# What's the use of health insurance?



## KCT (14 Dec 2006)

I'm a member of BUPA and have a young family. Given the fiasco today I'm starting to wonder what is the point of having health insurance. Anytime I've had to go to hospital I've been treated in the same place and in the same way as everyone else. I'm not sure what exactly I'm getting out of it and I wonder is it the fear factor that's keeping people in these health policies. Would it really be disastrous to rely on the state, after all we're paying for that anyway. Could anyone enlighten me on why we need health insurance.


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## dickvandyke (14 Dec 2006)

*Re: What's the use of health insurance ??*

good point! I recently changed jobs and lost my VHI, my sister works for them so I asked her should I take out my own policy- she said no don't waste your money!!!!!!!!!

I'm 26, healthy and I don't have kids but still..


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## Samantha (14 Dec 2006)

*Re: What's the use of health insurance ??*

I do think it is worth it to have health insurance especially if you need to see a consultant as the waiting list in public is long.
I have health insurance for the past 10 years but only used it recently this year. If I had to go public in the south east to see an ear specialist I had to wait to 2 years for first appointment, private I saw him within 4 month, same apply for eye specialist - waiting list is shorter 6 months but saw it private within a week which was good as my condition did require urgent intervention.


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## KCT (14 Dec 2006)

*Re: What's the use of health insurance ??*

Could you not just pay to see a specialist if you wished to skip the waiting list, I don't see why you would need to have health insurance to do so or do the specialists refuse to see someone who is offering hard cash ?? If you put away a % of what you pay into these these policies so that you had a pot of money in the event of needing to skip a waiting list would you be any worse off ?


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## BRICKTOP (14 Dec 2006)

*Re: What's the use of health insurance ??*

I have a tale to tell.........

My wife's cousin maintained he never needed VHI etc. "Waste of money, I'm only 34, no kids, single, in full health, fit as a fiddle etc" So he never bothered with it.

About two years ago he fell over a couple of times for no reason. After lenghty (expensive) tests he was diagnosed with MS. AFAIK he will not be able to get cover for this for years, so is left footing the bill for medication etc.

True story.

I would never scrimp on health insurance and I hope it is a waste of money for me.


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## KCT (14 Dec 2006)

*Re: What's the use of health insurance ??*

I'm playing the devil's advocate here but would the public health system not have covered these costs and paid for medication ? I suppose I really want someone to justify for me why one would need private health insurance beyond the reason of skipping a waiting list. Given that the treatment purchase fund is available to people waiting a while for a procedure and we are pretty much all treated in the same hospitals I'm struggling to find a reason why we are all queuing up to pay what is in effect another tax for a service that we already paid for.


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## ClubMan (14 Dec 2006)

*Re: What's the use of health insurance ??*



BRICKTOP said:


> About two years ago he fell over a couple of times for no reason. After lenghty (expensive) tests he was diagnosed with MS. AFAIK he will not be able to get cover for this for years, so is left footing the bill for medication etc.


If he attended hospital as a public patient on a referral from his _GP _then he should have be liable for no or limited hospital charges. Of course it could mean waiting lists compared to people who are going privately. But then there's the NTPF and the treatment itself will be the same whether public or private. Also - the drug payment scheme caps one's charges for certain medications at c. €85 p.m. Any unreimbursed drug/medical expenses may qualify for _MED1 _tax relief.


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## ajapale (14 Dec 2006)

What's the use of health insurance for older people in thier late 70's and older?


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## casiopea (14 Dec 2006)

> What's the use of health insurance for older people in thier late 70's and older?



Seriously? 

Both my parents are in their 70s and use their health insurance for all the same reasons you or I would.  Obviously being older they go to the doctor a bit more frequently.  My dad had a heart scare,  his stay in hospital was covered by insurance.  Is this a serious question? The answer is so obvious, apologies if Im answering a rhetorical question.


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## KCT (14 Dec 2006)

Don't over 70's have free medical cards ?


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## ajapale (14 Dec 2006)

casiopea said:


> Seriously?



Yes, I'm serious, but I do understand why you might be shocked.

I heard a lady on Joe Duffy today whose parent was had health insurance and who couldnt get private accomodation (these were resereved for emergencies according to the bed manager). So despite having health insurance they got the exact same treatment as was availiable in the public system. Clane private hospital would/could not take the patient. After a few weeks the health insurance did not extend to nursing home care and she is paying in excess of €3,000 for that.


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## gearoidmm (14 Dec 2006)

casiopea said:


> Seriously?
> 
> Both my parents are in their 70s and use their health insurance for all the same reasons you or I would.  Obviously being older they go to the doctor a bit more frequently.  My dad had a heart scare,  his stay in hospital was covered by insurance.  Is this a serious question? The answer is so obvious, apologies if Im answering a rhetorical question.



