‘Cos you deserve better

Have you noticed the sudden upsurge in radio and TV ads for private healthcare? Frankly, they sicken me.  “Because you deserve better” quotes one ad for a state-of-the-art private hospital. Because who exactly deserves better? Answer: Those who can afford private health insurance. But what about those who can’t, I ask? Don’t they deserve better too?

I hold private health insurance and I make no apology for it. I’ve a complex medical condition which requires regular medical supervision. Unfortunately, I cannot rely on our public health service to provide the care needed. Our health system has been so stripped of services that ‘public’ patients face long delays in accessing out-patient appointments and treatment. Privately insured patients can access care faster by paying for it. Such is the inequity of a 2-tier health service. Emergency care is different, it’s provided on the basis of need only. The delay in the public system, is putting people’s lives at risk. Remember Susie Long? I’m not prepared to risk my health because of our government’s failure to provide an equitable health service for all. I therefore see my health insurance as a priority, not a luxury. I choose to do without other non-necessities in life so as to afford the health insurance. I’m lucky to have that choice. Many don’t.

In these difficult times of recession, many people are struggling to maintain a roof over their heads/to afford enough food to feed the family. The advertisements for private healthcare appear very inappropriate in the circumstances. Of course, the real reason why these companies are advertising, has nothing to do with your welfare or mine. They are desperately trying to survive too.

Our Minister for Health has gone terribly quiet!

Dear Mary

To: Ms Mary Harney, Minister for Health & Children

I’m writing to let you know my views on the public health service. Having spent three days last week residing in the busy A&E department of a large teaching hospital, I feel qualified to comment. The experience has left me wanting answers to many questions. Please listen to what I have to say.

Last Friday my doctor sent me to A&E for emergency care as I’d developed a serious complication following surgery some weeks earlier. On arrival in A&E, I was rapidly processed by a triage nurse and seen by the registrar on-call. An immediate decision was taken to admit me to the hospital. I finally reached a ward on Monday afternoon! During the 3 days and nights spent in A&E, I was extremely well-cared for but the conditions were hell. The staff were so busy, patients had long waits for help. It was like being in a war zone, people lying on trolleys everywhere with further casualties arriving by the hour. It was also extremely noisy with little or no privacy. These conditions do not aid recovery.

My first question to you, Mary,  is this… why must sick and injured people be exposed to these awful conditions in order to be admitted to hospital? Where are the 1,000 extra beds you promised when you took over as Minister for Health 5 years ago? I sure could have done with one of those beds last Friday.

It was a great relief when I was finally transferred to a 4-bed semi-private ward where I remain. I’m receiving excellent medical and nursing care here. Thankfully, this hallmark of Irish healthcare remains intact despite the inadequate funding of our public health service. I’ve no doubt that this is due to the dedication of the staff who work in frontline services. The unit I’m in, has been recently refurbished and is beautifully fresh and clean. I’ve no complaints really except I’d obviously prefer to be in my own howm. The catering is good, plenty of good nutritional food and frequent offers of hot/cold drinks. I’m very aware that this aids a speedy recovery and subsequent discharge from hospital.  I’ve not always hit this lucky.

Over the years,  I’ve spent many weeks as a patient in this same hospital, on the public wards.  It has always been a grim experience in terms of patient comfort, lack of facilities etc. I don’t think much has changed although I have heard that hygeine levels have improved on the big wards. My medical history is extensive so I choose to hold private health insurance to ensure that I can get care when needed. My case is complex and so I cannot be admitted to one of the smaller private hospitals for treatment although I’m fully insured to do so. These smaller hospitals cannot provide the care I require.

I want you to know, Mary, that it’s distressing to observe your clear policy of starving the public hospitals of funding while you promote the development of co-located private hospitals. The staff who work at the frontline in our public hospitals, are fantastic but they are being stretched to the limit to provide the care needed in our under-resourced public hospital system.  I plead with you to stop bleeding our health service to death while you continue to promote an inequitable health service. Give us a break, Mary.

The semi-private unit I’m in, is excellent. I do not need for anything better as all my needs are being met here. I’ve hit lucky on this occasion as this is the most comfortable unit in the hospital. However, the WHOLE hospital should run like this unit. Instead, the majority of the rest of the hospital is no longer fit for purpose. It’s time to put our health resources to proper use. Surely everyone deserves fair and equitable healthcare?

I look forward to hearing from you.

