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The Scandal of Irish Health Care

by Frank Schnittger Tue Feb 24th, 2009 at 08:23:43 PM EST

Cross posted from the European Journalism Centre Think about it website
(Shameless self-promotion - please rate this post on the Think about it website above - its only one click away - and is part of a Euro blogging competition hosted by the European Journalism Centre)

In the midst of an economic and political melt-down with unemployment doubling in the past year the Minister for Health has found the time and resources to make Irish Hospital Consultants (senior specialist medical doctors) amongst the best paid in the world. Can anyone take Ireland seriously when there is such a scandalous reallocation of resources from the poor to the rich at the very moment when huge health service cutbacks are planned because of a €1.3 Billion Euro shortfall in the public health budget?

Harney agrees pay increase for consultants - The Irish Times - Tue, Feb 24, 2009

MINISTER FOR Health Mary Harney has given approval for the payment of significantly higher salaries for hospital consultants under the terms of a revised contract.

The Minister sanctioned, the new payments which will see consultants receive salaries of up to €240,000 per year in some cases, at the end of last week on foot of a verification process carried out by the Health Service Executive (HSE). The new increased salaries will be backdated to the beginning of January.

The introduction of the new contract, which the Government maintains will result in major work practice changes and greater benefits for public patients, will cost the exchequer about €140 million this year in gross terms and €72 million net after taxes and levies.

Under the new contract some consultants will see their salaries rise by between €50,000 and €60,000


It must be born in mind that many Hospital Consultants also earn more from their private patients than they do from their public work and that they frequently reallocate patients from their public to their private lists in order to maximise their income.

The mixed system of public and private medicine in Ireland has long been a public scandal.  Hospital Consultants have a vested interest in maintaining long public waiting lists as this forces their more urgent public patients to go private to receive timely attention. Public patients with suspected cancer can wait many months to be seen...

Hospital consultants also control both public and private admissions into hospital with the result that private patients take up 30% of the beds in public hospitals even though only 20% of the beds are formally allocated to private patients.

Readers from outside Ireland may wonder what private beds are doing in publicly funded hospitals in the first place?  The reality is that public and private patients use many of the same (publicly funded) facilities.  The system of private heath insurance is essential a system of organised bribery to get you ahead in the queue for many of the same services and facilities.

Whereas previously, private healthcare insurance was the preserve of the well-off to guarantee a private room in a hospital, now it is a prerequisite for anyone who needs prompt medical attention for an urgent medical condition - with the result that c. 50% of the population now buy it. However the costs have sky-rocketed because there is no market discipline to keep medical prices down.  Doctors can charge more or less what they want and the insurance company (Until very recently dominated by the state owned, ironically named Voluntary Health Insurance) just pays up.  The result is sky rocketing medical inflation for no improvement in service.  

Whenever waiting lists become a public issue the usual medical interest groups decry a lack of public funding resources.  But the public health bill rose by 418% between 1990 and 2002 and is now above the EU average with no appreciable impact on waiting lists.  Waiting lists are a necessary feature of the system to force patients to buy private health insurance which can then result in a doubling of consultant incomes.  Consultants typically charge €200 for a 20 minute private consultation.

Mary Harney is a hold-over from the now defunct neo-liberal "Progressive Democrat" Party who famously opined that Ireland was closer to Boston than Berlin.  When it comes to public healthcare she is certainly trying to achieve that goal.  Greatly increased insurance and direct costs for patients, huge increases in public expenditure, huge cutbacks in services, and a medical elite who can become multi-millionaires within a short space of time.

In the meantime, health outcomes remain mediocre with Ireland coming 21st. on the OECD table of health care outcomes.  Ireland scores particularly badly on male and female mortality from heart attacks (the highest in the OECD) and for potential years of life lost due to breast cancer.  Having lost my wife due to breast cancer I have reason to feel betrayed by a medical profession which has arrogated the vast bulk of medical resources to its own enrichment.  In her case we managed to arrange the best medical care possible but there are far too many unnecessary deaths in the Irish Health Care system.

