# Have doctor fees increased?



## Cahir (14 Oct 2003)

I had to go to the doctor on Saturday for a routine small procedure.  It cost €55.  The last time I went for this procedure in June it cost €45 and the time before that in July 2002 it was €38.  I didn't want to query it on Saturday as there were people in the waiting room and I didn't want them to know what I'd been there for.

Is there a standard pricing for doctors or are they allowed to charge what they want?

Just curious, not complaining!


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## rainyday (14 Oct 2003)

> Is there a standard pricing for doctors or are they allowed to charge what they want?


Like most professionals, doctors will charge as much as the patient will pay.


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## Rory (14 Oct 2003)

*GP Visits*

Cahir, the doctor probably had to get a plumber in durning the week to do a smallish 2 day job. The plumber probably charged him about €6,000 for the materials and labour. The GP assumes his €45 fee is pretty cheap so ups it to €55 and if he can get away with it I wouldn't blame him. Go into your local supermarket. 4 croissants for a £1 previously, now 0.56c each!! Prices keep going up and the sky is the limit.

Have doctors fees increased? As a father with two small children - you bet they certainly have, but then everything else has as well.


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## Ludraman (15 Oct 2003)

*Re: GP Visits*

"The plumber probably charged him about €6,000 for the materials and labour. "

By the rates quoted above, I presume that's your slang word for a gynecoligist?


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## Murt10 (15 Oct 2003)

*Re: GP Visits*

I only found out recently that my GP charges E40 during the week and E43 for Saturday


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## extopia (15 Oct 2003)

*Re: GP Visits*

Doctor fees in my area have increased from 20 pounds to 40 euro in the past 3 years. Nice work if you can get it.


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## rainyday (15 Oct 2003)

*Re: GP Visits*



> Nice work if you can get it.


Of course you can get it, Extopia. You just have to get exceptionally high Leaving Cert results, spend seven years in college, spend a few years working 75-100 hour weeks getting abused by drunks & drug addicts with all the security that 6-month contracts give you, get bullied by a few arrogant consultants, find a GP partnership willing to let you buy in (or start your own practice from scratch) etc etc etc.

Easy, ain't it?


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## InfoSeeker (15 Oct 2003)

*Re: GP Visits*

Well said RainyDay. We are fortunate enough to live in a country where the majority of people can access any profession that they want with a lot of discipline and sacrifice. Certainly would not begrudge them their rates as I see their work as a vocation and something that I would never wish to do myself. As with all things, shop around in your locality and you should get a reasonable market rate. Sure if we try and improve our diet and lifestyle we may reduce the cost of GP visits in the long term!!


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## uptheharps (15 Oct 2003)

*Re: GP Visits*

We (well my wife more so than me!) used a consultant gynaecologist last year for our new arrival. His fees had gone up from €1,300 to €1,800 from 2001 to 2002 - quite an increase. The Finance Act last year (I think) allowed routine maternity care fees as a tax deduction for the first time - effectively this consultant was using this as a basis for increasing his fees! Having said that we would have paid him twice that amount or more for the services rendered and the level of care given.


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## Ludraman (15 Oct 2003)

*Re: GP Visits*

......we paid our consultant as above, for 2 X 10min meetings and the birth (for which he wasn't present nor aware of!(we couldn't fit it in between 9 and 5)).

And no, we wouldn't have paid him twice!


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## Noisette (16 Oct 2003)

*GP Charges*

Is there not the danger that certain less well off members of our society may, to their detriment postpone a visit their GP because of perceived expense?


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## rainyday (16 Oct 2003)

*Re: GP Charges*

That danger certainly does exist, Noisette. Remember that the worst-off in society will have medical cards, so GP bills are not an issue for them. 

Do you have any alternative proposals (bearing in mind that any proposal needs to be workable for both doctors & patients)?


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## Noisette (17 Oct 2003)

*GP Charges*

Have some form of poverty measure Rainyday. 

Those who are well off (can afford to meet their medical needs) can afford to pay the full whack.

Those less well off - who cannot afford basic health insurance but are not poor enough to qualify for a medical card would have a portion of the fees met by the Government. 

On a side note, still don't fully understand why GP charges here are so high compared to our EU conterparts.


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## Investor (17 Oct 2003)

*Low income*

Rainyday

I suppose the issue of people not being to afford going to the doctor arises most for those on low to moderate incomes, not qualifying for medical card.