Steph @ The Biopsy Report

Check ‘N Go

I’ve booked so many flights over the last few days, I really don’t know whether I’m coming or going. I seem to have multiple trips to Nottingham booked and also a return ticket to London for Wimbledon but I’ve a little hurdle to get over between now and the tennis.  I’ve got a date (not THAT sort of date, Grannymar) and I’ve got funding too.

It’s been some week.  Since hearing of the date for my surgery in Nottingham, I’ve been struggling to get funding organised for the operation. When you require treatment outside Ireland, my health insurance company stipulates that you must gain prior approval for funding. There is a long list of criteria to be met and even though I hold comprehensive insurance, funding is automatically refused if surgery proceeds without prior approval. As very short notice was given for my surgery, an urgent application was submitted for approval and we waited with baited breath all week. Thankfully, the green light was given on Friday so now my surgery can proceed.

I travel to Nottingham early tomorrow for admission to a specialist unit at the hospital where I will be prepared for image-guided surgery on my head the following day.  A recent CT scan has revealed further osteomyelitic changes in the bone above and behind my right eye. This diseased bone is in close proximity to the frontal lobe of my brain hence complex surgery is required. Years of severe sinus infections with abscess formation have left the area well-scarred.  All being well, the endoscopic surgery should be completed in 2-3 hours and I hope  to be able to return to Ireland by early next week.  That’s when the fun really starts.

Surgery for chronic osteomyelitis involves detailed follow-up. Long-term antibiotic treatment is required and I will also have a drain exiting near my eye for several weeks post-op. This drain will be used to irrigate the operated area daily with targeted drugs.  I will be taught how to carry out this procedure myself while in hospital so that treatment can be continued at home. I will then return to Nottingham again for review and to have the drain removed.

When I first heard of the date for surgery, my heart fell as I have two tickets for a day at Wimbledon. I entered my name into the public ballot last autumn and hit lucky by getting two tickets for Court No 1.  This was like a dream come true so I didn’t hesitate in purchasing them along with flights to London.  News of my surgery initially dashed these plans but I haven’t quite given up hope yet.

My review in Nottingham happens to be on the day before I was due to travel to London to attend Wimbledon. I will fly to Nottingham for the check-up and overnight there before returning to Dublin.  However, I have a second plan up my sleeve which if it works out, will be a real coup. If I feel well enough after my check-up, I plan to travel on to London by train to overnight with my twin brother who will accompany me to Wimbledon the following day. I’ll then spend a second night in London before returning home on the flight I originally booked many months ago.  This probably all sounds a bit daft right now but it’s where I have my sights set. If I do make it to Wimbledon, it’ll be the best tonic ever.

My long suffering hubby will be with me in Nottingham and so I hope to have occasional access to his laptop while in hospital. I will do my best to update you on my progress and promise not to scare you with any gorey details. I would really welcome comments and while I may not always get to answer them, I would still love to hear from you.  On that note, it’s time for me to Check ‘N Go and get organised for tomorrow. I’ll be back soon!

A Real Supergran

I feel very out of touch with the blog world.  It’s been a roller coaster week here.  It’s got to the stage where when the phone rings, my heart falls.  No news, really is good news.

It all started on the day of the Heineken cup rugby final when my father was rushed to hospital by ambulance with chest pains. After an anxious wait in A&E, news came through that his pain was non-cardiac in origin and so once my dad’s condition had stabilised, he was discharged back to the nursing home.

The following day, my mum-in-law’s health suddenly deteriorated and we were told that her end was nigh. Thus begun a round-the-clock family vigil at her bedside which lasted for five days.  She died peacefully on Friday surrounded by her nearest and dearest. Her funeral will take place next weekend when family and friends will gather from around the world to celebrate a dear life. She was a wonderful mum and a real supergran and will be deeply missed.

In the midst of all this, my son Robin woke last Friday morning with a very swollen foot. He was due to leave at lunchtime on a walking holiday with friends so we had to act fast. His problem was solved by a visit to a VHI SwiftCare Clinic which had him assessed and processed in less than one hour and on his way to Kerry. The following morning Robin phoned to say that the swelling had moved up his leg and a phonecall to SwiftCare confirmed that he should return home.  I collected him off the train several hours later and ferried him back to the clinic for re-assessment. Again, Robin was seen very quickly and thankfully, this time the news was better. He was instructed to rest-up and allow the antibiotics to take effect. SwiftCare is a privatised clinic funded by a health insurance company, to deal with minor injuries and illnesses. I could not fault the care that Robin received there. It would have been a very different story had we attended the A&E department at our local hospital. By lunchtime today, Robin was back on the train to Kerry to re-join his friends.