Spending a further €140 Million p.a. on Medical Consultants who are already earning huge salaries at a time when there are already going to be €1.3 Billion cutbacks in services to public patients can only make this situation worse.

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And I thought the US was alone in its health care agonies. How does Ireland compare to the UK.  When we lived there during the 70s, it was well understood that health care system doctors supplemented their government incomes with private practice, but that seems to have gotten out of hand in Ireland.

I can swear there ain't no heaven but I pray there ain't no hell. _ Blood Sweat & Tears
by Gringo (stargazing camel at aoldotcom) on Tue Feb 24th, 2009 at 11:18:39 PM EST
Yea its hard to get directly comparative data but my understanding is that doctors get much better paid in the public system, and those that also do private work generally do a lot more of it.   I should perhaps have qualified my remarks by saying that not all Consultants do private work - especially those only just appointed, or those winding down their workload close to retirement.  There may also be a few out there don't don't want the extra work/money or who don't approve the distinction between public and private work - although I am not aware of any.  Some specialisms are a lot more lucrative than others - depending a bit on supply and demand and on the ability of the target market to pay.  But its generally a hugely remunerative area.

notes from no w here
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Wed Feb 25th, 2009 at 06:31:49 AM EST
[ Parent ]
The public-private mess sounds a lot like Poland with one big difference  - public sector medical salaries are pathetic in Poland.
by MarekNYC on Tue Feb 24th, 2009 at 11:33:06 PM EST
Is that a typo at: "...reallocate patients from their public to their private listen in order..." ? Should it be 'lists' or something?

And another at: "...coming 21st. on and OECD table of health care outcomes."

And at: "but there are far to many unnecessary deaths" - too instead of to. It may just be an american thing, but I would put a comma before 'but' there, to slow the pace at your closing.

Does your audience know what "Irish Hospital Consultants" are? Could it be a term of art only in Ireland? It took me several paragraphs before I grok'd that they aren't people who come in and advise on the strength of the communications systems making management more viable, blah blah.

And, if I can be so bold, like cooking, perhaps one should end as one has begun. Toss on some olive oil, garlic and basil...oops, tie in the consultants at the end, their manipulation causing the many deaths...or however you want to end, but we're suspended. "A fair system would see these Consultants lose their rewards for such...," or something to give a suggestion to the future that solves what we have.

Never underestimate their intelligence, always underestimate their knowledge.

Frank Delaney ~ Ireland

by siegestate (siegestate or beyondwarispeace.com) on Wed Feb 25th, 2009 at 03:54:15 AM EST
Apologies, I'll fix the typos and clarify the terminology.  As always with Health Care, it's difficult to tie the inputs directly to the outputs - except indirectly via the priorities created by finance.  But the reality is that there are going to be €1.3 Billion cutbacks this year - at a time when the pay increase for the 1,400 most senior doctors will cost €140 Million - hey that's actually 100,000K per head!

notes from no w here
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Wed Feb 25th, 2009 at 06:20:19 AM EST
[ Parent ]
I understand. The piece is well done, regardless of my comment. Perhaps just ending with a snippet of what you just wrote, in pith, to tie or wonder at the 100,000 per person paying for new advantages to the advantaged...or something, just to not subtly end with an anecdote but with a well defined message.

Never underestimate their intelligence, always underestimate their knowledge.

Frank Delaney ~ Ireland

by siegestate (siegestate or beyondwarispeace.com) on Wed Feb 25th, 2009 at 07:54:21 AM EST
[ Parent ]
I have added a final paragraph:  

"Spending a further €140 Million p.a. on Medical Consultants who are already earning huge salaries at a time when there are already going to be €1.3 Billion cutbacks in services to public patients can only make this situation worse."

