Co-location:Government has no idea about its cost

[rotcod76]

There is an interesting article on the front page of the Examiner under the above heading.Perhaps a more computer-savvy person than myself could post said article here.
I know that some of you have heard too much about the subject and others would like to know more about same.It seems to me that most of the arguments for and against have been based on ideology.The central question is will the Co-location project work?The "it's better because it's private " brigade argue with the "we can't have a 2 tier system " [ What have we got at present?] brigade.As Wren and Tussing have stated in their excellent book "How Ireland Cares":"A central question about the Government's plan is whether the addition of private beds in new private hospitals will liberate beds for public patients on a one-for-one basis." Their own answer is no but they are uncertain re the numbers as appear to be the HSE.Professor Drumm,for example does not believe that critically ill or seriously injured patients will be transferable.After studying the casemix in the Limerick Regional Hospital where 85% of patients are acute admissions with 15% planned admissions,after looking at case complexity and duration of stay issues I estimate the per centage of tranferable patients to be 30%.If anyone believes that the whole shooting-match will move next door the price would be a mega insurance rating of F,G,H,IorJ.We then have a "hole in the bucket dear Liza" where minor to moderate case can't free up public hospital beds because the insurance rating is in the stratosphere .Even if the cases that are suitable are transferred there will be a considerable rating mark-up which will also keep patients out as private patients in public hospitals only pay 50% to 60% of their economic costs.This will tend to defeat the purpose of the plan.Without the insurance mark-up I estimate that only 317 beds at most will be freed-up by a scheme which is supposed to free-up 1000 .With the insurance mark-up we could be looking at around a hundred.There also may be patients fearful of going to a hospital with no track record.I am certain that the scheme will not free up 1000 beds in the 8 hospitals . The beds will cost the same as if they were publicly built.I have written on this issue last July in the Examiner and this July in the Irish Times.My blog is healthforthepeople.blog.com.I assure you that if I thought the scheme had an iota of a chance I would support it.Unfortunately I am reminded of the Emporor's New Clothes and,for some reason,the Pied Piper of Hamellin!

[Ronanr]

Could you please rewrite you post in a more clear style, rotcod.

I cannot figure out what you are saying.

[Ronanr]

Without the insurance mark-up I estimate that only 317 beds at most will be freed-up by a scheme which is supposed to free-up 1000 .With the insurance mark-up we could be looking at around a hundred.

Are you saying that patients who transfer to the private hospital will be charged top-up fees?

[rotcod76]

Here is the Examiner article in full:

26 July 2007

Co-location: Government has no idea about its cost

By Paul O’Brien and Áine Kerr
THE Government does not know the full cost of its hospital co-location plan, officials have admitted in internal documents obtained by the Irish Examiner.


The confidential briefing papers from the Department of Finance also hint some social welfare commitments may have to be delayed.

On the issue of co-location, officials warn Tánaiste and Finance Minister Brian Cowen that Health Minister Mary Harney’s plan will require “careful monitoring” because it is not yet clear what the costs will be.

The department’s concerns centre on the annual running costs of the public beds freed by co-location.

However, Ms Harney’s party last night claimed the warning was out of date.

A PD spokesman suggested the briefing papers, dated June 2007, may have predated a Cabinet meeting of June 26 at which ministers were briefed on the full costs involved in co-location.

The spokesman said the Cabinet was also informed of the National Development Finance Agency’s evaluation that the plan represented value for money.

Under the plan, sites on a number of public hospital campuses will be sold to developers to build private facilities. Private beds will then be moved out of the public hospitals and into the co-located facilities. In this way, Ms Harney hopes to free 1,000 beds in the public hospitals for public patients.

The locations of the first six projects were announced earlier this month: St James’s Hospital and Beaumont Hospital in Dublin; Cork University Hospital; Waterford Regional Hospital; the Mid-Western Regional Hospital in Limerick; and Sligo General Hospital.

In May, the PDs said the average running cost of a bed in these hospitals was more than €350,000 a year. However, the party claimed the cost of running each of the 1,000 public beds freed by the co-location plan would be “considerably less than half” this figure.

This is because the required staff to run these beds are already in place at the hospitals, and extra staffing costs won’t arise in the way they would if new public beds were being purchased.

The department seemed less sure in its briefing papers. Under the heading of “co-located hospitals”, the papers state: “This requires careful monitoring.

“It is not clear what the cost will be of using any public beds freed up by the creation of new private hospitals, whether the case mix will change or whether staff and equipment costs will arise.”

The briefing papers were prepared by the department to brief the incoming finance minister following the general election. In the event, Fianna Fáil was returned to power and the outgoing minister Mr Cowen was re-appointed to the position.

The papers were released to the Irish Examiner under the Freedom of Information Act.

http://www.examiner.ie/irishexaminer/pa ... qqqx=1.asp

[rotcod76]

Could you please rewrite you post in a more clear style, rotcod.

I cannot figure out what you are saying.

Perhaps the apparent density of my article is appropriately dense for such a dense idea.Basically I wrote more than I intended and forgot about the odd paragraph.You might find my ideas more clearly expressed in the articles on my blog.