Thankfully, today has been a rest day.  There’s been no news as yet on a date for my surgery.  Right now the silence from Nottingham, is a welcome reprieve.

Equity of Care?

Misdiagnosis and inappropriate treatment are common concerns for individuals suffering from a serious medical condition. In Ireland more than 1.5 million people can access a second opinion service at no additional cost to themselves. Best Doctors helps people facing serious illness to get the most appropriate care. It’s unique database has harnessed the knowledge of over 50,000 doctors identified by their peers as the best in their specialities. Access is available through three insurance companies in Ireland – VHI Healthcare, Hibernian Life & Pensions and Combined Insurance (IRL) – who pay an annual fee for the service.

The service operates as follows. An insured person who is diagnosed with a serious illness, has the option of having their case reviewed by Best Doctors. On the patient’s request, the health insurance company arranges for Best Doctors to contact the patient. A Nurse Advocate is then assigned, who contacts the patient or their doctor for a copy of all the patient’s medical records. Using their database, Best Doctors identify the most appropriate specialist from around the world to assist in reviewing the patient’s case. The selected specialist(s) comprehensively reviews the test results, diagnosis and prognosis and a report is sent to the patient and their doctor. Doctor patient confidentiality is maintained at all times throughout the process. Patients wishing to have Best Doctors review their medical file continue to have medical care with their own consultant who now has the back-up of other world renowned specialists.

This all sounds very reassuring until you realise that almost 50% of the Irish population hold no insurance cover added to which, not all health insurance companies pay into the scheme. Surely every patient facing serious illness, should have access to the best and most appropriate care available? Do all patients not deserve access to the skill, experience and insight of these highly trained doctors? Nope, sorry! Unless you’re a member of an insurance company which is participating in the scheme, access is denied. It seems care is given based on a person’s ability to pay for health insurance instead of their medical need. There is a fundamental struggle going on over the soul and shape of Irish healthcare.

Battling On

I turned on the news this evening to hear that 909 patients around the country are waiting to have a colonoscopy and some of those people have been waiting for more than two years. In December, our Minister for Health told the HSE to comply with a target of access to a colonoscopy within four weeks of being referred by a doctor. I had a private consultation with a gastroenterologist this afternoon and have been booked for an urgent colonoscopy next Monday morning. This sadly, is the difference between public and private health care.

Unfortunately, the antibiotic I’ve been on for the past 8 days (Vancomycin), has failed to bring a nasty colitis under control. After almost six weeks of worsening symptoms, I’m in real need of help. While this means having to go through a dreaded colonoscopy again, right now that seems like a doddle compared to my present circumstances. The diagnosis is most likely to be an antibiotic-associated colitis caused by the ongoing treatment for the chronic infection in my head. However, biopsies are required to confirm this and also to rule-out other possible causes, such as Crohn’s Disease.

While queueing to see the doctor today,  I received a call from another doctor’s office. The surgeon in the UK has requested a CT scan of my skull before I travel to Nottingham for a review consultation. My surgeon in Ireland has organised the scan for tomorrow and I will travel to the UK in a couple of week’s time to receive the verdict. It’s certainly been all go today.

The reason I’m able to access prompt medical care for my health problems, is simply because I hold private health insurance. The policy is a huge burden on our family budget each year but I cannot afford to be without it. The delay in accessing investigations in our public health service, is costing lives. It seems that little has changed since the untimely death of Susie Long who succeeded in highlighting the inequities in the system. The Irish Cancer Society has described the waiting times as unacceptable. I’d describe the situation as scandalous and it’s time the HSE was held accountable.

RTE News Bulletin

My Two Cents

The HSE is facing more than a €1 billion shortfall in it’s finances this year. Are we surprised? I don’t think so. The HSE is a faceless organisation wasting millions of taxpayer’s money every year to fund it’s quagmire of management levels and all at the expense of frontline healthcare. In a bid to address the budget deficit, the HSE is devising a major cost cutting plan to downsize our health service and you can be sure that it won’t be the HSE to suffer the consequences. While waiting to see a specialist yesterday in an over-crowded out-patient clinic at a large public hospital, I came up with some alternative ideas for the HSE to consider. Instead of solely concentrating on cost-cutting measures in our hospitals, I would suggest that the HSE would be well-advised to look at opportunities to complement our health service.

