US vs. Irish Healthcare Experiences

D

daltonr

Guest
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

Ironically (I'm never sure if I'm using that word correctly).

Mrs daltonr and I spent a few hours in a US Emergency room last night after being rear ended at traffic lights.

I know that there are people who think my only goal is to talk down Ireland, and talk up everywhere else, so you can take this with a pinch of salt if you like. These are the facts.

This was a fairly solid hit directly from behind, and we both had some neck discomfort. I didn't think it was anything permanent, and thankfully it isn't, but the police officer told us how to get to the nearest hospital, it was only a few minutes away so we decided to get checked out.

We have VHI and US Auto Insurance, but no US Health Insurance. I wondered how much it would cost and who would pay. Turns out it'll automatically go through our Insurance and they will pursue the car owners insurance.

We arrived, in what looked like the lobby of a nice hotel, we filled in a very brief form. Literally it just asked for Name, Gender, DOB, details of the injury and Social Security Number.

We were called within 10 minutes to be assessed by a triage nurse. About 10 minutes after that we were separately called and taken to private rooms with our own TV (76 channels), my room had a private bathroom, Mrs daltonr was obviously less important and didn't get a bathroom

The ER had 27 of these rooms, that I could see, most seemed to be occupied. The only person I saw on a trolly outside of these rooms was a woman being wheeled in from an Ambulance.

It took a while for them to process us, first I was visited by someone who could get details of my address, next of kin, more on how I was injured, details of my insurance if any etc. They could have made me fill all this out when I arrived but this way I got one on one help in answering the questions, and all I had to do was sign my name.

I was examined by a physicians assistant, taken to xray, and eventually given some paperwork telling me things to watch out for, the name of a doctor to follow up with if I needed to. Advice on pain killers etc.

The whole process for me took 2.5 hours from walking through the door to being discharged. In between I had my own TV and honestly at times, nearing the end of an episode of Cold Case I was hoping they'd take a few minutes longer before coming back with results.

Mrs daltonr took longer and needed a second set of xrays, but she was all clear too.

We both agreed this was 5-star health care. We assumed it was because Sunday nights are quiet, but I kept hearing the staff referring to being backed up, and other staff members like administrators were volunteering to help out. It turned out that their computers had gone down and as a result X-Ray was backed up. I honestly didn't notice, I can only imagine that if there were no problems I never would have gotten to see who was guilty on Cold Case.

In the end it took about 5 hours to fully sort out Mrs daltonr, but neither of us felt like we'd been kept waiting. One one occasion an orderly accidently clik the Nurse call button in Mrs daltonr's room and a nurse arrived within seconds. Later when she had been taken to xray I picked up the TV Remote and the Nurce call button went off again, must have been dodgy, but again the nurse was there within seconds.

On the way out an Administrator came into the ER to take us out so the medical staff wouldn't have to leave. She brought us to a room to explain that the whole thing would be billed to the auto insurance and we wouldn't be getting a bill.

We had to ask how much this all costs. We'd heard stories and the curiousity was too much for us. Besides, if I chop my finger while cutting a steak, I'd like to know if I can afford this level of care.

"You had x-Rays right", "Yes", "No MRI's or anything like that", "No"
"About $200"

I'm presuming that that's $200 each, I forgot to ask.

That's it. We genuinely could not have been more comfortable if we had been at home on the couch. For one thing we don't have cable TV at come.

The whole visit had the air of a business that was trying to turn us into repeat customers while hoping we'd never need to be. Even the paperwork we were given on leaving expressed appreciation for being allowed to treat us.

$200 is about EUR160. That's only EUR100 more than a trip to A&E in Ireland would have cost. Granted in Ireland there's a 600 a year cap, but what do you really get for that 600. I need to go and look at how much Health Insurance that 600 a year would provide.

-Rd
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

Hi Rd,

There is one reason and one reason only why your experience in the US was better; the money follows the patient there, i.e. they are a source of revenue whereas here the patient is a drain on revenue. Here you are something that the hospital spends money on. In the USA you are something that the hospital makes money on.
The same sorts of reimbursement schemes operate in Germany and other EU countries. In those countries the patient gets a good service. Here that is not the case.
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

"I don't think there should be a question of withholding medical treatment from anyone, regardless of how they were injured. However there is no reason why some punishment can't be applied."

This is an area of debate to which I regularly return in my own mind. On the one hand, it seems callous to deny someone treatment. On the other, there is always a scarcity of resources in a medical system, in the sense that no matter how much service you offer, the public seem to be able to take all of it. This means that when you offer medical services, you are always making a choice; if you spend money on A+E, you have less to spend on coronary care, . If two badly injured people present at the same time, both equally badly injured, one being a drunk driver and one being his innocent victim, is it reasonable to treat the innocent victim first? I would say yes.

On the other hand, if the drunken driver has life threatening injuries, but the innocent victim only has a dislocated shoulder, it would seem reasonable to treat the drunken driver first.

Easy so far.