If you have two/three children and they get the usual ear infections etc in the winter, this could cost €120-140 in a single week to visit doctor.  My experience is that kids never seem to get ill all at the same time (so one visit could cover all) but rather the illness travels around the family over a couple of weeks.  I can see where there is a band of people who would and do put off going to the doctor when they shuld because of cost.

The solution, its not an easy one!


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## BOXtheFOX (18 Oct 2003)

*VHI fee + excess is the real cost of VHI.*

Ever notice that you are always just below the Excess Threshold of VHI when you want to make a claim at the end of the year as well.


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## Ammie (19 Oct 2003)

*Medical Expenses*

Well I've found a solution that works for me - I'm off up North...

Cheaper cost of living (cheaper food/clothes etc etc), and no medical expenses or dental expenses to worry about, as it's all covered by the NHS.

It's a pity we don't have something similar here, instead of charging people because they're sick.


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## rainyday (14 Nov 2003)

*GPs are con artists*

I an one of those who now puts off going to the doc because of the price.
I have had the flu last year and suffer from asthma.
I didnt go to the doc because its too expensive.
I have to pay €45 every 6 months for prescriptions for my inhalers.

Here's My last experience.

It goes like this - Monday.
Me: Hi Doc.  I nedd a new prescription.
Doc: Fine. scribble scribble - 30 seconds later - 'Thats €45 please'
Me: I also have a wart on my hand.  I see you have that freezing stuff on your table can you zap it for me while i'm here?'
Doc: Make an appointment for tomorrow and i'll look after your wart.
Me: OK.

Tuesday:
Me: Hello, here's that wart i was telling you about yesterday.
Doc: Freezes it in about 30 seconds - 'Thats €45 please'
Me: But you told me to come back when i was here yesterday.  I didn't think you were going to charge another €45 for another 30 secs work.  If i'ld know that i would have got you to do it yesterday.
Doc: I don't do Warts on Mondays.
Me: Well _obscenity removed by RainyDay_ too.  I'm never coming back here again.

---------------
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How about an hourly rate for a doctors visit.  Make sure they have to publish it then people can see how they are getting ripped off.


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## Dr Benton (14 Nov 2003)

*Re: GPs are con artists*

I am not certain that you are really interested in the probable explanation because you seem to have made your mind up.

Most GPs have a specific day of the week when they do procedures. The flask you saw on your doctors desk on Monday was probably empty. Liquid nitrogen evaporates quickly and isn't permanantly kept in most practices or even most hospitals. It is usually delivered or collected once a week for immediate usage by a doctor. It is not free. It must be purchased by a doctor who has training in its use and who is insured for the possibility of adverse events. 

By the way, I have never cursed at a patient. I think you will find most doctors don't. I wish I could say the same for the way our patients sometimes speak to us.


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## rainyday (14 Nov 2003)

*Re: GPs are con artists*

Hi Hillary - Did you ever think about asking the prices in advance of getting the treatment, so you can avoid all that nasty confrontation?


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## Dairymaid (14 Nov 2003)

*Professional Fees*

A Dubliner who emigrated to UK early 70's to get myself (a) an education and (b) work appropriate to my intelligence I sympathise with what's "between the lines" in this thread!  My then 82-year-old widowed mother became frail and needy 3 years back.  Happily she received wonderful medical care in a Dublin teaching hospital and for the last year of her life in a residential nursing home...funded by a lifetime of high contributions to VHI insurance!!  Questions and discussions with medics concerned in her treatment were no problem (I work in the NHS in the UK and know what to ask) However when it came to Social Workers, nursing staff, GP's etc. they positively EXUDED disapproval of attempts to discuss their decisions and financial implications of my mother's care.  One of the reasons I appreciate this Askaboutmoney forum is this reticence to discuss money and terms openly in Ireland.  Now in my late 50's, having travellled widely and seen how other people approach money, this aspect of Irish culture still puzzles me.  If I go to my GP with a potentially life-threatening condition (or even something trivial but anxiety-provoking) I want WHATEVER treatment is necessary to alleviate it. That's not a situations where one should have to haggle about how much it will cost and these are situations where not knowing the financial implications can add to the stress and the illness.    It does not seem ethical that professionals in Ireland (it doesn't happen here in UK!!!) can ask for "what they think they can get".  Apropos the arduous training of medics and what is being purported to be their low initial salary, we need to remember that all healthcare professionals are trained at the expense of the State, are provided with a job for life and excellent pension schemes as well as social status, and commit through the Hippocratic oath to serve, not to exploit, their patients and clients.