For starters, let’s look at the area of catering in our hospitals. The catering budget  must be astronomical and yet the wastage of food is phenomenal. Over the years, I’ve had many stays in hospital and I’ve often joked that this provides a saving on the family budget as my board and lodgings when in hospital, are fully covered by my health insurance. I pay dearly for health insurance and am fully entitled to this return. All medical card holders when admitted to hospital, are entitled to free care in our public health service. Those patients who are not entitled to a medical card and who do not hold private health insurance, pay a small daily levy for in-patient care. The point I’m trying to make here is that everyone regardless of income, has to budget for their daily nutritional expenses so why should the State or an insurance company be expected to pick up the tab for our food requirements when we’re in hospital? I guarantee you that if patients were  charged for their meals, the wastage of food in hospitals would be radically reduced.  Granted a lot of hospital food is inedible but again if patients were subsidising the cost, the standards would automatically improve.

Another aspect of hospital care which should be addressed, is the way out-patient clinics are managed in our public hospitals. There is no charge for appointments or investigations once a patient is in the public system and like all free services, it is open to abuse. By comparison, those who hold health insurance, must pay-as-they-go to be investigated within the private system, the difference being of course that they enjoy the benefit of shorter waiting times. While private health insurance is fairly comprehensive for in-patient expenses, out-patient expenses are generally poorly reimbursed. I would like to propose that all patients should be expected to pay something towards the cost of their appointments. I believe that a small charge for an out-patient appointment in a public hospital, is not unreasonable. It would not only help to offset budget deficits but would also reduce the number of appointments as public patients would take ownership of their healthcare just like privately insured patients are forced to do. This in turn would free-up non-consultant hospital doctors (NCHD) and reduce overtime expenses for the HSE.

I know I’ll be unpopular for these suggestions but I don’t care as I see it as the right way forward. At a time when the government is asking everyone to shoulder the economic difficulties, we can start by taking responsibility for our own health service. Every single person in this country should have equal, speedy, and efficient access to safe healthcare. At the moment, we have a 2-tier, apartheid health system where those that can afford health insurance, have the fastest access to health care.  Let’s use patient power to save our public health service and stop the degradation planned by the HSE.

And before anyone asks why as a privately insured patient, I was seen yesterday in a public out-patient clinic, let me explain. I had no choice in the matter as I required endoscopic investigation and this service is no longer available in private consulting rooms as a result of the boom in MRSA litigation. MRSA has little to recommend it but in this regard, it has worked in my favour. I got to enjoy an appointment with my own choice of consultant, in perfectly adequate facilities and at the expense of the State.  Point taken?

Some Day…

Do you have health insurance or is this something you’ve put off until another day? If you’re young, fit and healthy, the chances are you’ve never really given your health much thought. Why would you worry when you haven’t had to face huge medical bills? With the rapid privatisation of our health service, health care in Ireland is becoming more like the 2-tier system in the States. Those with insurance will get top dollar care while those without, will suffer.

About five years ago, my GP sent me urgently to the A&E department of our local public hospital as I had developed acute abdominal pain. I was processed by the triage nurse and allocated a trolley in a cubicle so that the doctors could assess my condition. Once my blood tests had come back from the lab, the decision was made to admit me overnight in case I needed to go to theatre. I was put on a drip (nil by mouth) and lined up on a trolley in the centre of the department along with scores of others, in a queue for a bed. I hit lucky on that particular occasion and was transferred to a ward in the middle of the night. By the following day, my abdominal pain was severe (my intestine was blocked by an abscess) and it was decided that a CT scan should be performed to ascertain if surgery should be performed. I was started on intravenous antibiotics while I awaited the scan but kept fasting in case surgery was required. This was bearable until a harassed looking junior doctor appeared at my bedside to announce that the CT scanner had broken down and was awaiting repair. By the following morning (day 3), the scanner was still out of action and my situation was beginning to look very bleak. Around lunchtime, the same doctor rushed in and asked me to confirm that I had private health insurance. I did, thankfully, so the decision was made to transfer me to the private hospital, to avail of their scanner. The scan confirmed a diagnosis of acute diverticulitis with obstruction of the bowel but it was seen to be resolving so I could finally be taken off the emergency list. Had I not had health insurance, I hate to think that I may have ended up having investigative surgery as no scanner was available to make the diagnosis. Please don’t get me wrong here, I received excellent medical care during my 10-day stay in this public hospital and was very grateful for it. However, the system was clearly in overload and patients were suffering as a result. My insurance was worth every penny to get the care I needed when I needed it most.

