# Two-tier Health System



## dereko1969 (19 Sep 2012)

Proof, if ever it was even required, that those in the public health system are treated worse than those paying for private health care.

[broken link removed]

"_*A consultant surgeon who delegated an operation to a registrar who carried out the wrong procedure said if he had known Baby X was a private patient he would have done the procedure himself*_."

So even though he also had a contract with the State to provide consultancy services, the only contract he was bothered with was his contract with private insurers?


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## Yachtie (20 Sep 2012)

I know a theatre nurse in one of the country's biggest hospitals. She told me categorically that all patients regardless of whether public or private receive the same treatment by nursing staff. 

From experience, I would somewhat agree that consultants don't necessarily operate on the same basis and that's where we need the reform. With so much HSE administration in place, there has to be an easy way of public vs. private being dealt with in the background without the frontline staff even knowing which patient is 'worth more'. 

I also think that there should be a clear split in time any medical professional deals with public vs. private patients, mainly to ensure that public patients are not eternally stuck on endless waiting lists. Consutants should be paid the same amount of money per patient and if private health insurers are willing to pay a bit more for appointments, then the hospital budget should be supplemented by the excess. In my opinion, private health insurance should serve no other purpose than to buy patient an appointment sooner, rather than better quality care.


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## Purple (20 Sep 2012)

Consultants should be public or private, not both.


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## Firefly (20 Sep 2012)

Purple said:


> Consultants should be public or private, not both.


 
When you put it like that, the solution seems so obvious.


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## Shawady (20 Sep 2012)

We recently became aware that our child needed to attend an eye specialist. He needs to see someone now as it will be too late to do anything for his condition in 2 to 3 years. All the hospitals have a waiting list of at least 2 to 3 years so it's not an option. The fact we pay 2.5K a year on health insurance was irrelevant. We rang around a couple of private hospitals and got an appointment within one week (for a fee of €150 of course).

Something wrong with the system.


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## truthseeker (20 Sep 2012)

Agree Shawady.

I had the same experience at the beginning of this year when my GP referred me to an ENT, she gave me a referral letter and said to check with his secretary how long his public list versus private was - and choose myself. His public list was 2 years long, anywhere he sat. His private list was 3 weeks long (same places). Naturally I took the 3 weeks.


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## Protocol (20 Sep 2012)

truthseeker said:


> Agree Shawady.
> 
> I had the same experience at the beginning of this year when my GP referred me to an ENT, she gave me a referral letter and said to check with his secretary how long his public list versus private was - and choose myself. His public list was 2 years long, anywhere he sat. His private list was 3 weeks long (same places). Naturally I took the 3 weeks.


 
*In my opinion, that is immoral, unChristian, and a shame on our society.*

I have great respect for doctors.

But two separate waiting lists based on ability to pay is criminal in my opinion.


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## Purple (20 Sep 2012)

Protocol said:


> I have great respect for doctors.



I don’t.
There are as many (or more) greedy, dishonest and unscrupulous doctors as any other trades or professions. I’d say they are probably more self serving than any other profession as they believe their own hype.
If they were really that interested in helping people they wouldn't charge as much as they do (I include all doctors in that statement).


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## Purple (20 Sep 2012)

Protocol said:


> But two separate waiting lists based on ability to pay is criminal in my opinion.



Where's the universal health insurance system that this government promised?

The state shouldn't employ any doctors or nurses; there shouldn't be any public healthcare system. There should by publically funded insurance for those who cannot afford it themselves. That way everyone is a private patient as far as the doctor is concerned so he or she will see the illness and not the next repayment on their boat.


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## truthseeker (20 Sep 2012)

Protocol said:


> *In my opinion, that is immoral, unChristian, and a shame on our society.*
> 
> I have great respect for doctors.
> 
> But two separate waiting lists based on ability to pay is criminal in my opinion.



I agree. Traditionally ENT is a busy one in the public system for whatever reason.

There may be other consultancies where the public Vs private waiting list difference is a lot shorter.

Another reason that someone may prefer to go private is the guarantee of continuity - they will actually see the consultant himself and not one of his minions. I had the bad luck to be in the public system for years with an orthopediac issue (the original operation was as a teenager, they used to give me an annual appointment thereafter until I just stopped going one year in my early 20s because of the lack of continuity). Each year I would waste most of the very short appointment bringing whoever I saw up to speed on what the original problem was, what was done in the operation, the problems I was now having (or not) etc.. I always just felt it was a waste of time. No one actually listened to me, no one actually knew why they were seeing me, I was basically just taking up a slot on the public system because the standard procedure was to have me come back in once a year. 

So much time is wasted in the public system in this way.


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## Yachtie (20 Sep 2012)

Purple said:


> Consultants should be public or private, not both.