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## Ellie978868 (14 Nov 2003)

*GPs ARE con artists*

The experience outlined by Hilary is one i have heard about a lot.
OK, so maybe there was no liquid nitrogen in the tank.
30 seconds work is not worth €45.
I have had warts removed and thats all there is to it. 30 seconds.
And dont pretend to tell me that the patient used a whole tank of liquid nitrogen for a wart.
Thats the answer of a typical doctor.
How about telling us how much liquid nitrogen costs.
How much do you use on a wart? maybe 5 mililitres at most i bet.

Aso how come Dr that you didnt comment on the hourly rate.  
I think that makes the most sense of all.
You wouldnt be trying to get rid of patients in 30 seconds then would you?


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## Homer (16 Nov 2003)

*Re: GPs ARE con artists*

Hi Ellie

I think that's something of a generalisation that is probably unjustified.

I've no doubt there are some GPs who are mainly in it for the money and there also a lot of GPs for whom it is a vocation (but most of whom probably don't object to the fact that it also pays very well).

The case mentioned of the patient who was asked to call back the following day for wart removal and was charged another €45 sounds like the GP falls into the first category.  Our own GP recently increased his charge to €45 (amazing how they all seem to move in tandem) but generally charges considerably less for repeat visits.  This strikes me as a fair approach.

I remember a thread some time back that referred to a practice in another country of having variable charges depending on the length of the consultation - short, medium or long.  While this seems sensible, it will only take off if it becomes general practice.  Maybe we could lobby for such a change?

Regards
Homer


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## sluice44 (16 Nov 2003)

*Re: GPs ARE con artists*

I'm not a medic but I've a lot of sympathy for them.  When a medic makes a mistake people generally die.  When was the last time you made a mistake in your job?  It takes a very long time for them to qualifly and then...people sue them!

Next time you visit your GP, ask them how much their insurance is.  Divide that by 365 days and then add in all the regular bills for running an office.

You should shop around for your GP.  I'm an asmathic and my GP writes my Ventolin prescriptions for free (and he drives a HUGE Mercedes).  He charges me €40 for everything else.

Sluice


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## jem (16 Nov 2003)

*Re: GPs ARE con artists*

I disagree with many that have posted on this tread, and no I am not a doctor I am an accountant.
It is a highly skilled job that takes year to qualify in, and then there is the work in the hospitals before decent money can be made. The hours are terriable and the stress is worse. A friend of mine who is a doctor recently was off work for months due largely to the stress of work.
As far as I am aware , at least down in the sticks of Tipp, return visits are free eg if you go to the doctor on Monday and he tells you to come back on Thursday to check you again you don't pay the second day.I  will admit that with one or two if offered will take the money the second time but they are not the norm, Also if you are a regular patient of a doctor normally you wouldn't have to pay for a repeat prescription unless you needed to see the doctor for some reason.


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## Tommy (17 Nov 2003)

*Re: GPs ARE con artists*

I too think that many of the complaints voiced here are unfair and unwarranted.

For doctors and other professionals, their daily insurance cost is not the annual cost divided by 365, but the annual cost divided by the number of workdays per year. 

Professional standards compliance requirements and practice management needs usually mean that time spent with patients (ie earning time) is only a fraction of a GP's total working time. I would guess that maybe only 50% (possibly less) of a doctor's working day is chargeable time.

Unless GP's and doctors in general are paid well, the quality of patient care will suffer as our best n' brightest opt for careers as techies, barristers etc.


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## naughton (18 Nov 2003)

>Unless GP's and doctors in general are paid well, the >quality of patient care will suffer as our best n' >brightest opt for careers as techies, barristers etc.
Disagree with
  quality == pay

Ireland is becoming more and more like USA .
The middle/lower income will not be able to afford it

Here in Japan , I pay next to nothing for visiting
a local doctor .
they`re paid but not as high as Ireland!
AND service is better.


For the past few weeks , the family medical cost would have been up to 1000euros if I lived in Ireland .

