Poor value in public and private health
I was horrified to read that the Irish health system, when counting both the private and public sectors together, is one of the most expensive in the world, according to the Organisation for Economic Cooperation and Development (OECD).
It consumes a greater proportion of national resources than equivalents do in similar countries.
Strange, then, that the outcomes of this system leave an awful lot to be desired.
Now that it’s winter again, the system is in serious trouble once more. Emergency departments are grossly over-loaded.
On some occasions over the last week, there have been 600 unfortunate people on trollies.
It’s like this every winter, without any lessons learned from the previous years.
It keeps repeating itself, except, unlike in the movie, Groundhog Day, there is no happy ending.
A number of constants suggest that those managing the system know there will be a problem each winter.
Our primary, locally based healthcare is totally inadequate, despite successive reports urging dramatic improvements.
Secondly, Irish winters are always cold, wet, and depressing, and so people are prone to illness.
And people are living longer. There are more people around, and there will be even more in the future, and illness during winter is hitting harder and more often.
Why, then, do we continue to have the same old problems, again and again?
That question is more urgent, when you consider that we are one of the richest countries in the world.
There is a multiplicity of reasons, from the intransigence of the extremely strong vested interests on all sides to a failure of government and politicians to bite the bullet and resolve the issue for the benefit of all of our people.
The next election, and the retention of seats, seem to have become the greatest priority.
That this has been the case for years suggests that we are all a bunch of mugs. How else can you describe us, when we allow those we elect to repeat the same mistakes, year after year?
The HSE is a dysfunctional and expensive monster.
With 100,000 employees, and an annual health budget of €14bn, it is an enormous organisation.
At the best of times, organisations that large are difficult to manage.
There are just too many competing interests and there are multiple priorities.
Effectively managing these organisations requires special individuals.
Those individuals need smarts, grit, determination, persistence, and a hard neck.
We do not appear to have found those people, yet.
Just as importantly, those special people need the backing of government to overcome those who would help them to fail.
Right across the board, there are tremendous individual employees in the HSE, who put in a lot more than they get out of it.
They have, at heart, the interests of those of us unfortunate to have to require their services.
We are lucky that those employees exist and do what they do. As always, the system is the problem.
A huge mistake was made when the Goliath that is the HSE was created.
The fact that considerable rationalisation did not occur simply made the problems much worse.
Even if we had the resources, throwing money at the problem will not solve anything.
It would only put more money into the pockets of employees, particularly those with the strongest clout.
The people who gain the most are not always those who deserve the most.
Someone suggested, the other day, that what we should really do is sub-contract the whole operation to the Netherlands.
It’s the flavour of the month, as far as health systems go.
Option one is that our government finally does the right thing.
The right thing is to create a flexible and manageable system that has minimal waiting times across the board; a system that is not the most expensive in the world and which only uses trollies sparingly.
The alternative is more Groundhog Days.
