EU countries with higher (in some cases substantially higher) infant mortality rates than the US. Russia, Israel and Argentina, fairly developed nations I would have considered, also have higher rates and the US comes in about the same as Italy, New Zealand and South Korea.
So nice try, if you’re smoking crack, but otherwise rubbish.
Kensei -
pensions, health care, unemployment etc- I much prefer these things to be in the hands of the government
Do you have a private pension or are you relying on the state pension? I certainly know a few people who have taken out insurance against losing their job (looking like a good move in the current environment). Both unemployment benefit and the state pension are quite low. Both (as currently constituted) depend heavily on the number of workers per dependent remaining high to be affordable (even at current low levels). Ireland’s social security bill is almost as high as our tax revenues (>21bn vs just over 30bn!). Certainly in the south, all 3 areas are covered by the state but supplemented by private cover to varying degrees.
We have already pulled a few issues here you glossed over in the original piece.
That’s the purpose of a comments section. I gave an overview that ran to 8 paragraphs of a topic that probably warrants a book (that would take considerable time to research in depth!). But yes, we did make good progress.
Mack
Do you have a private pension or are you relying on the state pension? I certainly know a few people who have taken out insurance against losing their job (looking like a good move in the current environment). Both unemployment benefit and the state pension are quite low. Both (as currently constituted) depend heavily on the number of workers per dependent remaining high to be affordable (even at current low levels). Ireland’s social security bill is almost as high as our tax revenues (>21bn vs just over 30bn!). Certainly in the south, all 3 areas are covered by the state but supplemented by private cover to varying degrees.
I have a private pension. Where I have to manage the investing myself – again in historical terms a big fuck off risk shift towards me. I do not want another one. I have unemployment insurance, because I need to make sure my mortgage is covered in the event of losing my job. It’s expensive.
And please stop quoting unrealistic figures. It’s dishonest. You need to quote peak to peak or trough to trough figures. Expenditure will always lag sudden drops in income. It is also likely that the tax base will recover to some extent (but obviously not completely) in the medium term.
And some of the Republic’s benefits are unusally generous.
Dave
I haven’t read the New Yorker article and I’m not bothered with magazines and their assorted agendas.
Fuck me, David. NUCLEAR FAILAGE.
What I am disputing is that doctors will perform procedures that are not required and that cause undue distress to poor granny for profit.
Perhaps you should read the bloody article before going on a four post rant.
Kensei -
Irish social welfare payments aren’t particularly generous in European terms, just more generous than the UK – which is one the lowest payers in Europe http://notesonthefront.typepad.com/politicaleconomy/2009/03/dear-sarah.html.
Generous social welfare is something like a Ponzi scheme – it absolutely depends on larger numbers of new workers coming through to support pensions (even at relatively low levels) and large numbers of workers to support other non-workers. Yes we’re in a severe recession now, which is cyclically reducing the dependency ratio (making this stuff obvious to us) – the fall in European birth rates will structurally do the same thing eventually.
Casper
Interesting comment. Efficiency as used in this context isn’t quite the same as it’s everyday use and is highly related to availability.
In every country a limited number of resources / funds (state or otherwise) are available for providing health care – while potential demand for health care services in financial terms is almost limitless.
Here is an article by Tim Harford that highlights this problem quiet well -
http://timharford.com/2006/03/bitter-medicine/
Ann Marie Rogers needs a drug, Herceptin, to save her life (she has breast cancer). The NHS refuses to pay for it. They have a bearucracy, NICE, which determines which services the NHS can make available to it’s patients.
Because there are limited resources a decision must be made on treatments some how. Unfortunately treatments will always be unavailable to some who need them in any health care system. What efficiency in this context does, is deliver more effective treatments for a given spend.
It is important to note that the Singaporeans spend less than half the amount the Irish do per capita (less than a fifth of what the Americans do). If we were to adopt and properly implement a more efficient service – we could deliver better health care (and more services) to more people. We don’t need to cut our spending to their level, but it would be desirable, in my opinion anyway, if we were to get more bang for our buck.
Mack
On a long enough time scale the population comes back into sync. The problem is short termism and a lack of generational acounting, rather than the inherent nature of the benefits. Ireland is not forecast for a structual problem for quite some time anyway.