Another case , is where my friend travelled home , child got sick , went to local doctor & was asked if
he was paying by travel insurance ....Cost went up
because of Insurance

Ireland needs to bring in accountability 
If a patient pays , he gets a receipt based on 
doctors tax # 

In general , doctors should be paid well but costs
should be controlled and this includes medicine as
well !!
It is another case of ripoff Ireland and this is a 
parson living in Japan(expensive country in the world)
and I think that doctor/insurance/food are more expensive in Ireland 

Also service is pretty bad in Ireland & you can include
the medical in that as well


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## rainyday (18 Nov 2003)

> Another case , is where my friend travelled home , child got sick , went to local doctor & was asked if



If this is true, your friend should report this to the [broken link removed] claim fraud hotline.


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## Carol (18 Nov 2003)

*GP*

I had a case where my French inlaws visited a local GP at his surgery. They had their E111 with them. GP claimed a higher fee as he recorded it as a home visit!


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## rainyday (18 Nov 2003)

*Re: GP*



> GP claimed a higher fee as he recorded it as a home visit!


You really should report the GP to the Medical Council.


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## naughton (19 Nov 2003)

Hi RainyDay

The friend is not going hang around and waste his
time . He is on holidays and it was his local family doctor
Also about reporting , I don`t think that the Insurance 
companies are going to pass the "PROFIT" to their 
customers .
Insurance companies are PART of the ripoff!!

Another point 
  Insurance company is japanese & not Irish

This is going off topic !!

What I`m essentially saying 

 Prices have gone up 
 Services standard have not !!
 Middle class etc will not have health insurance
  as is the trend in USA


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## Shane (19 Nov 2003)

*GP - Prices and Service.*

My GP (well you get whoever is on at the time) charged €45 a visit. Last week I changed to one who charges €35. 

Surgeries here are antiquated and show no signs of reinvestment. I sometimes wonder if doctors keep themselves up to speed in modern medicine as they flick endlessly through their Mims directory for prompting.

I well remember going to my doctor as I had a bad cold that I couldn't shake off. I also had ferocious hip pain. Spent an hour in the waiting room and 5 mins in his consultation room. He treated my cold but told me to come back about my hip. (his thinking was obviously €45 + €45). That wouldn't happen in any other country.

So Naughton I agree with you.


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## Carol (19 Nov 2003)

*GP - Prices and Service.*

Thanks Rainyday. Sounded like some sort of evasion to me.


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## rainyday (19 Nov 2003)

*Re: GP - Prices and Service.*

Hi Naughton - It sounds like you/your friend is ranting without actually being prepared to do anything constructive to fix the problem. He won't have to extend their holiday to complain. Just write them a letter or an email - it will take 5 minutes.

If GP posts are a licence to print money, one wonders why [broken link removed].


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## naughton (20 Nov 2003)

*Re: GP - Prices and Service.*

Hi RainyDay
Reporting is not going to increase # of GPs
Again going off topic 
Best to create a separate thread on this

>Young doctors could not afford huge mortgages and >the cost of staffing a new GP practice

Welcome to the real world of business & life !
This is the same for everyone 


From what I can see 
Why don`t we create an office where we can have a 
number of GPs & not just one

In a typical irish town , there`re single GPs
& they`re not too young either 


From what I understand , being a consultant is 
less hours and better money but as in any business
people will start their own business sooner or later

The lack of GPs is NOT the cause of the crazy prices
that are set in Ireland 
I`m speaking from the most expensive country in
the World....Japan

it is ripoff & unless we say that the prices will go to
100euros in the near future!
When I tell people in Japan about the prices , they`re
totally shocked


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## rainyday (20 Nov 2003)

*Re: GP - Prices and Service.*



> Reporting is not going to increase # of GPs


No - but it will prevent that doctor from overcharging in future, which was a significant part of your complaint. Why wouldn't he/you be prepared to report it?


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## Tommy (20 Nov 2003)

*Re: GP - Prices and Service.*

I find it very hard to believe that any sane doctor would put their reputation, practising cert and career at risk by fraudulently claiming a clinic appointment as a home visit - least of all when the patient is in a position to know this. 

It is all very well for people to rant & rave about doctors charging too much but when people embellsih their complaints by saying things like "and they`re not too young either" (as if one's age was any reflection of their professionalism etc) you must ask whether the tirades are motivated by logic and reason or something else entirely.


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## Carol (20 Nov 2003)

*Re: GP - Prices and Service.*

Tommy. Should I name and Shame?

Irish GP €45. French GP €18. What is it in Japan? The UK? Germany? Australia?