I'm sorry, but if he went in as a public patient he wouldn't have to pay.

The main difference I can see is that some consultants are more likely to see their private patients more regularly while leaving the pubic patients to their juniors (who, incidentally can have anything up to 10 years experience).  Even this is becoming less common as the older, more VHI-minded consultants are being weeded out.


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## ClubMan (14 Dec 2006)

Private health insurance does not guarantee that the level of private accommodation covered will necessarily be made available in any or all specific cases. 

Private health insurance allows you to skip waiting lists and get semi/private accommodation in both cases where applicable.


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## gearoidmm (14 Dec 2006)

They should get rid of the whole concept of private beds in public hospitals.  It leads to two problems:

1. The perception among people that there is a two-tier system.  Even if it isn't true, a public patient might feel that he is going to receive inferior treatment compared with a public patient and more attention form the consultant.  The truth is that in general the footsoldiers on the ground (ie NCHDs and nurses) are essentially blind as to which patients are private or not and treat everyone the same - as they should.

2. It leads to false expectations among the private patients who feel that they are entitled to special treatment because they are paying for health insurance.  Most private beds in public hospitals these days are taken up by patients with infections like MRSA and trying to explain to some stuck up so and so that they have to slum it with the public patients because of this and that their much vaunted VHI makes no difference in hospital is no fun.

As far as I'm concerned, if you have private health insurance and you want all the trappings, go to a private hospital - there are enough of them around these days.


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## polaris (14 Dec 2006)

If you are generally in good health, below the age of 40 and have no dependents, you shouldn't bother with private health insurance. Under the current risk equalisation system you can wait until you're 40 -45, when the risk of contracting serious illness increases, join up and pay exactly the same premium as a 21 year old.


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## pinkyBear (14 Dec 2006)

With risk equalisation - younger people pay the same rate as older people (even though they do not claim )- the thing is with car insurance older people pay less than car insurance ( because they don't claim ). This appears to be a huge disparity in the insurance game!


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## ClubMan (14 Dec 2006)

polaris said:


> If you are generally in good health, below the age of 40 and have no dependents, you shouldn't bother with private health insurance.


A possible exception might be a woman planning to have children and who wants semi/private maternity care.


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## KCT (15 Dec 2006)

The same applies regarding maternity care also, even with health insurance there is no guarantee the consultant will be present or that private/semi private accomadation will be provided. I really do wonder what we're actually paying for except for being able to skip a waiting list.


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## casiopea (15 Dec 2006)

gearoidmm said:


> I'm sorry, but if he went in as a public patient he wouldn't have to pay.



No need to apologies gearoidmm, I dont know whether he was public or private. I actually dont know if its VHI or medical card that pays for my mums monthly medication.  I do know that they think health insurance is worth it and I do know that they have claimed on their health insurance.

Ajapale,  I see your point.  I think its an attitude thing at the end of the day.  I personally agree very much with bricktop:



> I would never scrimp on health insurance and I hope it is a waste of money for me.


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## Bob_tg (15 Dec 2006)

It strikes me that some people will pay health insurance no matter what the price.  I think, therefore, that the leading questions should be: "What is the limit for paying health insurance?"


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## Ravima (15 Dec 2006)

If you want to see consultant quicker than on public list, you MUST go private. If you then see consultant privately, you must get whatever treatmetn requited on a private basis. 

You cannot have initial contulattion PRIVATE and then seek the treatment with the same consultant PUBLIC.

If that were the case, it would be even more unfair than the current system


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## pernickety (15 Dec 2006)

i had vhi cover when pregnant with first child but realised i would get free care if I said i had no cover, which is what i did, as i couldn't afford it. what the hell is that about? i ended up in a public ward and had no problem with that, great care, and when there were some complications afterwards i was given a private room anyway. some system!

btw in france there is no such thing as skipping a waiting list (how ridiculous is it to let someone with more money go to the front of the queue, i wouldn't let them in the post office) but if you are public you get reimbursed a lot of the charges (e.g. 14 out of 20 for a doc's visit) and if you have private insurance you get reimbursed some more.


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## ClubMan (16 Dec 2006)

pernickety said:


> i had vhi cover when pregnant with first child but realised i would get free care if I said i had no cover


You don't have to *say *that you have no cover. You just have to opt for public treatment. If you opt for semi-private or private care then you can pay yourself of claim on your health insurance. Public treatment may mean more waiting around for appointments etc. and will mean public accommodation.


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## gearoidmm (16 Dec 2006)

It would be okay except that public treatment in the Rotunda for example means 10 to a room in the prenatal ward - victorian conditions really.