That sounds very simple but also very impractical. If consultants had a  choice of being either public or private, there would be no consultnts  available for public patients.



truthseeker said:


> Agree Shawady.
> 
> I had the same experience at the beginning of this year when my GP referred me to an ENT, she gave me a referral letter and said to check with his secretary how long his public list versus private was - and choose myself. His public list was 2 years long, anywhere he sat. His private list was 3 weeks long (same places). Naturally I took the 3 weeks.



My husband was referred for some sort of a test at the end of June and got an appointment 2.5 weeks later, thanks to his private health insurance. 

A colleague of his was referred for the same procedure in January this year as a public patient and still hasn't had his appointment. 

I loathe this two-tier system based on ability to pay but would also hate being at mercy of public healthcare if something ever went seriously wrong. Just think about it, cancer which could have been 'caught' early enough to be treatable can get to advanced stages by the time you get an appointment to be seen. That's terrible!


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## Purple (20 Sep 2012)

Yachtie said:


> That sounds very simple but also very impractical. If consultants had a  choice of being either public or private, there would be no consultnts  available for public patients.


No, there are some that only have public lists.
Do remember that on top of their pay they are provided with receptionists and support staff and, as far as I know, have their insurance paid. They would have to pay for all that themselves if they only had a public list.


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## truthseeker (20 Sep 2012)

Purple said:


> No, there are some that only have public lists.
> Do remember that on top of their pay they are provided with receptionists and support staff and, as far as I know, have their insurance paid. They would have to pay for all that themselves if they only had a public list.



Yeah, my understanding is that its to do with use of theatre, staff and insurance.

Thats why you tend to see a guy who sees both public and private in the same hospital - they make arrangements in places where they are already seeing public patients to see private ones too.

But its got to be more complex than that, if you are private only you probably wont have access to newer techniques being taught in the big teaching hospitals (or pioneering them yourself).

I know my last orthopediac guy looked down on a previous one Id seen because he was private only now and he actually commented sneeringly 'couldnt get a public salary'.


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## Purple (20 Sep 2012)

truthseeker said:


> he actually commented sneeringly 'couldnt get a public salary'.




That has more to do with money than access to skills.
The average payment per consultation is usually higher for public patients when you take all of the payments, including staff etc, into account. That's certainly the case with GP's where it's €50 average for private and €65 average for public. a 30% premium for working in a protected sector... not bad!


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## Guest105 (20 Sep 2012)

Purple said:


> Where's the universal health insurance system that this government promised?


 

What has happened to this promise??  

Every voter should ask Minister Reilly about this promise of universal health insurance the next time he comes knocking looking for votes.


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## Purple (21 Sep 2012)

cashier said:


> What has happened to this promise??
> 
> Every voter should ask Minister Reilly about this promise of universal health insurance the next time he comes knocking looking for votes.



...and how are they going to introduce universal free at the point of delivery GP care without it?


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## Firefly (21 Sep 2012)

IF ABORTION was available in Ireland there would be a 10-month waiting list, Senator John Crown warned today.

http://www.independent.ie/national-...fends-abortion-waiting-list-joke-3236119.html


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## truthseeker (21 Sep 2012)

Firefly said:


> IF ABORTION was available in Ireland there would be a 10-month waiting list, Senator John Crown warned today.
> 
> http://www.independent.ie/national-...fends-abortion-waiting-list-joke-3236119.html



More worryingly, from that link:



> He said: “113,000 patients waiting for a year or more to be seen and 16,600 waiting four years or more to be seen – these are appalling figures.”



Who would wait 4 years or more to be seen?


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## Firefly (21 Sep 2012)

Crazy, considering the billions that we are spending every year for a small population.


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## Shawady (21 Sep 2012)

truthseeker said:


> Who would wait 4 years or more to be seen?


 
My elderly next door neighour told me had a procedure for a non-life threatening condition after a 3 year wait.
His son lives in another EU country and has the same condition. He had it done after 3 weeks!


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## truthseeker (21 Sep 2012)

Shawady said:


> My elderly next door neighour told me had a procedure for a non-life threatening condition after a 3 year wait.
> His son lives in another EU country and has the same condition. He had it done after 3 weeks!



Yeah, I suppose if you had something that wasnt painful or life threatening you might wait.

I havent really had experience of anything like that, any time Ive needed to see a consultant my life was being quite adversely affected by whatever was wrong.


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## Yachtie (21 Sep 2012)

Purple said:


> No, there are some that only have public lists.
> Do remember that on top of their pay they are provided with receptionists and support staff and, as far as I know, have their insurance paid. They would have to pay for all that themselves if they only had a public list.