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## Tommy (20 Nov 2003)

*Re: GP - Prices and Service.*

Feel free to do so on strict condition that you provide your own name, address and contact details with a statement assuming full responsibility for liability in the event of a successful defamation action by the person(s) involved.

BTW, you are not necessarily comparing like with like in comparing Irish GP charges with those in France or elsewhere. Afaik in France, a large part of GP fees are subsidised directly by the State via punitive personal taxation. This may also be the case in other countries. I doubt very much if GPs cost much less in the UK than they do here. Also, doctors don't charge €45 per visit in my neck of the woods.


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## naughton123 (20 Nov 2003)

*Re: GP - Prices and Service.*

Japan:

Just paying government PRSI
 doctor visit
  Children till 6 ....Free in certain areas of Tokyo
  Other places of Tokyo ...about 8-10euros

 Adult Visit
   10-15 Euros 

BTW
 Taxes/PRSI are not high 

Tommy:
 I feel that people make a lot of excuses for prices
 Compare to France/Germany , the service is better there 

Point that I`m making is
  1. Service is better for Taxes/Price you pay aboard
  2. Ireland prices have skyrocketed for any excuse
      that Irish people make
  3. "Some" doctors charge extra prices for insurance
      claims ..There is no fix price so Insurance 
      companies can`t claim

Now look at prices above for Japan & tell me that
I`m crazy !
Don`t make excuses by saying taxes/service etc
I can tell u that I`ve access to X-rays/MRI within a
day & pay nothing extra

You need private insurance here for long hospital stays etc but that is the same everywhere !

MI
Irish people need to stop making excuses on paying
prices that are that crazy


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## Carol (20 Nov 2003)

*GP - Prices and Service.*

Ones disbelief doesn't alter the nature of the fact Tommy but your advice is appreciated. In passing, if one printed or said something and a person took a defamation action and lost what are the possible outcomes?


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## tellcodude (20 Nov 2003)

*Doctors*

I have yet to go to a Doctor (i live in Dublin) that doesn't charge for a repeat visit.
I got a script for inhalers -  €45 then was told because i am asthmatic i should get the Flu vaccine so i agreed and was told to come back next day.
It took 2 minutes and cost €60, then i hear on the news that the vaccine is given to the GP free by the state.

Grand total of €105 for about 5 minutes work.
Now thats money grabbing.


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## rainyday (21 Nov 2003)

*Re: Doctors*

Can I make two recommendation to all those who feel 'done' by their GP's;

1) Tell your GP - You really won't change anything by posting about it here. But if you look the guy in the eye and tell him exactly how you feel, it might have some impact.
2) Ask your GP about fees in advance of any treatment. When he suggests a return visit, ask him if you will be charged for that visit (or tell him you expect not to be charged for that visit).


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## naughton (21 Nov 2003)

Agree with Rainyday on those points

Wondering why in Ireland we don`t create a
Price Table as in the case of Fuel Prices Web Site

Now have to get expensive travel insurance for 
Christmas ;->


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## jimmyflyd (23 Nov 2003)

*More*

I'm sure people do this already. I do, but it makes no difference.
An hourly charge displayed outside the doctor's or dentist's office is that way to go here.


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## Tommy (23 Nov 2003)

*hourly rate?*

Given that our health services are already grossly inefficient and prone to clogging up, I doubt if it would be wise to introduce a system whereby doctors would be encouraged to stretch out the length of consultations to maximise their fees. 

Dont fool yourself into thinking that any such scheme would reduce patient costs.

First of all how do you calculate the stated hourly rate - exclusive or inclusive of overheads, support staff costs etc?

Secondly how would you ensure that patients wouldn't simply be required to spend longer and longer hanging around surgeries being "assessed" by nurses etc with doctors popping in once or twice per hour to "add" their opinions - thus justifying an apparently "reasonable" inclusive hourly rate of say €100 per hour - in much the same manner as hospital consultants now operate?


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## glasshouses (23 Nov 2003)

*throwing stones*

Book-keepers and accountants.
Draughtsmen and architects.
Apprentices and electricians, brickies, builders, hairdressers.

No shortage of "added" opinions, is there?


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## Mary (23 Nov 2003)

*NI*

or there's Option three, which I'm doing;

3) Move to Northern Ireland

Where you aren't made to pay for gp/consultant consultations, medicines, hospital stay, ambulances etc.  You are not penalised for "choosing" to become sick.


