Is this a great country or what?

February 23, 2010

I phoned the insurance company this morning, as instructed, for news on my application for ‘prior approval’ for surgery.

The lady in customer services checked my file on the computer, and said… “We need 5 working days to process your application.”

I replied that the application was submitted by fax last Wednesday morning (marked URGENT) and that this was now Day 5.

I was asked to hold the line.

After a long wait while she contacted the claims department, I was told… “Sorry, there’s no update on your application.”

I, again, explained that the surgery is due to take place this Friday, that the surgeon is booked, the hospital bed is booked, the flights are booked, the hotel is booked and that I’m due to travel to Nottingham in less than 48 hours time!

A long silence ensued.

Finally, the reply came… “You could try phoning again, this afternoon.”

“When you need us, we’re there”  Grrrrrr!

With thanks to Grannymar for keeping me smiling…

SENIOR HEALTH CARE SOLUTION

So you’re a senior citizen and the government says no health care or pension for you, what do you do?

Our plan gives anyone 65 years or older a gun and 4 bullets. You are allowed to shoot 2 MPs and 2 Senior Government Officials.

Of course, this means you will be sent to prison where you will get 3 meals a day, a roof over your head, and all the health care you need! New teeth, no problem. Need glasses, great. New hip, knees, kidney, lungs, heart? All covered.

And who will be paying for all of this? The same government that just told you that you are too old for health care. Plus, because you are a prisoner, you don’t have to pay any income taxes anymore.

IS THIS A GREAT COUNTRY OR WHAT?!


When you need us, we’re there

February 21, 2010

The VHI pride themselves on being there when you need them. I’m due to undergo revision surgery in the UK next Friday. The arrangements have been made, flights and hotel are booked but if the pen pushers in the VHI don’t get their act together, it will all be cancelled. Facing surgery is never an easy task but when you have to fight to get insurance cover for it,  it can be soul destroying. Surely it’s not right that a health insurance company can hold you to ransom like this?

People associate VHI Healthcare with excellent hospital cover. I’ve been insured with them since childhood and with my medical history, it’s fair to say that I’ve given them a good run for their money. With medical costs soaring, holding private health cover should offer peace of mind. However, should you find yourself in a position where you require treatment that is not available in Ireland, be warned! There is no guarantee of insurance cover.

No matter what level of insurance you hold, you will be made to grovel for treatment abroad by a process called ‘prior approval’ and if you fail to tick all the right boxes, cover will be refused. What really bugs me about this process is that it interferes with patient autonomy and the doctor-patient relationship. The VHI make the decisions.

The VHI state in their terms and conditions that “VHI Healthcare does not provide cover if a member travels abroad specifically to get treatment. However, in exceptional circumstances and subject to prior approval and satisfaction in full of specific criteria, we will pay up to the plan amounts outlined in the Table of Benefits.”

I was first sent ‘abroad’ for surgery in 2007 as treatment options in Ireland, had run out. The VHI subjected me to the process of prior approval and despite meeting all the specific criteria, my application for funding was turned down. This caused untold stress at a time when I was facing major surgery. The funding was subsequently granted on appeal and the operation went ahead as planned, in Nottingham.

I was referred back to the UK last year to undergo further radical surgery. Again, the VHI insisted on prior approval and again my referring consultant was asked to complete an in-depth questionnaire and supply academic evidence to support the proposed surgery. On this occasion, funding was sanctioned on the first attempt but the VHI kept me on tender hooks right up to the week of surgery.

Two weeks ago, I travelled back to Nottingham for a consultation with the surgeon who last operated on my head. I was referred back to him with a post-operative complication which has failed to respond to treatment in Ireland. The surgeon advised that some revision surgery is required. On contacting the VHI on my return, I was informed that prior approval must be sought for any surgery outside Ireland.

I have spent the last 2 weeks trying to get the revision surgery ‘approved’ in time. If it has to be cancelled, I will have to wait another month for surgery. On phoning the VHI last Friday, I was informed that I would be notified by post of their decision. When I reiterated that the matter is urgent, I was asked to phone again on Tuesday. That’s two days before I’m due to travel to the UK and there is no guarantee that my application will be approved.

“When you need us, we’re there”

Well, I need the VHI now so where the hell are they?


Equity of Care?

April 26, 2009

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.

second-opinion

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.


Get It Right

April 17, 2009

I’m fed-up listening to the mixed messages coming from the Department of Health and the HSE. One minute our Minister is vowing to provide extra beds in the health service and the next we’re being told that we’ve got too many beds. It’s time that Harney and those muppets in the HSE made their minds up.

We have a new chief medical officer (CMO) of the Department of Health, Dr Tony Holohan and in his first media interview since taking up his appointment, he announced that the Irish health system has too many hospital beds. Brendan Drumm, CEO of the HSE, is also peddling the same message. Meanwhile, our Minister for Health’s solution to relieving the bottleneck in A&E, has been to promote private for-profit co-located hospitals as a means of fast-tracking new beds into the system. At the same time, the Dept of Health has deemed our smaller hospitals ‘unsafe’ and is busily closing them down without first adjusting the conditions in the ‘centralised’ units’, with adverse consequences predicted.