But what if the drunken driver's injuries are just very very slightly more threatening than those of the innocent victim? Is it fair to ask a doctor to make a moral judgment in these circumstances? I can never quite decide.
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

On the other hand, if the drunken driver has life threatening injuries, but the innocent victim only has a dislocated shoulder, it would seem reasonable to treat the drunken driver first.

Easy so far.

But what if the drunken driver's injuries are just very very slightly more threatening than those of the innocent victim? Is it fair to ask a doctor to make a moral judgment in these circumstances? I can never quite decide.

Isn't this part of the storyline of Lost? Where Jack had the option of helping the driver who caused an accident, and the victim of the accident? And he decided to help the victim first at the expense of the life of the driver?

The crash where the driver was Shannon and Boones father, and where the victim was Jacks future wife?
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

friend of mine was in the Lourdes in Drogheda recently. a drug dealer high on drugs was in the bed next to him. kept threathening to throw himself out of the window. doctors and nurses attending him all the time. my friend ( heart problems) said they hardly had a minute for anybody else such was the demand this junkie was making on them. and to make matters worse, he was 'dealing' on his mobile whenever it rang. dont know what floor this all happened on but if it was any height at all ( lourdes is quite high) I wouldn't have stood in his way. request the people to move their cars from under under the window, no point in him causing more damage than need be.
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

This is interesting and all that but is it on topic?
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

Not really; apologies; Perhaps you could judiciously delete and\or split the thread
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

Might be worth a seperate Health Topic, but what will it achieve? Any number of great ideas could be proposed here, not one of them will be implemented.

My US Experience got me thinking. Over here the hospitals compete with each other. I know that hell will freeze over before Ireland abandons it's victorian idea of the state providing healthcare in a centralised way, where the vast majority of staff regardless of hospital all work for the same boss.

But is it time to consider a more aggressive push towards private hospitals? (Tenuous attempt to stay on Topic coming up)....With Bertie Aherne claiming to be one of the last socialists, it's unlikely to happen. But should it happen?

Most people will agree that the problem with Health is no longer about Money, therefore it's no longer about either/or decisions as to who gets treatment.

That being the case, what is it all about? Something isn't right.
It appears to be a problem of administration. Is it possible in the Irish Medical system to bring about wholesale change in the system, or does that fact that most of the employees work for the same boss work against progress.

If a particular hospital wants to change procedures to improve the lives of patients, what happens if consultants disagree, or doctors disagree, or nurses disagree, or even orderlies disagree? If any group objects you risk a strike that could spread far beyond the walls of the hospital to every hospital in the country.

Is someone like Bertie Ahern who's survival depends on avoiding confrontation, going to allow that to happen, or is he going to back down on the changes?

If all hospitals were competing with each other for the patients business, and if staff worked for the hospital and no higher common boss, would that improve the move to a more modern healthcare system?

Oh but what about the poor I hear you say? They'll never be able to afford healthcare if it's run like a business. Well, yes, there are serious questions about the US model, but I can't see why in a country as small and wealthy as Ireland these can't be overcome.

A simple solution would be to have the government become a customer of these hospitals, play them off against each other to negotiate a good bulk rate and then let the government allocate the healthcare it buys to whichever citizens it feels most deserve it.

The problem in the US isn't that healthcare can't be provided to the poor, it's that the government here prioritises other things like defence spending. I don't see that being an issue in Ireland. They might prioritise government jets or sweet deals for property developers, so you still need to be wary.

In a system where the service provider resents the presence of the consumer you will never get any kind of service or satisfaction for the consumer. In a system where the service provider depends on the consumer you may get somewhere, which I think is the point purple made above.

-Rd
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

Not really; apologies; Perhaps you could judiciously delete and\or split the thread
Don't apologise! I'm as guilty as anyone of bringing this off topic. I suppose I meant what DaltonR said above (I was just waiting for him to articulate it better than I can :D )
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

I was just waiting for him to articulate it better than I can :D

Taking longer to say the same thing isn't better. :)

-Rd
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

Surely all hospitals in the US aren't the same, though? I remember- some years ago admittedly- one of my brothers worked in a hospital in Philadelphia and the way he described the place was fairly vivid- junkies tied to chairs, shouting, screaming, fighting, blood, guts and tears- constantly being in the firing line etc. Or is it that that was a public hospital and the one Daltonr went to is private?
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

Surely all hospitals in the US aren't the same, though? I remember- some years ago admittedly- one of my brothers worked in a hospital in Philadelphia and the way he described the place was fairly vivid- junkies tied to chairs, shouting, screaming, fighting, blood, guts and tears- constantly being in the firing line etc.
At least we don't have a two tier health system; they are all like that here :D
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

Or is it that that was a public hospital and the one Daltonr went to is private?

According to this:


The hospital I visited seems to be part of a not-for-profit co-op of sorts.

Interesting that here:

They refer to patients as Customers.

A major problem I see with Bertie and Co, is that they are privitising things that arguably don't need to be, or shouldn't be, like Aer Lingus, and like the Copper in the phone system.