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## joeymalin (29 Nov 2003)

*You must be joking*

Don't even try to tell me that you think that putting up an hourly rate outside a surgery is not possible.
Of course it is, the same way anyone else manages to charge an hourly rate.  All tradesmen, professionals, must sit down and do their sums to arrive at an hourly rate suitable to them.  Doctors aren't so stupid they wouldnt be able to do this either.
This hourly rate would add one important factor to the market...... COMPETITION.
If a punter sees one doctor charge €30 per hour and another charge €100 which will they go to?

There should be a particular standard of service.
If i go to a doctor i would love pay for his skill by TIME.
If he leaves me waiting while he goes off and does something else then he's not entitled to charge me for this time is he.

It strikes me as clichey that all the accountants, solicitors etc are defending the doctors in this matter.
Could is possibly be that if doctors are forced to adopt an hourly rate then all other over chargers will sooner or later be forced by the govt to follow suit.  
I WISH.


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## rainyday (29 Nov 2003)

*Re: You must be joking*

Charging by the hour/minute isn't really the answer. There are many ways for a doctor to scam such a system by dragging out consultations, if they wished. Just as there are many ways for accountants/plumbers/solicitors/programmers to scam such a system.

The answer is simple. Ring the Doc beforehand - Ask him or his secretary for the cost in advance. If he can't give you a price, keep on phoning round until you get one.

Mind you, that implies that price is your major decision making criteria when choosing a doctor - Is that really what you want?


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## naughton (1 Dec 2003)

>Mind you, that implies that price is your major decision making criteria when choosing a doctor - Is that really what you want?

Rainyday 
I agree with most of what u say especially about
ring the doc beforehand

But all docs have the same qualification !


Now if you had a common cold etc any doc will do!

price != quality 
as i said before


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## Tommy (1 Dec 2003)

In any professional job (or indeed any role in life) factors such as expertise, experience, manner etc matter to customers just as much as formal qualifications. 

In any town or region in Ireland you will hear stories of "bad" doctors, accountants, solicitors, auctioneers, dentists etc all of whom have the same qualifications as their peers and competitors, but who (according to customers) let their customers down in some way or other. No matter how cheaply these guys offer their service, many people generally choose to stay away. Would you prefer an expensive dentist or a clumsy dentist? 

Even when the service provided is top-class, some other things (price apart) can put people off. One particular professional who has been recommended many times on AAM as providing a quality, value-for-money service has been criticised by other contributors who have complained about their manner and way of dealing with people. Some of these people said that they wouldn't deal with this person again.


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## rainyday (1 Dec 2003)

> But all docs have the same qualification !


Not really. Sure - they all have the same basic initial qualification, but they do go on to specialise in other areas. And even if they did all have the same qualifications, this doesn't mean that they are all equal. I've been fortunate enough to find a superb GP, who doesn't rush his patients, is reluctant to dish out the drugs unless strictly necessary and has a great manner. I certainly wouldn't consider changing my GP to save a fiver per visit.


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## naughton (2 Dec 2003)

Rainyday/Tommy

Of cource everyone goes to doctor that they`re
comfortable with !
I do it as well

My point is that you`re associating price with it 

It comes down to this
Customer 
  Japan Doctor Visit for Adult approx 10-14 euro
  Japan Doctor Visit for child till 6      Free

  Ireland Doctor Visit for Adult approx   30-55 euro
  Ireland Doctor Visit for child till 6   ??


I`m basing this non-medical card but PRSI payments
PRSI payments are low(don`t have a %)


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## Tommy (2 Dec 2003)

As  I said earlier, you may not be comparing like with like - ie are our tax rates, state healthcare system, social priorities and culture etc similar in Japan to Ireland? Just because something costs less in Japan or Bolivia doesn't automatically mean we are getting bad value if we pay more in Ireland. Conversely, if a pint costs €10 in Scandanavia doesn't mean that it is good value in Dublin at €5.


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## Marie (3 Dec 2003)

*Professional fees*

As far as I know medical training in the Republic is state-subsidised, no?  Therefore the PUBLIC purse pays for doctors' expertise and this is what creates the muddle about what's being paid for, and at what stage of service delivery.  The problem seems to be that only some aspects of the healthcare system are free to only some patients. That is the situation the NHS here in the UK is heading towards with public-private partnership, the increase in so-called "private healthcare" (which is as I'm pointing out actually subsidised by the general taxes!).