Second – give her 100,000? Fungability of money. She could blow it on coke to feel better, and we are left with the choose to let her die slowly or have some treatment. It is qualitively worse. Second, I can’t see how it fails to shoot up costs. Third, it may not be close to enough. Fourth, that is an extreme case where it is a likely fatal illness; insurance could probably cover this quite well if it was taken early enough. Harford might not see how its worse, btu I don’t se how many other people reacht he same conclusion.
Kensei -
Second – give her 100,000? Fungability of money. She could blow it on coke to feel better, and we are left with the choose to let her die slowly or have some treatment
Mammy statism, eh? Do you really think I dying patient would blow cash for a life saving treatment on Coke? I’ve seen tons on fund raisers for ill children in time, and contributed occasionally too – to be honest – it never even crossed my mind they might blow it on drugs!
1. You could give her a special medical services only debit card.
2. There is evidence to the contrary
3. In this case, yes I think it is
4. There are many, many other such cases – and they are always going to be there. But is it better that we allow patients to choose between say a hip operation and going blind? Or is it better to have bureaucracy make that decision?
I honestly don’t understand where the outright hostility to investigating alternatives to state based health comes from? Is the NHS the best model for health service, in your opinion? Could you supply evidence to back it up (no health service is perfect so it’s easy to find faults)? Also, bear in mind where we are in the south – our system is already a mix of public and private health and is significantly different to what you guys have up north..
Kensei -
Yes, private health insurance could well help in this case. However around 23-24% of her wages (employee and employers contributions combined) would already been spent on National Insurance.
Kensei -
The problem is short termism and a lack of generational acounting, rather than the inherent nature of the benefits. Ireland is not forecast for a structual problem for quite some time anyway.
I agree on the short termism, but if the benefits aren’t self-sustainable it becomes a problem eventually. If not me for me, then my daughter and if not her then her children etc..
I would not want them to be caught in a generation that thought it could rely on a generous state pension only to find, having supported their parents, that their weren’t enough workers to support them!
Mack
Mammy statism, eh? Do you really think I dying patient would blow cash for a life saving treatment on Coke? I’ve seen tons on fund raisers for ill children in time, and contributed occasionally too – to be honest – it never even crossed my mind they might blow it on drugs!
There’s never been a bogus one? False positives? I don’t know what she’d do with the money. That’d be the point.
1. You could give her a special medical services only debit card.
Doesn’t matter. She’s now 100,000 better off.
2. There is evidence to the contrary
You are moving towards a US system a tendency to overconsume. Plus, centralised bargaining power? Bye.
3. In this case, yes I think it is
You cannot imply the general form a single specific case, Mack.
4. There are many, many other such cases – and they are always going to be there. But is it better that we allow patients to choose between say a hip operation and going blind? Or is it better to have bureaucracy make that decision?
It is not an apples or apples comparison. It’s not the same patients, Mack. And there is some evidence they are protecting people form a tendency to overconsume health care.
I honestly don’t understand where the outright hostility to investigating alternatives to state based health comes from? Is the NHS the best model for health service, in your opinion? Could you supply evidence to back it up (no health service is perfect so it’s easy to find faults)? Also, bear in mind where we are in the south – our system is already a mix of public and private health and is significantly different to what you guys have up north..
There are better European models I believe, but they pay higher taxes and charge and the NHS gets a lot of bang for buck. I don’t mind investigating other models – as long as more risk is not shifted to me, and as long as it doesn’t shift too much power to private comapnies. I just don’t like a lot of the suggestions made here.
I called in due to the number of hits assuming that by this stage we we discussing Godwin’s law, the Cruthin and flags and yet we appear to be discussing social and economic policies.
Well done youssuns.
Kensei
And there is some evidence they are protecting people form a tendency to overconsume health care.
I would have thought the opposite. There are less GPs per capita in the Republic of Ireland than in Northern Ireland, yet I’ve never had to wait longer than 15 minutes to see one, as soon as I arrive at the GPs having made the decision I want to see one. One of the reasons for that I imagine is the fact you have to pay €50 each time you visit (and that the more patients a GP sees in a day the more money he makes). Better to ask a pharmacist, or google, or Nurse Line unless you are sure you need it.
Mack
It’s not really representative – and the lack of going to the GP in the first place due to expense is a problem in itself. The cost problem is what happens when the Doctors start suggesting treatments.