The reality is that as things stand at the moment, our health service is in disarray. We have chaos in our A&E departments because of the bottleneck caused through lack of beds. The reason for the log-jam is because our tertiary healthcare services have been neglected over the years and many OAP’s now have no choice but to occupy hospital beds long term. Instead of Harney wasting her time and our money on privatising healthcare in this country, the focus should be put on developing primary care. Nobody refutes the fact that hospitals are not the safest place to be when recuperating from surgery. Primary care is the way forward, with enhanced outpatient care taking place in GP surgeries and public health clinics. This would cut the need for bed numbers with patient care moved to an outpatient or a community setting.

However, the Dept of Health and HSE have repeatedly failed to explain their role. The mixed messages emanating from the Health department are doing nothing to improve public confidence in the health service. Let the new CMO of the Dept of Health come out and tell us what the plans are. We need to know that the problem of  overcrowding in our hospitals will be solved. We need to hear that primary care will get the investment needed to take the pressure off the hospitals. Stop the indecision, we need reason to be hopeful.

There’s one thing that mustn’t be forgotten in all of this and that is the patient. Think back to the last time you were in hospital. What meant the most to you? Was it the good/bad facilities or was it the friendly staff who cared for you? What really counts when one is ill, is kindness but sadly, this is rapidly disappearing as our health service is decimated by mismanagement. The Minister would do well to remember the need for a familiar smiling face.


Health Access

March 26, 2009

Do you agree that all patients should be entitled to equal access to healthcare whatever their lifestyle choices? This was the motion put forward for last night’s Health Debate, the first of six debates to be held across Ireland in the 2009 Pfizer Health Debates series in association with The Irish Times. These debates on healthcare are open to the general public, free of charge, through advance registration and provide a forum for those attending to articulate perspectives and concerns. I couldn’t resist the temptation.

Last night’s debate was chaired by Irish Times columnist, Fintan O’Toole. Well-known economist, Jim Power argued against the motion along with Prof Charles Normand, professor of health policy and management at Trinity College, Dublin. They went head to head with Labour’s health spokeswoman, Jan O’Sullivan and Dr Donal O’Shea, consultant endocrinologist who spoke in favour of the motion. Before the debate commenced, the chairman asked the audience for a show of hands on the motion. Interestingly, there was fairly equal distribution of those ‘in favour’, those ‘against’ and the ‘don’t knows’.

Did you know that obesity accounts for 40% of all cancers? Add smoking to the equation and it becomes a 70% causal factor. Last night’s debate raised many philosophical as well as practical arguments. Should people who adopt risky lifestyle behaviours like smoking or abusing alcohol, be given the same access to healthcare as people who adopt healthy lifestyles? Is equity of healthcare, a fundamental right for everyone? Should people be judged by their lifestyle choices? How do we define which patients are worthy of treatment? Should our limited resources be put into educating people to change their behaviour? Who decides on these huge moral issues?

diet-shakeThe debate was opened to questions from the floor giving the audience an opportunity for engagement before the final show of hands was taken. The motion was overwhelmingly carried in favour of equal access to healthcare for all patients regardless of lifestyle choice.

I voted against the motion and for good reason. I happen to believe that hard decisions need to be taken to stop the drain put on hospital resources through risky lifestyle behaviours. Look at the problems in A&E with the drunks and drug addicts. Are you happy that they get the same priority of treatment as the genuinely sick and the elderly? Instead of waiting to treat the problems caused by unhealthy lifestyle choices, healthcare resources could be allocated to educating people to take responsibility for their lives. I also believe that people with serious illness are being denying optimum treatment by our failure to prioritise treatment on the basis of genuine need. The poor survival rate in this country for cystic fibrosis sufferers, is the direct result of a system that refuses to make decisions. The cervical screening programme is another example of the failure to prioritise. It was rolled out last year, 21 years after the government first agreed on the need for such a programme. It’s time people woke-up to the fact that patient’s lives are being lost through lack of government leadership. Our health service is rudderless and it remains to be seen if Captain Harney and her First Mate Drumm, will stay with the sinking ship.

The next debate in the series takes place in Cork in UCC, on 29/04/09 and will discuss the hot topic of co-located hospitals. This issue has already generated much discussion nationally so it should be a lively debate.


Make Your Voice Heard

October 20, 2008

Last week the Government caused uproar by announcing plans to scrap the automatic entitlement to a medical card for all over-70’s. Having lulled the elderly into a false sense of security that they would be entitled to free healthcare until the end of their days, they are now trying to claw back on this commitment. There is no denying that this country is facing a serious economic downturn and that harsh cutbacks are required to sustain public finances but this callous plan to target the elderly, is despicable.

Enough has already been said about the bungled campaign to introduce a ‘means test’ for the over-70’s medical card. I have never felt so angry and frustrated by the gross incompetence shown by our Government in their handling of this issue. They are guilty of causing great fear and anguish to those most vulnerable in our society. The comments made over the weekend by our Minister for Health, Mary Harney and our Taoiseach, Brian Cowen have done nothing to allay the fears of the elderly. Now the Government is floundering around trying to find a way out of the controversy created. Our health service is no longer alone in it’s descent into chaos.

A public rally has been organised outside the Dáil at lunchtime on Wednesday to protest against this Government’s attempt to mug the elderly. If you too have been outraged by this medical card débâcle, I would urge you to show solidarity with the elderly and support this protest.

Assemble @ 1pm on Wednesday 22 October in Kildare Street, outside the Dáil.