And they are keeping some public services like health anchored to an old fashioned and failing model, when it arguably should be run more like a business, or a number of competing businesses.

I'm starting to care more about whether the Democrats can beat the Republicans, than whether the Democratic Left can beat The Republican Party.

-Rd
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

I know that there are people who think my only goal is to talk down Ireland, and talk up everywhere else, so you can take this with a pinch of salt if you like. These are the facts.
Why do you bother persistently moaning about Ireland if, as I gather from your recent history on AAM, you are now living in the US?

I visited the San Mateo Medical Centre (south of SF) a few years back as a (non accident) ER patient. They did some investigations (physical examination), reassured me that there was nothing serious wrong (possible torn muscle in the abdomen/chest) and discharged me with a prescription for some painkillers dispensed on the way out. The service was very courteous, efficient (especially the triage process) and methodical. They invoiced me for about US$400. As far as I know this is a lot more expensive than what would have been charged if I had attended an Irish hospital as a public A&E patient. Admittedly the wait might have been longer. But not necessarily. We attended Temple Street on a public basis with our son a while back and the total time in the hospital was about an hour. When my father was terminally ill with cancer a few years back he was in and out of hospital and only once had an extended wait (overnight which was arduous and not really acceptable for anybody in that situation to have to put up with) in A&E.

All anecdotal but some evidence that things are not always as (bad as) some people like to assume...
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

All anecdotal but some evidence that things are not always as (bad as) some people like to assume...

I agree. I am sure if you talk to alot of Americans, they would say that they are getting access to a third rate medical system because they can't afford the $400 invoiced to Clubman and can't afford the insurance that would give them a good standard of care. Wonder what the experience would have been if a homeless person had walked into that Centre DaltonR instead of you with insurance.

Not trying to defend the Health System here by any means. As Clubman mentions, people are treated very badly at times by the system.
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

Why do you bother persistently moaning about Ireland if, as I gather from your recent history on AAM, you are now living in the US?

Firstly because Unless I manage to sort out a more permanent Visa, I'll be forced to return to Ireland in December.

Secondly I currently still pay tax in Ireland.

Thirdly Who are you to ask why anyone moans about anything when you've spent years moaning about the same slang term?

All anecdotal but some evidence that things are not always as (bad as) some people like to assume...

Anecdotal, Some evidence, not always, some people, assume.

A ringing endorsement if I ever heard it. If I had posted about any topic using anecdotal evidence about peoples assumptions you'd be on it like a ton of bricks.

Have the rules changed? Is anecdotal evidence based on personal experience now ok?

-Rd
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

Well, I'm sure this will give comfort to those who hate the US model, but in the interests of fairness I've followed this up to get an itemised bill.

The person who gave me an off the cuff estimate of about $200 was obviously not used to dealing with people who walk in off the street.
My final bill came to $600.

This is still acceptable to me, considering the level of care received, although it's right up against the upper limit of what I'd call acceptable, to charge someone walking in off the street with no insurance. I'm looking into how much annual insurance would cost to give me this level of care, which will be the real test. I'm also curious to see how much I could save by going to perhaps a 3-star facility.

Mrs daltonr had bigger issues and two sets of x-rays, her bill came to $1100. This I think is excessive, but again, I need to see what Health Insurance would cost to get a true picture.

I don't know if the involvement of auto insurance inflates the price, I hope not.

On the bright side the other drivers auto insurance company has offered to send us a cheque today. I suspect the reason for that might be a desire to settle as quicly as possibly to head of the involvement of lawyers. But whatever the reason it's appreciated.

They've offered to have our car fixed on Friday, and will provide a rental car. Again very impressed with that kind of efficiency.

The question still remains. What constitutes an acceptable level of healthcare. How much does would it cost? And is there any chance of getting it using the Irish system?

Some would argue that prices I quoted above show that the US system is just too expensive to work. But you all pay that much in Ireland whether you visit the A&E or not, because so much of your tax is put into Health, and then on top of that you pay for Health Insurance too.

There's a mid point somewhere in there if we can just find it.

-Rd
 
Re: Bertie Ahern: Good deal or bad deal for people of Ireland

daltonr: even with health cover ( vhi in this case) you dont always get the service that's necessary. last year I posted that my then 17 year old son complained of pains and to cut a story short was given a doctors note to get an x ray in the Louth hospital. Louth diagnosed appendicitis but stated that they weren't 'allowed' to perform operations on a Friday after 6pm and took him by ambulance to Lourdes in Drogheda. The doctor in the Louth also stated that he would be operated on that evening or at worst early on Saturday. Suffice for this post to say that he was operated on at 4pm on the Saturday when there was already leakage (their term) and he was in great distress. Needless to say we got the statement from vhi about a few weeks later and while the Louth didn't bill for anything the Lourdes and the consultant certainly did. itemised bill even showed how much 'extra' it was by going via vhi. and this was for a 17 year old student. give him his due he discharged himself on the monday and refused to go back to the rip off 'check-up', which would have just entailed a 'how are you ? if I am not mistaken.
 
Back
Top