‘Cos you deserve better

August 27, 2009

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?

jack and jill

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!


Held To Ransom

August 9, 2009

Having spent the best part of the last month undergoing treatment in a semi-private ward of a large public hospital, I’ve seen first-hand how our health service operates. It’s the same old story. Once you get through A&E and into the system, the care is excellent. But it’s not all a bed of roses.

In Ireland, we have a 2-tier public health service with a unique mix of public/private patients and public/private consultants. Approximately one third of hospital consultants work in public-only practice. That leaves 70% of consultants allowed to practice publicly and privately. These consultants enjoy the best of both worlds. They do not have a boss, their hours are not monitored and many enjoy extraordinary salaries. Granted, our Minister for Health, Mary Harney has tried to exert control over hospital consultants by introducing new contracts (terms and conditions with the State) and new posts of clinical directors (about 100) to manage and monitor hours. However, having watched the consultants do their ward rounds over the last month, I’ve come to the firm conclusion that we’re all being held to ransom. It’s time someone blew the whistle.

I witnessed consultants reassuring elderly patients that there was no hurry for them to go home. I’m talking here about patients who had very obviously recovered from the acute illness that brought them into hospital. These patients had homes to go to with family in support, they were not waiting to be allocated a nursing home bed. We hear so much about the shortage of beds in our acute hospitals. Why are the consultants not working hard to free-up beds?

I saw the look of disbelief on the faces of the junior doctors (NCHDs) as a consultant announced further tests on a young girl who’d been in hospital for many weeks and whose tests had all come back normal. This girl appeared very well to me so why was she occupying a hospital bed? Why were her investigations continuing as an in-patient?

group insurance

Could it be that hospital consultants choose to have a proportion of beds occupied by patients who require minimal input of care/time? Patients whose health insurance will continue to reimburse both the hospital and private consultant as long as they occupy a bed? Is this the realistic truth? I presume that the NCHDs remain silent on this issue because their jobs depend on pleasing the consultant?

I don’t know about you but my conscience finds it very difficult to accept that ‘well’ patients are occupying hospital beds when I know that acutely ill patients are lying on trolleys in A&E?

We have some fantastic consultant doctors in this country who are totally dedicated to their profession and I’ve no wish to tarnish their reputation. However, as a patient, I feel a need to protect our health service. The fact is, I depend on it.


Save our Health Service

March 4, 2009

A letter to the editor of the Irish Times, caught my attention the other day as it’s topic was the health service. I was very pleased to find that it’s content confirmed my views about the abuse of out-patient clinic appointments in our public hospitals. The contributor proposed some ideas to solve this problem, measures which would also help to reduce waiting lists and raise funds for hospital services.

The letter was headed “DNA and Hospital Waiting Lists”

save-our-health-service“Madam, – Sheila Gorman (February 19th) notes that last year St James’ Hospital had almost 25,000 “DNAs”. As she explains, a “DNA” is someone who did not attend the hospital for their appointment. They did not call to cancel or postpone and so the hospital’s time was lost.

In my own area of Pembroke-Rathmines, St Vincent’s Hospital had 26,878 “DNAs” last year.

Assuming similar figures for hospitals across the country, waiting lists could be cut dramatically by appealing to those who have made medical appointments which they no longer require to cancel their appointment. This would also help to ensure that those most in need of medical attention get it sooner.

In the UK, NHS dentists request a £20 deposit from patients booking an appointment. This is later refunded or discounted from the bill. If the patient does not attend,and fails to cancel in time, the dentist keeps the £20. A similar scheme for our hospitals would either reduce waiting lists by hundreds of thousands or raise millions of euro to provide better services.

Could this be a simple way to improve our own health service for medics and patients alike?”

Source: The Irish Times online.

There are probably lots of reasons why so many public patients do not attend for hospital appointments but I would say prime amongst them, is a lack of respect for our inefficient health service. I’m all for making our present health service more efficient but only if it results in improved patient care. The sooner we get a system of universal health insurance in place, the better.

For anyone interested, world-famous cancer specialist, Professor John Crown will address a Public Meeting in Blanchardstown tomorrow evening. The meeting, hosted by Deputy Joan Burton of the Labour Party, will deal with issues relating to the future of Connolly Hospital, Blanchardstown and will facilitate questions by members of the public.

Where? St. Brigid’s Community Centre, Blanchardstown
When? Thursday 5th March 2009 at 8pm

Prof. Crown will address the meeting on the importance of introducing universal health insurance to put an end to our 2-tier health system.


My Two Cents

February 25, 2009

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. bed-occupancy-rateAll 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…

August 25, 2008

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

August 10, 2008

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.


Privatisation

June 30, 2008

Do you wanna be in my bed, my bed, my bed…

Need I say more about the so-called ‘reform’ of our health service?