Is there some sort of stipulation as in how many public patients a consultant who uses a room in a public hospital, has his insurance and staff paid by the HSE, has to see every day / week / month / year? Without having strictly defined minimum numbers, a counsultant could technically see one or three public patients a week / month/ year which would explain such long waiting times for public patients.

I remember being referred to the consultant years ago when I didn't have private health insurance. I received a letter stating the date and time of my appointment and that the €150 fee is payable by cash or cheque as there were no credit / debit card facilities. I wrote to the GP who referred me and told him that I wasn't happy about the fee (my referral was for a consultant to rule out an already 90% ruled out possibility and wasn't to do with anything overly serious). An hour later I received a phonecall informing me that I would be seen on the same date, same time as a public patient.


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## Gordanus (24 Sep 2012)

Purple said:


> No, there are some that only have public lists.
> Do remember that on top of their pay they are provided with receptionists and support staff and, as far as I know, have their insurance paid. They would have to pay for all that themselves if they only had a public list.



Surely you mean they'd have to pay all the receptionists & support staff (including theatre nurses) themselves if they only had a PRIVATE practice?  Eg those working in private clinics need to contribute to the payment/employment of support staff.   Those consultants using HSE facilities for their private patients - are they paying the HSE for the time of the nurses and other support staff?? Anyone know?

The HSE pays most of insurance for consultants and other doctors they employ as far as I know.



Yachtie said:


> I loathe this two-tier system based on ability to pay but would also hate being at mercy of public healthcare if something ever went seriously wrong. Just think about it, cancer which could have been 'caught' early enough to be treatable can get to advanced stages by the time you get an appointment to be seen. That's terrible!



Yes.  A close relative died because his curable cancer wasn't caught in time.  There is something very rotten in Ireland, and it's just been exemplified by the latest community health centre scandal, with O'Reilly prioritising his constituency and then shamelessly using an interview about it to make an election-type speech to his constituents.


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## Yachtie (25 Sep 2012)

I do have to add that I am not 100% sure about the proposed 'free for all' health care at the GP level (if it ever materialises) for a very simple reason. A sister in law of mine lives in a country where such system is in place and brings her kids (2 and 4 yo) to see a doctor every couple of weeks, often with stuff as small as sniffles or upset tummy. I am not saying that people should neglect their health and go to see a doctor only if a limb is about to fall off BUT I can see this 'free for all' system creating unneccessary congestion in GP's waiting rooms and therefore reducing the level of care we are all currently given. Even a small, nominal charge of maybe €10 per visit, re-deemable at the end of tax year or something similar would deter those who go to GP just to be told to keep warm and take plenty of fluids.


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## truthseeker (25 Sep 2012)

Yachtie said:


> I do have to add that I am not 100% sure about the proposed 'free for all' health care at the GP level (if it ever materialises) for a very simple reason. A sister in law of mine lives in a country where such system is in place and brings her kids (2 and 4 yo) to see a doctor every couple of weeks, often with stuff as small as sniffles or upset tummy. I am not saying that people should neglect their health and go to see a doctor only if a limb is about to fall off BUT I can see this 'free for all' system creating unneccessary congestion in GP's waiting rooms and therefore reducing the level of care we are all currently given. Even a small, nominal charge of maybe €10 per visit, re-deemable at the end of tax year or something similar would deter those who go to GP just to be told to keep warm and take plenty of fluids.



I agree with you Yachtie. Although its years since my GP ever diagnosed anything, Dr Google has always given me the answer and when I go and tell her I think Ive got, whatever, she tend to just agree!

This business of repeat prescriptions for certain medicines like the contraceptive pill, asthma inhalers, anti inflammatories etc that require a doctors appointment that are a terrible waste of time, or referrals when the person knows they need referral (for an old problem that flares up from time to time for example).


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## Complainer (25 Sep 2012)

Yachtie said:


> I do have to add that I am not 100% sure about the proposed 'free for all' health care at the GP level (if it ever materialises) for a very simple reason. A sister in law of mine lives in a country where such system is in place and brings her kids (2 and 4 yo) to see a doctor every couple of weeks, often with stuff as small as sniffles or upset tummy. I am not saying that people should neglect their health and go to see a doctor only if a limb is about to fall off BUT I can see this 'free for all' system creating unneccessary congestion in GP's waiting rooms and therefore reducing the level of care we are all currently given. Even a small, nominal charge of maybe €10 per visit, re-deemable at the end of tax year or something similar would deter those who go to GP just to be told to keep warm and take plenty of fluids.



I remember seeing the figures for GP visits per patient per annum for NI (free GP care) and ROI - broken down by medical card holders and non-medical card holders. There were all largely the same. We all have our 'sister-in-law' stories, but as a whole, free GP care doesn't create more visits.


cashier said:


> What has happened to this promise??
> 
> Every voter should ask Minister Reilly about this promise of universal health insurance the next time he comes knocking looking for votes.