OK?

notes from no w here

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Wed Feb 25th, 2009 at 11:40:05 AM EST
[ Parent ]
I think it is a better ending. As long as I have my editor hat on, can I recommend that you make it into at least 2 sentences?

And my 2nd question; What effect are you trying to create?

You've walked us up to this point so well. What do you want to do with us? Just to make us despondent? To encourage us to rail against the system? To get us involved with something? There are a few hundred more variations...we're standing at the door. Where should we go?


Never underestimate their intelligence, always underestimate their knowledge.

Frank Delaney ~ Ireland

by siegestate (siegestate or beyondwarispeace.com) on Wed Feb 25th, 2009 at 06:20:51 PM EST
[ Parent ]
There's a similar phenomenon in France, of competition between a basic public sector and a insurance-funded (mutuelle as it is called, although nowadays many are private insurance companies) more expensive sector. But my general impression is that the shorter yet more expensive waiting lists are more usually found for non-life threatening diseases - particularly dental care ; and if you want to cut the queue in case of urgent, life threatening cases, it is more important to know the right people or to ask forcefully enough, than to have more money to spend.

Un roi sans divertissement est un homme plein de misères
by linca (antonin POINT lucas AROBASE gmail.com) on Wed Feb 25th, 2009 at 06:25:52 AM EST
In Ireland, in any field, knowing the right people and being able to speak the right language is all important.  You have to be quite assertive and articulate as a patient, or patient representative to be sure of getting appropriate treatment.  One doctor kept referring to the wrong breast when my wife was being prepared for a mastectomy.  She ended up writing an arrow with "It's this one!" with a market pen on the correct one in order to be sure that the correct one was removed.  

You may think this was a joke.  But the incidence of medical mistakes is horrendous and there is, of course, little accountability.  If you want to take a medical negligence case you have to fly Specialists over from England to testify.  One Irish doctor will only rarely testify against another.

notes from no w here

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Wed Feb 25th, 2009 at 06:38:03 AM EST
[ Parent ]
Mastectomy of the wrong breast happened yesterday in France... They although did the correct one afterwards, though.

Un roi sans divertissement est un homme plein de misères
by linca (antonin POINT lucas AROBASE gmail.com) on Wed Feb 25th, 2009 at 06:49:07 AM EST
[ Parent ]
Errors happen, and will always happen. The thing is to keep them to a minimum.

BBC News | WALES | Inquiry ordered into kidney blunder

The Welsh Health Secretary said an inquiry would take place after a hospital removed a patient's only healthy kidney by mistake.


Any idiot can face a crisis - it's day to day living that wears you out.
by ceebs (ceebs (at) eurotrib (dot) com) on Wed Feb 25th, 2009 at 07:45:13 AM EST
[ Parent ]
There have been some high profile inquiries for gross abuses - one consultant gynaecologist did hundreds of unnecessary  womb and ovarian tube removals over many years and was only stopped after a brave nurse blew the whistle.  He told his patients he needed to do so "to save their lives" and seemed to get a kick out of such dramatic interventions and being the "saviour" of patients.  For years his medical colleagues said nothing and he was even cleared by an internal medical inquiry before finally being prosecuted in the ordinary courts and dismissed.  The state will likely picjk up the tab for millions in compensation to the patients he damaged for life.  It takes a really serious scandal for it to come out into the open and not be successfully covered up by the profession.

notes from no w here
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Wed Feb 25th, 2009 at 08:24:04 AM EST
[ Parent ]
I mentioned this mostly because of the coincidence of reading Franck's comment just after seeing the aforementioned inciident on Google News...

 

Un roi sans divertissement est un homme plein de misères

by linca (antonin POINT lucas AROBASE gmail.com) on Wed Feb 25th, 2009 at 08:33:24 AM EST
[ Parent ]


notes from no w here
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Wed Feb 25th, 2009 at 08:24:53 AM EST
[ Parent ]


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