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.

So Dat’s Dat!

After ten years, ten months and ten days in office, Bertie’s finally gone! You cannot but wonder if Mary Harney will soon be following him. Brian Cowen, our Taoiseach-in-waiting, is due to receive his seal of office tomorrow and will announce his new cabinet shortly afterwards. Will he show Mary the door?

I had to laugh when reading about the HSE in the Sunday Indo yesterday. “A bloated system”. “HSE belt tightening is a fat lot of good”. “The HSE like everyone else needs to tighten the belt, to cut a little fat”. “The HSE will soon resemble a hippopotamus in bondage gear”. I”ll give you one guess as to what stimulates this sort of language from newspaper columnists. You’re right! Our present Minister for Health is no advert for healthy living and after three and a half years in the job, she’s definitely looking the worse for wear. Harney took on this role in September 2004 with promises to reform the health service. During her time in office, she is credited with achieving a reduction in A&E waiting times, putting a new cancer control programme in place, reducing operation waiting times and the introduction of hygiene audits.

A recent report provided by the HSE, showed that in the first two months of this year 44 per cent of patients in hospital emergency departments awaiting admission, had to wait longer than the official maximum target period of 12 hours. The report also revealed that the number of patients waiting more than 24 hours for admission increased by 57 per cent over the same period last year. The only thing that has improved is the HSE’s daily fiddling of the figures to make it look like there is a reduction in the numbers on trolleys.

As regards the cancer control programme, Mary Harney secured at enormous cost, the appointment of a top cancer specialist, Prof Tom Keane. His mission is to restructure cancer care in this country with the introduction of 8 new centres of excellence. According to John Crown, a medical oncologist, none of the four centres planned for Dublin will be comprehensive. “The plan is that colon cancer is treated in one place, lung cancer in some other place. That is not excellence in care. It is a system based on compromises which are in turn based on medical politics”. Under the new plan, there will be no centre of excellence located north of a line between Dublin and Galway. This system is already doomed to failure.

Waiting lists for operations have been reduced but at a huge cost. Surgeons and their operating teams in our public health system are frequently left twiddling their thumbs when their operating lists are cancelled because of the shortage of beds for elective admissions. Meanwhile the HSE is paying top dollars to the private hospitals via the National Treatment Private Fund (NTPF) to have public patients treated in the private system. This madness is Mary’s solution to the long waiting lists. Talk about false economy.

And finally the hygiene audits. Mary Harney promised back in 2005, to tackle health care associated infections (HCAI) and said that the target over the next three to five years would be to reduce hospital-acquired infections by 20 per cent and MRSA by 30 per cent. The numbers of patients becoming infected with MRSA fell only slightly last year. Newly released figures show there were 533 cases of bloodstream MRSA infection reported last year, compared with 588 in 2006, a reduction of less than 10 per cent. Overcrowding, poor cleaning, haphazard hand hygiene, infrastructural defects, and lack of infection-control staff particularly microbiologists, is favouring the spread of the hospital superbugs. Our Minister for Health is more interested in budget control than infection control and patients remain at serious risk of infection.

New official figures have shown that the HSE is now €95 million over budget for the first four months of the year. The HSE has drawn up a series of controversial proposals to claw back on the financial overrun. These include hospital bed closures, the curtailment of A&E services and new restrictions on the issuing of medical cards and drug-cost reimbursements. There is also a proposal to divert the €185 million earmarked for the development of services for the disabled, older people and those in palliative care. We ain’t seen nothing yet in terms of cutbacks and the impact this will have on patient care.

There is increasing unrest amongst those working in the health service and patients too, are fast losing patience. Mary Harney’s credibility has been badly damaged by a series of cock-ups and system failures during her tenure in office. The failure to get the new consultant’s contract up and running has been a major blow to her plans. Her promises to reform the health service, have not materialised. The question remains. Will Brian Cowen take the easy route and leave Mary Harney to continue to take the flak or will he have the courage to show her the door?

The Health Debate

Well, actually it was more of a discussion than a debate and even though I didn’t succeed in getting to have my say, I’m glad I tuned in to Your Call on Newstalk106 yesterday. As was predicted, both our Minister for Health and the CEO of the HSE, declined the invitation to take part in a live debate on the health service. Not one to be easily dissuaded, Brenda Power went right ahead and chaired a lively discussion with a panel of experts which included a well-known retired cardiac surgeon, a GP, a health economist and Newstalk’s own economics editor plus contributions from various phone-in callers. While the opinions of the panel differed at times, everyone was in agreement that morale within the health service is at an all-time low.

The following is a brief synopsis of the opinions expressed during the programme: “We do not have a health service – we have a dysfunctional, immoral state system. Services are not joined-up and are hampered by a dysfunctional transport system. The health service is a black hole with €15 billion spent on it last year and further massive cutbacks in health spending are inevitable. The GP’s have not been consulted on hospital development plans and funding has been pulled from GP training schemes and out-patient services. Management problems within hospitals are directly affecting vital services such as cleaning. The prevalence of MRSA and other superbugs, has caused a widespread fear amongst patients of going into hospital. Over 52% of the population take out health insurance because of the rationing in the system. The National Treatment Purchase Fund (NTPF) is ‘like a finger in the dyke’ and is not cost-effective. The NTPF pays more than private health insurance schemes to secure treatment for public patients in private hospitals and in the process, is denying access to patients who pay for top health plans. Emergency departments (A&E) are unfit for purpose. Bed capacity is a big issue and few are in agreement with the HSE’s opinion that more beds are not needed. Rehabilitation facilities are almost non-existent throughout the country. Psychiatry has been badly neglected as a service. The plans for co-located hospitals are a joke. It is immoral to have one standard of care for public patients and another (better one) for private patients. Focus should be put on the public service but there is no incentive in place at the moment. Numerous reports have been produced on the health service but they have not been acted upon. The hallmark of quality service is ‘morale’ and the present ethos within the health service is one of low trust, low morale and no sense of direction.”

So, while nothing particularly new or startling came out of this discussion, it did provide a good overview of the problems that exist. The bureaucrats within the Dept of Health and the HSE should hang their heads in shame at this long litany of dysfunction. Patients have suffered for too long without the basic healthcare they deserve. The general consensus of opinion from the panel was that trust has broken down and a change of mindset is needed if a way forward is to be found. Many feel that our Minister for Health should resign as the level of confrontation has become too great for co-operation. Progress will only become possible if the powers-that-be learn to engage with the people on the ground, and listen to their views. We can only hope this process started yesterday.