That said, the quality of medical and nursing care is still excellent, just that some might be put off by having to share a room with 9 others at such a time


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## ClubMan (16 Dec 2006)

When my wife was in a public ward being induced she had more immediate things to worry about than the other 8 or so people in the same ward in the same situation! She went to semi-private accommodation (_Lille Suite_) under _VHI _cover after the birth though.


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## imogen (16 Dec 2006)

I can promise you it is very useful indeed when you become paralysed within the space of 24 hours at the age of 43 and you discover you need a course of immunoglobulin costing around 4000 euros to stop your immune system attacking your nerves and causing more neurological damage as soon as possible. 

Of course I would have got treated eventually without BUPA but the damage caused to my nerves would have been worse and the recovery time longer. Resources are an issue in many clinical decisions - people with GBS and CIDP in the US and UK public health care systems suffer lack of treatment from time to time caused by shortages of immunoglobulin or shortages of resources to pay for it. I am sure the same resource issues affect the HSE.

It was definitely worth the premium cost. It still took me 2 years to recover to about 95% of my normal self.

On the other hand BUPA was a total waste of space when I broke my finger because to suit the consultants and provide access to eg X-rays the hospital puts everyone through the public system anyway...

Don't think it will never happen to you. Stay well... like Bricktop said, you're still winning if the premium costs ARE a waste of your money.

Imogen


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## gearoidmm (18 Dec 2006)

imogen said:


> I can promise you it is very useful indeed when you become paralysed within the space of 24 hours at the age of 43 and you discover you need a course of immunoglobulin costing around 4000 euros to stop your immune system attacking your nerves and causing more neurological damage as soon as possible.
> 
> Of course I would have got treated eventually without BUPA but the damage caused to my nerves would have been worse and the recovery time longer. Resources are an issue in many clinical decisions - people with GBS and CIDP in the US and UK public health care systems suffer lack of treatment from time to time caused by shortages of immunoglobulin or shortages of resources to pay for it. I am sure the same resource issues affect the HSE.
> 
> ...



As a matter of interest, was your treatment done in a public or private hospital?  I have never heard of anyone being refused immunoglobulin treatment for the lack of private insurance.  In terms of paying for such treatments, it isn't BUPA that pays for it anyway.  The government picks up the bill for all drugs over a certain cost and in particular some of the more expensive, newer treatments (eg EPO) are covered by a separate system and the patient never gets a bill.


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## Slash (18 Dec 2006)

My experience over the last few years has taught me the following:

- If you go into hospital via A&E, generally you go to a public ward. If it looks like you will be there for an extended period, they may move you to a private or semi private if you request it, but if you are only there for a few days, you will be left in the public ward even if you have private health insurance and ask to be moved (I only learned this recently).

- If you have an elective procedure that is planned in advance, then you are likely to be given a private or semi private ward if you request it, since the consultants generally have beds available in the private and semi private sections for their patients.

My mother was in hospital for six months this year, about half of that time was in semi private. The total bill, including accommodation, drugs, and procedures came to €43,000 (yes, forty three thousand!). VHI paid the lot. No way could we have paid it ourselves.

A couple of years ago, my wife was admitted to hospital via A&E. She required an MRI scan. She had BUPA. The lady in the bed beside her also required an MRI scan. She had no health insurance. My wife had the scan on the following day. The other lady was told she would have to wait three days. No explanation was given, but it seemed pretty obvious to me.

Health insurance is expensive but I wouldn't be without it.

That's just my opinion, for what it's worth.


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## ClubMan (18 Dec 2006)

Slash said:


> My mother was in hospital for six months this year, about half of that time was in semi private. The total bill, including accommodation, drugs, and procedures came to €43,000 (yes, forty three thousand!). VHI paid the lot. No way could we have paid it ourselves.


You would not have to if she had gone public. Your liabilities would be capped at a relatively low amount. Of course going public may mean waiting lists depending on the situation.


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## imogen (18 Dec 2006)

GearoidMM

I already said I would have got treated eventually, but I do not think it would have been as fast and while IVIG doesn't help everyone, if you are one of those who is going to respond, you need to get it as fast as possible to minimise damage along with some quite expensive diagnostic tests (MRI and NCV), which definitely were picked up by BUPA. I think that BUPA coverage just made taking decisions less troublesome for the consultant. 

Since I was sick I have done hospital visiting for the GBS association and I have come across quite a few people who had no access or severely delayed access to immunoglobulin. Don't get me started on physiotherapy (or rather the lack of it). 

I was lucky because I'm in the catchment area of a major hospital with a neurology service and being from a medical family, I knew there was something badly wrong and took myself in to A&E. Try being in eg Ennis where there is no neurology coverage... I would also like to state that I totally support a free health service at the point of delivery like the NHS, and I do not approve of being forced to take out private health insurance by health service failures.