It's difficult to get a clear idea of health costs in Ireland.  My recent experience was of my 84-yar-old mother who had even after retirement and widowhood paid for GP consultations and for necessary medicines for heart-condition etc.  When I looked around my family there were 5 uncles, aunts, attending GP surgeries probably fortnightly, all paying VHI insurance covering their medical conditions/hospitalisations etc.  This didn't compare favourably to the UK where GP treatment, pharmacy, AND necessary inpatient admissions would be free.  

HOWEVER when my mother became very ill (she died last October) and required admission to a Dublin hospital, her treatment and accommodation was superb (she HAD, admittedly, VHI full cover!).  An elderly brother of hers over from Surrey fell and broke his hip whilst visiting her in the hospital, had a heart-arrest during his hip-op, and was subsequently seriously ill in intensive care for the next 3 months.  He did not have the likes of VHI, but received (as had my mother on VHI) outstanding medical and nursing care, including being accompanied back to Heathrow by a young medic.  His problems only started when he got back to our seriously-depleted service in the UK, where he nearly died a few weeks later through medical negligence.

Sounds as if the health services in the Republic would be best served - given the scale - by funding exclusively from public taxation.  Standards and clinical governance would also be then more easily applicable to the profession and everyone would benefit


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## Frank (4 Dec 2003)

*GP Fees*

They should have a clear customer service charter.

If they keep you waiting 20 mins beyond your allotted appointment time they should offer you some form of compensation. Time is money, especially these days. 

You wait for ages. They only spend five minutes with you, do not really listen to you, and relieve you of €45. No wonder there is such an increased risk of misdiagnosis. Do we have many medical malpractice lawyers here in Ireland.


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## naughton (4 Dec 2003)

Tommy

>Conversely, if a pint costs €10 in Scandanavia doesn't mean that it is good value in Dublin at €5.

enjoyed that !!

For me I don`t think that Taxes are 3-4 times more
expensive here

Friends who have returned home have said startup
costs are expensive which is expected 
They don`t mind that !
they also say that standard of living whixh is true
(no matter what anyone says)


After they settle down , their biggest complaint is 
Doctor charges .


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## John (5 Dec 2003)

*GP Fees*

Fees have increased service decreased.


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## darag (5 Dec 2003)

*Re: GP Fees*

Marie, do you not think that the priority should be for
people like your uncle and mother who urgently required
serious hospital care instead of making gp visits 
and "unnecessary medicines" free?  that's the conclusion i'd 
draw from your experience.


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## Marie (9 Dec 2003)

*GP Fees*

Darag - The problem is insufficient public knowledge about pathology.  The risk with limiting access to GP's is the potentially fatal case (like undiagnosed meningitis).  I lived in Italy for a year in 1968 and was impressed by the extensive use made of pharmacists'.  People initially consulted (a) family and relatives about their symptoms (b) their local pharmacist, who had power to prescribe (c) as a last resort - and that meant the ailment MUST BE serious - the doctor!  It comes down to the power accorded the medical establishment (and by that I don't mean they arrogate that power; it is actively BESTOWED on them by the populace).  I value the medical fraternity and their specialist knowledge but perhaps here, too, we could have a "step-down" approach?  If pharmacists and other specialist professions allied to medicine had greater profile then doctors would be freed up to work more efficiently at a different level.  Sure!


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## naughton123 (17 Feb 2004)

*Re: GP Fees*

Well after going home and getting screwed on
the rentacar at christmas...it was time to go to
GP
One kid got sick ...cost 40 euros for 2mins...medicine
12 euros....
Travelled down the road & the other kid got sick
Cost ..30 euros for 2 mins (different doctor ..smaller town) & another 12-13 for medicine


so overall approx 90 euros for 2 kids sick

I`ve no problem paying for emergencies BUT
when I got on the airplane  , I`ve realized that 
Ireland is got beyond comprehension

BTW kids are fine but got colds again & it costed
me nothing when I got home


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## rainyday (17 Feb 2004)

*Re:  Re: GP Fees*

So what medicine did the doc's perscribe for a child's cold?


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## naughton123 (18 Feb 2004)

*Re:  Re: GP Fees*

Hi RainyDay
Wow forgot the name of the medicine 
It was Pink and tasted terrible ;->

They were vomiting 
It was flu/cold with stomach bug

Visiting the 2 doctors all happened with 2-3 hours ;->
Ooooh what a great day it was 

I just want to emphasize something ...I don`t mind
paying but Wow ...what a cost for people living with kids !!