Painful and all as it is to defend Reilly, the last thing we need is to rush into turning our system upside down based on a model that is largely unproven. Be careful what you wish for.


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## Purple (26 Sep 2012)

Complainer said:


> I remember seeing the figures for GP visits per patient per annum for NI (free GP care) and ROI - broken down by medical card holders and non-medical card holders. There were all largely the same. We all have our 'sister-in-law' stories, but as a whole, free GP care doesn't create more visits.



Link please.

From talking to GP's I know (including one I'm married to) they disagree with your views. They must all be wrong.


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## roker (30 Sep 2012)

I have an eye appointment for Feb 2014, a lot of eye problems require prompt attention, if I go private will I have to pay consultant follow up fee's as well as the first fee?


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## Purple (30 Sep 2012)

roker said:


> I have an eye appointment for Feb 2014, a lot of eye problems require prompt attention, if I go private will I have to pay consultant follow up fee's as well as the first fee?



Call and ask them.


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## truthseeker (30 Sep 2012)

roker said:


> I have an eye appointment for Feb 2014, a lot of eye problems require prompt attention, if I go private will I have to pay consultant follow up fee's as well as the first fee?



I think probably.


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## orka (1 Oct 2012)

roker said:


> I have an eye appointment for Feb 2014, a lot of eye problems require prompt attention, if I go private will I have to pay consultant follow up fee's as well as the first fee?


This has been asked a couple of times before on AAM and I think the feedback was that while you might very occasionally find a consultant who will see you for a first consultation privately and then move you onto his public list for treatment, the general rule is that if you start seeing a consultant privately, you must continue the treatment privately - otherwise many people would pay the initial consultation fee to skip the public queue.


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## Complainer (2 Oct 2012)

orka said:


> This has been asked a couple of times before on AAM and I think the feedback was that while you might very occasionally find a consultant who will see you for a first consultation privately and then move you onto his public list for treatment, the general rule is that if you start seeing a consultant privately, you must continue the treatment privately - otherwise many people would pay the initial consultation fee to skip the public queue.



It's hard to see how this could be enforced. What happens if you run out of money after the initial consultation - are you refused life-saving treatment because you had the temerity to pay last time? Unless HSE or the hospital has a documented policy around this, they can't refuse treatment. You may not get to skip a queue, but you can't be refused.


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## orka (3 Oct 2012)

Of course people can go back to the public system.  What I meant was that if you want to continue being treated by the consultant ahead of the public queue, you will probably need to pay - so for roker's eye problems, he might see a consultant for a first appointment but if he then wants to go public, his next consultation/treatment might be after his original public appointment of Feb 2014.


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## truthseeker (3 Oct 2012)

orka said:


> Of course people can go back to the public system.  What I meant was that if you want to continue being treated by the consultant ahead of the public queue, you will probably need to pay - so for roker's eye problems, he might see a consultant for a first appointment but if he then wants to go public, his next consultation/treatment might be after his original public appointment of Feb 2014.



I have generally found that its waiting for the first appointment that is the bottleneck. Once you are in the system things tend to move faster. And for some treatments its necessary to be seen within a certain time frame after treatment begins (so you might get put on a prescription and then have to be checked a few weeks later) - as an example, I saw an orthopediac surgeon privately, 1 week wait for the appointment, it would have been 6 months on the public queue. The surgery needed wasnt covered by my insurance so he put me into his public list for surgery, only 6 weeks wait. After the surgery I had to be seen within 2 weeks - public also (his post op queue was necessarily short as people had to be seen to remove stitches etc). At the post op appointment he told me if I needed to see him again to phone and make a public appointment but to be sure to say I was already a patient of his as Id be seen faster. So from initial phone call to post op appointment was 9 weeks in total - and only the first appointment was private. Had I waited for a public appointment it would have been maybe 8 months in total.


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## Purple (4 Oct 2012)

Complainer said:


> Painful and all as it is to defend Reilly, the last thing we need is to rush into turning our system upside down based on a model that is largely unproven. Be careful what you wish for.


The system is in place in many European countries. They all spend less per head on healthcare and have better health care outcomes (better services). Don't let the facts get in the way though.


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## Firefly (4 Oct 2012)

Complainer said:


> It's hard to see how this could be enforced. *What happens if you run out of money after the initial consultation - are you refused life-saving treatment because you had the temerity to pay last time?* Unless HSE or the hospital has a documented policy around this, they can't refuse treatment. You may not get to skip a queue, but you can't be refused.


 
I think the latter part of your post raises an interesting point. However, for the highlighted section above, would you like to explain why someone would be reckless in paying for healthcare if the public waiting list is so bad? Surely this is a symptom of a failed healthcare system rather than a problem with the patient, who cannot wait?


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