With regard to insurance the private co-located hospital will have to charge the economic cost of each patient's treatment which is double what the insurers pay the public hospital .At the moment as I stated the insurers pay 50%-60% of the economic cost of a private patient's.This will have an impact on insurance ratings for such private co-located hospitals.I expect them to double and IN THE PROCESS prevent the freeing up of public beds.Remember this scheme has had no white paper.The Minister can use my articles if she wants.

[FutureTaoiseach]

The article also states the PDs argue that the document on which the article is I think the motives of the leakers have to be seriously questioned - after all we know the public-sector unions oppose anything that reduces their monopoly of power by involving the private-sector in areas dominated by the public-sector. All I can say to them is tough. The patients' needs must come first, and that is what co-location is about. The outgoing govt won more votes than the so-called 'alternative' and therefore have a mandate to pursue co-location - which was also a FF policy. 30% of hospitals in France are private providing 15% of bed capacity. Which surely makes it doubling ironic the Left are opposing this - given their usual positive contrast of continental health-services vis a vis our own. It seems they want the quality of the French health-service without French-style health-service mechanisms.

[rotcod76]

The article also states the PDs argue that the document on which the article is I think the motives of the leakers have to be seriously questioned - after all we know the public-sector unions oppose anything that reduces their monopoly of power by involving the private-sector in areas dominated by the public-sector. All I can say to them is tough. The patients' needs must come first, and that is what co-location is about. The outgoing govt won more votes than the so-called 'alternative' and therefore have a mandate to pursue co-location - which was also a FF policy. 30% of hospitals in France are private providing 15% of bed capacity. Which surely makes it doubling ironic the Left are opposing this - given their usual positive contrast of continental health-services vis a vis our own. It seems they want the quality of the French health-service without French-style health-service mechanisms.

1 Mary Harney stated that her aim with co-location was to free-up 1000 beds by building private beds beside public hospitals in co-located hospitals.In her original speech to the Senate she stated that the beds publicly provided would cost €1000 million to the state and privately provided would cost €480 million .
2 Looking at the 8 hospitals left in the scheme I cannot see more than 300 beds freed-up based on casemix , case complexity and length of hospital stay in acute cases ,which tends to be longer than in elective cases . It is all very well talking about getting 1000 privately built beds for €480 million .If Minister Harney ONLY GETS 300 PUBLIC BEDS freed-up for
€480 million by her method she would be a lot better off building 480 beds by public tender for the same price.There is another problem.The VHI realise that at present the co-located hospitals include MORE THAN 1000 beds . They are worried about the extra beds as Vincent Sheridan believes that private medicine in this country is supply-driven,not demand-driven.They should be more worried about the 700 beds which will add to a saturated private pool.In fact the VHI is threatening not to cover the new hospitals,as reported in this week's Irish Medical Times.
3 It is my belief that the insurance costs for patients in areas "benefitting"from the scheme will be such as to actually increase the load on the public system in order to cater for evacuees from the private system , thereby more than offsetting the 300 beds released .
4 A few years ago I gazed in wonderment at advertisements for the "ECDL".I could not believe that people would study a driving license.Now I understand that it is good computer training.This scheme is good for people who want to study a series of false assumptions and non-sequiters.I feel like one of the people already in the water when the tsunami strikes and whom no-one can hear. The main din in this case is that between rabid free-marketeers [especially when there is a big subsidy involved ] and left-wingers who shout two tiers[ and did not realise up to now that we already had a 2 tier system !!]
5 I do not have a problem with Private Hospitals taking on minor to medium acute cases now.Why do they have to become co-located to do so?
6 Don't say you haven't been warned .

[FutureTaoiseach]

€480 million by her method she would be a lot better off building 480 beds by public tender for the same price.There is another problem.The VHI realise that at present the co-located hospitals include MORE THAN 1000 beds . They are worried about the extra beds as Vincent Sheridan believes that private medicine in this country is supply-driven,not demand-driven.They should be more worried about the 700 beds which will add to a saturated private pool.In fact the VHI is threatening not to cover the new hospitals,as reported in this week's Irish Medical Times.

But you know well how damn long it takes for anything to get done in the public-sector. I would far sooner trust the private-sector because it isn't dominated by lazy public-sector unions who go on strike for such frivolous reasons as being asked to work in a different room or to use a new computer-system. Look at what happened with that new hospital in Cork which didn't open for ages because of a standoff with the union. Small wonder people are disillusioned with the capacity of the public-sector to deliver. Whenever more money is pumped into the black-hole that is the public hospital system the unions go on strike and demand more money and when they get it people then wonder "oh why hasn't there been improvements?". I'm glad that we have a Health Minister prepared to take on the vested interests opposed to the structural reform without which we will continue to throw good money after bad without getting improvements on the ground. I believe the Minister's proposals deserve a chance instead of being dismissed before they've even taken shape and I believe the Irish people share my view on this matter.