Best wishes

Imogen


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## gearoidmm (18 Dec 2006)

I agree wholeheartedly that access to certain ancillary services such as physiotherapy and convalescence are sorely lacking for public patients but any consultant who would even consider denying life-saving treatment for a patient on the basis of whether or not they have insurance in this day and age should be fired.

Unquestionably there are delays if you are waiting for elective surgery and it is a disgrace that you can get radiotherapy faster if you have insurance but I like to think that these days once you go into a public hospital the only difference that insurance makes is that you might get a single room.


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## Murt10 (18 Dec 2006)

I had some "plumbing" problems 2/3 years ago and the GP referred me to see a Consultant Urologist in the Mater. I rang to enquire how long it would take to see him. Publicly - middle of next year. Privately - Is next Monday okay. 

I was admitted to the Mater Private a short time later and spent two days there. I'm in plan B of the VHI and they didn't completely cover the cost of the stay. A day after being discharged I developed an infection and was running a very high temperature. I went back to the Mater Private but they wouldn't touch me, as they had discharged me and i was no longer their responsibility.  

Typical great private sector medicine here. Something goes wrong with the treatment you received as private patient, but the private sector fob their mistakes off on the public system who has to pick up the pieces. 

I was sent to the public A&E Dept. It was totally unreal there, talk about a culture shock. There was some wino lying on a mattress on the floor in the waiting room. He was semiconsious and attached to a drip. The nurse took his blood pressure every 10 - 15 minutes. She then came over and took every new patients blood pressure. Did she wash her hands or anything else. Not a chance. Ironic that I was back there because of some infection I had picked up in the private part of the hospital.

Anyway I was eventually taken up to a ward and the treatment I received after that was okay. I do however object to mixed urology wards. The girl in the next bed was being examined by a nurse and the curtains between us did not go the full length of the bed. She was shielded from people walking down at the end of the bed, but not from someone at the top. 

I made a bit of a bit of a fuss about the curtains but I didn't want to embarrass the girl by telling all and sundry the real reason I was so annoyed  about the curtains. 

The Urology ward is also in the old part of the hospital and there are inadequate toilets to deal with the number of patients.

I think I had better stop there.

Anyway, to get back to the original post. If you want to see a consultant with a relatively minor, non life threatning illness, then you have to see them privately. Whether you use the VHI or not or whether it represents value for money is another matter

Brendan was on the Last Word aa month or two ago with Matt Cooper argueing that a younger person should self insure and save their VHI premiums. When the time comes they can pay for the private treaatment out of their savings and the taxman will give you a 40% rebate.



Murt


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## gearoidmm (18 Dec 2006)

Matt,

I agree completely.  A lot of doctor friends that I know say that they would never go near a private hospital if they actually had something wrong with them.  This is because the level of medical cover there is nothing like what it is in public hospitals.  The junior doctors who work there are generally only passing time - these are not official training posts so anyone with any ambition wouldn't touch them.  Add to this the fact that the consultants are also working in public hospitals and so are not there if something does go wrong.


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## huskerdu (19 Dec 2006)

I agree that the system stinks. The main reason for having private health insurance is to skip waiting lists. 
NTPF does not complete fix this, as they will only deal with you after you have been seen by a consultant and refered for surgery. The waiting lists to be seen by a consultant can be months. 

Its insurance.  As some one already said, you hope its a waste of money. 
I have never claimed on my house insurance, but I know its a good idea. 

I have claimed on VHI three times, even though I was young, fit and childless. All 3 were non-urgent issues, but things I did not want to wait 1 year to be treated for. 

The fact that you are getting a semi-private bed is erelevant. You have a much higher chance of being quickly transferred to a ward from A&E, if you have private health insurance.


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## ClubMan (19 Dec 2006)

huskerdu said:


> You have a much higher chance of being quickly transferred to a ward from A&E, if you have private health insurance.


Can anybody back this assertion up with some facts?


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## huskerdu (19 Dec 2006)

Its all anecdotal, Clubman. Certainly, it happens, as was stated here, that VHI does not get you an instant bed, but I have also heard of cases whre the person with VHI was transferred to a bed a lot quicker.


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## KCT (19 Dec 2006)

The gov. spend nearly three grand each year for every man, woman and child in the country on the health service. I can't say how many of these people need the service each year but it can't be more than half. 

In order to insure they can skip waiting lists half the country pay another six hundred each. In all honesty there's a case to be made for the gov. to give all that money back to the people, scrap the "free" health system and let people pay for it themselves. The private sector would soon eradicate waiting lists, I know it's an over simplistic arguement but the current system is so bad that it's beyond reform.


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## ajapale (30 Aug 2010)

Related question move to its own thread here.

Private Health Insurance, how are private rooms allocated?


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