Health insurance is a complicated business. It’s designed this way so that the insurers are protected against excessive charges by private doctors and also to restrict patient benefits. There are three main insurance groups in Ireland and they each purposely have slightly different health plans so that it’s almost impossible to compare like with like. I have spent vast amounts of time over the years, trying to work out which plan offers the best deal for my family. It was years before I realised that each member of the family can hold a different policy to meet their individual needs but don’t expect your insurance company to tell you stuff like this, ‘cos they won’t. I review our policies every year to see how we can reduce costs yet still retain adequate cover for both emergencies and day to day care. There are all sorts of clauses to catch you out, so be careful what you change. And remember, it’s too late to look for insurance when you’ve already become ill because penalties will abound. You have to put in the work yourself if you want to see improved benefits. I long ago gave up hoping that an apple a day would keep the doctor away.

Going It Alone

Do you have private health insurance? If you’re young, fit and healthy, the chances are you’ve never even considered taking out cover. Maybe you are relying on tax relief to ease the blow of medical bills? This is fine although if you develop a serious illness or require prolonged hospital treatment, you could end up in financial trouble.

In Ireland, everyone is entitled to free hospital care, subject to certain daily bed charges or casualty (A&E) fees but thanks to our 2-tier health service, waiting times in the public system tend to be much longer than in private health care. Over a million Irish people, with incomes below a certain level, are covered by the state General Medical Service scheme, for totally free hospital care. However, if you develop a long-term health problem but do not qualify for a medical card or hold private health insurance, you could find yourself in trouble with medical expenses.The more serious your illness, the more costly your treatment. Those on a lower rate of tax, can only claim back 20 percent of their medical costs. If you plan to rely on tax relief to make your medical expenses more affordable, you need to make sure that the treatment or care you receive qualifies for tax relief. The hospitals, doctors, dentists and therapists you see must be approved by the Revenue Commissioners – otherwise, you may not be eligible for relief. Some of the things that qualify for relief include doctors’ and consultants’ fees, prescriptions from a doctor or consultant, treatment in a hospital or approved nursing home, routine maternity care, in-vitro fertilisation, wheelchairs prescribed by a doctor, orthodontic treatment, and surgical extraction of impacted wisdom teeth.

If you have private health insurance, you can still claim tax relief on your medical expenses but only on those expenses which have or will not be reimbursed by your insurer. And remember, if you do not have any health insurance cover whether by choice or because you simply cannot afford it, there is always the National Treatment Purchase Fund (NTPF) if you end up needing hospital treatment. If you are a public patient on a public hospital waiting list and have been waiting over three months for an operation or procedure, you may get your treatment free of charge if you qualify for this scheme.

Private health insurance is not an automatic guarantee of financial security – cover can be refused on a technicality or expenses may be only partially covered – but it does offer peace of mind in case of serious illness. The fact that over 50 percent of the population choose to have health insurance cover, says a great deal. While you may be happy to wait, sometimes your health cannot afford the delay.

Risk Equalisation

Does that affect me? The answer could be ‘”Yes”. ‘If you are old/suffering from a long-term medical condition then this week’s ruling in the Supreme Court could well end up costing you a great deal more for health insurance cover.

Risk equalisation is a scheme to ensure that community rating is implemented whereby everyone, young and old, sick or healthy, pays the same premium. It is a scheme that provides for insurance companies with fewer elderly subscribers to compensate other companies who have higher numbers of medically vulnerable subscribers. This week, the Supreme Court struck down legislation which our government had in place to ensure that risk equalisation was enforced. Up until now, this legislation placed restrictions on other insurers thereby restricting competition within the private health insurance market. The VHI is the longest serving health insurance provider and carries the largest number of elderly customers. It currently holds a monopoly with 70 percent of the health insurance market and as the state insurer, was protected up until now by risk equalisation. This week’s decision is without doubt, an embarrassment for the government and it may have serious consequences for the VHI and it’s subscribers. A more detailed explanation of the situation can be found here in this week’s online edition of The Irish Medical Times.

Competition is good but a balance has to be found whereby those most vulnerable in our society are not squeezed out of the private health insurance market. This latest development potentially represents a big upset to our Minister for Health’s plans to privatise the health service. Her future in the Department of Health, is looking more than a little bleak.