[rotcod76]

€480 million by her method she would be a lot better off building 480 beds by public tender for the same price.There is another problem.The VHI realise that at present the co-located hospitals include MORE THAN 1000 beds . They are worried about the extra beds as Vincent Sheridan believes that private medicine in this country is supply-driven,not demand-driven.They should be more worried about the 700 beds which will add to a saturated private pool.In fact the VHI is threatening not to cover the new hospitals,as reported in this week's Irish Medical Times.

But you know well how damn long it takes for anything to get done in the public-sector. I would far sooner trust the private-sector because it isn't dominated by lazy public-sector unions who go on strike for such frivolous reasons as being asked to work in a different room or to use a new computer-system. Look at what happened with that new hospital in Cork which didn't open for ages because of a standoff with the union. Small wonder people are disillusioned with the capacity of the public-sector to deliver. Whenever more money is pumped into the black-hole that is the public hospital system the unions go on strike and demand more money and when they get it people then wonder "oh why hasn't there been improvements?". I'm glad that we have a Health Minister prepared to take on the vested interests opposed to the structural reform without which we will continue to throw good money after bad without getting improvements on the ground. I believe the Minister's proposals deserve a chance instead of being dismissed before they've even taken shape and I believe the Irish people share my view on this matter.

I commend you for wanting to see something done,but I feel duty bound to point out the flaws in actual application of the Minister's plans.There was probably a computer expert who saw some problems with the PPARS system and kept quiet.I don't want to do the same.I have worked as a surgeon and general practitioner in Canada,in the NHS as a surgical registrar in both general surgery and orthopaedic surgery ,as well as in casualty and surgical jobs here before going to England.When I worked in the old Richmond Hospital as a casualty officer the only Medical cases treated were Emergencies :chest pain,acute asthma,overdoses,anaphylactic shock ,diabetic crises and epilepsy.All medical cases requiring admission are now sent to A&E,whether they need emergency treatment or not .I was shocked to see what I would regard as non-emergency medical admissions sent to A&E when I recently worked in the A&E department in ENNIS.They should go directly to the wards,but there are no beds.If at the time Mary Harney announced her plan she had built 1000 beds we would be well on the way to having these beds by now.Instead we have the prospect of 100-300 public beds freed and havoc in the health insurance sector.I assure you that I have done my impact analysis with no ideological agenda.In fact up to the emergence of co-location and the neo-Hanly agenda I would have voted for the PD's. Their former leader is an old friend and class-mate from school.I assure you that there is a massive difference between having a lawyer in Justice and someone with no therapeutic background in Health.

[qtman]

€480 million by her method she would be a lot better off building 480 beds by public tender for the same price.There is another problem.The VHI realise that at present the co-located hospitals include MORE THAN 1000 beds . They are worried about the extra beds as Vincent Sheridan believes that private medicine in this country is supply-driven,not demand-driven.They should be more worried about the 700 beds which will add to a saturated private pool.In fact the VHI is threatening not to cover the new hospitals,as reported in this week's Irish Medical Times.

But you know well how damn long it takes for anything to get done in the public-sector. I would far sooner trust the private-sector because it isn't dominated by lazy public-sector unions who go on strike for such frivolous reasons as being asked to work in a different room or to use a new computer-system. Look at what happened with that new hospital in Cork which didn't open for ages because of a standoff with the union. Small wonder people are disillusioned with the capacity of the public-sector to deliver. Whenever more money is pumped into the black-hole that is the public hospital system the unions go on strike and demand more money and when they get it people then wonder "oh why hasn't there been improvements?". I'm glad that we have a Health Minister prepared to take on the vested interests opposed to the structural reform without which we will continue to throw good money after bad without getting improvements on the ground. I believe the Minister's proposals deserve a chance instead of being dismissed before they've even taken shape and I believe the Irish people share my view on this matter.

I commend you for wanting to see something done,but I feel duty bound to point out the flaws in actual application of the Minister's plans.There was probably a computer expert who saw some problems with the PPARS system and kept quiet.I don't want to do the same.I have worked as a surgeon and general practitioner in Canada,in the NHS as a surgical registrar in both general surgery and orthopaedic surgery ,as well as in casualty and surgical jobs here before going to England.When I worked in the old Richmond Hospital as a casualty officer the only Medical cases treated were Emergencies :chest pain,acute asthma,overdoses,anaphylactic shock ,diabetic crises and epilepsy.All medical cases requiring admission are now sent to A&E,whether they need emergency treatment or not .I was shocked to see what I would regard as non-emergency medical admissions sent to A&E when I recently worked in the A&E department in ENNIS.They should go directly to the wards,but there are no beds.If at the time Mary Harney announced her plan she had built 1000 beds we would be well on the way to having these beds by now.Instead we have the prospect of 100-300 public beds freed and havoc in the health insurance sector.I assure you that I have done my impact analysis with no ideological agenda.In fact up to the emergence of co-location and the neo-Hanly agenda I would have voted for the PD's. Their former leader is an old friend and class-mate from school.I assure you that there is a massive difference between having a lawyer in Justice and someone with no therapeutic background in Health.

You've been ranting about this 300 bed and cost calculation issue on this Forum for too long.

Co-location is not just about cost; its also about the speed with which extra capacity can be delivered in to the system.

A public bed isn't any use to someone 2 years after they've died.