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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 2:41 pm 
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Mantissa wrote:
I really don't think there's any point in discussing further. You also don't seem to have read the last link I posted which discusses how non-fringe these groups are.

I read it. I don't buy the notion that active gay men aren't aware of the risks because of it. We're not talking about a 15 year old in Texas who gets knocked up because her boyfriend tells her she can't get pregnant the first time.

Blaming religious fanatics for everything, [even Chemsex induced HIV :shock: : ] is a cop out


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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 3:43 pm 
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I blame the Pope for chemsex and I blame the Archbishop of Canterbury for the bugchasers

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 3:47 pm 
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the dude wrote:
I blame the Pope for chemsex and I blame the Archbishop of Canterbury for the bugchasers


Seems fair.

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Tue Apr 25, 2017 6:07 am 
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Mantissa wrote:

The adherence issue is covered by the study. I'm not sure whether you saw my comment immediately prior to yours, but the study shows that HIV infection rates are significantly lowered among people who were prescribed the drug. In other words, this includes whatever non-adherence rate there is in the real world.

In terms of whether the State should fund it, set aside the moral question and look at it as a cost-benefit. You have a high-risk population and you know that without PrEP, X% will become infected. Would you rather treat them all prophylactically @ €500/month for a few years while they're young and irresponsible, or would you rather treat the infected % for the rest of their lives with HIV anti-retrovirals at €2000/month (or whatever- cannot find good numbers for Ireland but apparently the lifetime average cost of treatment is around €500,000). You'd need to know all the variables like how many years they're likely to remain high-risk etc but it's not a complicated calculation. Much like the cost-benefit for vaccinations.

Of course you could add in the moral issue -- if you can stop people from contracting an incurable disease with a simple and easy treatment, is it moral to not to it, at any price? I don't know the answer.


I had a quick look at the study. My point is that even if non-adherence is accounted for, over time adherence will probably fall, given the risk profile of the people we are talking about.

That is why I made the boy racer analogy. We are talking about a high-risk practice consciously undertaken by a very small minority of young men. They are fully aware of what they are doing. No amount of 'education' will change this.

I wasn't aware of the lifetime cost of anti-retrovirals compared to the cost of PrEP. On these grounds the cost-benefit payoff. To be honest Una's article annoyed me in the first place because she grounded this in a minority rights argument rather than a public finance one.

It may be a hard sell though. The vast majority of taxpayers (straight and gay) are either celibate or monogamous so the 'Why should I pay for their behaviour?' argument will spring to mind.


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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Tue Apr 25, 2017 9:03 am 
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Skippy 3 wrote:
It may be a hard sell though. The vast majority of taxpayers (straight and gay) are either celibate or monogamous so the 'Why should I pay for their behaviour?' argument will spring to mind.

Preventative medicine is odd like that though. Almost nobody would argue against the State paying to treat sexually transmitted diseases, or life threatening obesity, or smoking/bacon-induced cancer, or people who've fallen off cliffs whilst rock climbing.

Maybe we feel that's OK because the "irresponsible" person is suffering.

But would you want the State to pay for free vapes, or diet pills, or personal fitness trainers, or rock climbing supervision?

I think the only way to process it is to ignore morality and look at pure costs/benefits to the State. If the State is going to have to pick up the resulting bill then it makes sense for effective prevention to be funded, if that preventing returns its investment.

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Tue Apr 25, 2017 6:50 pm 
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Eschatologist wrote:
Preventative medicine is odd like that though. Almost nobody would argue against the State paying to treat sexually transmitted diseases, or life threatening obesity, or smoking/bacon-induced cancer, or people who've fallen off cliffs whilst rock climbing.

Maybe we feel that's OK because the "irresponsible" person is suffering.

But would you want the State to pay for free vapes, or diet pills, or personal fitness trainers, or rock climbing supervision?

I think the only way to process it is to ignore morality and look at pure costs/benefits to the State. If the State is going to have to pick up the resulting bill then it makes sense for effective prevention to be funded, if that preventing returns its investment.


I take your point. My point is a little more meta though.

Studies invariably show that preventive medicine is more effective than treatment after the event.

These studies often don't highlight the fact that:
-People are lazy and often don't take the treatment
-People get complacent. If the preventive practice appears to be working they stop with the treatment

There are many things about my diet (quantity and quality) that I know are bad for me in the long run. But I still consciously consume them.

Of all the groups I would trust to adhere consistently to preventive medicine, young men on the chemsex scene is pretty low down the list.


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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Tue Apr 25, 2017 9:03 pm 
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Skippy 3 wrote:
Of all the groups I would trust to adhere consistently to preventive medicine, young men on the chemsex scene is pretty low down the list.

Well I have to bow to your superior knowledge of the chemsex scene, but in my experience of dangerous sports, participants both novice and experienced tend to be incredibly careful because they know the risks. Some of them still ended up dead, but not for lack of diligent preparation.

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Thu Sep 07, 2017 9:45 am 
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HSE overspending to create €300m financial deficit

https://www.irishtimes.com/news/health/ ... -1.3211986

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Thu Sep 07, 2017 2:36 pm 
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NegativeEquity wrote:
HSE overspending to create €300m financial deficit

https://www.irishtimes.com/news/health/ ... -1.3211986


You could read that headline in two ways. My first thought was that they are deliberately overspending to create the deficit to secure more funding. But surely they wouldn't do that.

Money always finds a home. I think of councils that will dig up a perfectly good road and resurface it to use up their budget allocation otherwise they wouldn't be able to justify receiving the same funding next year.

It's such a complex monster I can't begin to get my head around it all.

There are always plenty of incentives to spend more and more but what are the real incentives (professional or personal) to actually saving money? Kudos, promotions, pay rises?

Or is a stick approach being applied at all?

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Wed Mar 28, 2018 9:32 pm 
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State/Industry Medicine Pricing Agreements, Cost Savings and Counterfactuals: the Case of Ireland

ESRI paper here
http://www.esr.ie/article/view/862/181

Quote:
Abstract: Ireland’s Minister for Health claimed cumulative savings of €600 million for the 2016-2020 framework agreement with the Irish Pharmaceutical Healthcare Association. These savings are estimated using an implausible counterfactual of no agreement, since multiannual State/industry agreements are longstanding, while, since 2013, the State has powers to set medicine prices. A better counterfactual is the status quo: replicating the 2012-2015 agreement and extending its term for one year. This alternative counterfactual results in estimated cumulative savings of only €290 million. Greater transparency and more prudent choice of comparator for savings estimates would provide confidence in the estimates and more accurately demonstrate the likely savings that will be achieved.


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