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## daltonr (18 Feb 2004)

*Re:  Re: GP Fees*

I'd have given the 2nd kid half of the 1st kids medicine.

 

-Rd


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## bubbles (19 Feb 2004)

*you can't do that*

You don't know for sure that the two children suffer from the same condition!  Symptoms may be the same to the untrained person, but could be from totally different causes. Think about the symptons for meningitis.

My mother-in-law had a bit of a turn one day and took her husband's medicine as she thought it was for the same sort of symptons she had, and she ended up in hospital quite ill.

You cannot take any chances with a child. That's why there are a lot of families in Ireland where the mothers of young children never go to the doctor for their own problems; whatever money is available for medical costs is spent purely on the children.


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## daltonr (19 Feb 2004)

*Re: you can't do that*

I guess my smilie didn't get accross the humour in my suggestion.  

Maybe this would have been better:    

-Rd


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## tobo (20 Feb 2004)

*Re: GP Fees*

Frank asked:



> Do we have many medical malpractice lawyers here in Ireland.



That question is now very hard to answer given that us lawyers are now so restricted in promoting our particular skills, specialties and services.  How would it be if doctors could only promote themselves as a doctor rather than as a surgeon, a gynaecologist, a neurologist, etc.  Greater transparency whether that be in respect of prices, services offered, quality standards and other matters of concern to customers should be introduced in respect of all the professions including medicine and law.  Then the public may have a real choice.


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## bubbles (20 Feb 2004)

*oops!*

Apologies, Dalronr, I thought you were serious!

Bubbles


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## naughton123 (20 Feb 2004)

*GP Fees*

Hi Dalton 
I got it first time

sad thing is :
 that they were the same medicine with same dosage

but of course I can`t take a risk between a baby 
and a toddler


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## purple (1 Mar 2004)

*Restricted entry*

The Irish College of General Practitioners (ICGP) controls the number of doctors that can train vocationally as GP's. You need your vocational training to get a medical list. The candidates are selected by interview so the old boy/old girl network it alive and will. 
This means that they can control entry into the GP industry, it is a long time since my leaving cert economics but as far as I remember if you can control supply or demand you can generate supernormal profits. I know a GP in Kildare who charges E30 per surgery visit. On extra charge for follow up visits/ collection of blood tests etc. I asked him why he didn't charge more, he said he earns over 200k p.a. the way it is, he's not a greedy ba%$£*d! (in his own words).
The problem is that doctors, like all professionals, need independent regulation. Can you imagine if the taxi drivers had, upon deregulation, said "We will set up a council of taxi drivers to set and police the standards within our profession, and don't worry we won't be self serving". 
They would have been laughed out of it! 
Are we the public being told that professionals are a better sort than the rest of us and so are not as subject to independent scrutiny?
I know lots of lawyers and doctors, many in my own family, and they are no better or worse that the rest of us. Why are they treated as if they were?


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## Tommy (1 Mar 2004)

*Re: Restricted entry*



> "We will set up a council of taxi drivers to set and police the standards within our profession, and don't worry we won't be self serving".



This is precisely the argument that journalists (the same people who preach the mantra of accountability for everyone else) have made in the past 6 months to resist the introduction of Press Council to enforce standards. Bet you won't read that in the newspapers...


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## purple (1 Mar 2004)

*Re.Press Council*

Absolutely! Journalism is one of the most heavily unionized bodies in the country. 
The big picture is that we have a system of "professional" groups that goes back to the era when it was acceptable for members of the gentry to engage in only certain forms of employment and so a distinction had to be made between them and the riff-raff. They could not be taxed or supervised as if they were commoners. They were gentlemen and their honor was above reproach, so how dare some little civil servant, who actually had to work for a living, inquire after a gentleman's business. They had to restrict entry in case the "wrong sort" got in. They had to self regulate in case one of their members wouldn't play the game. Hence we have the professions. 
I am not saying it is like this now but the notion that a kid from Finglas who gets through college and has the smarts has the same chance of becoming a consultant, or managing partner in a firm of solicitors, as the kid who's parents are in the same game or went to the right school is laughable!

When those in the game can control who and how many the new players will be, they control the game.   
High prices all around the the doctors are only trotting after the lawyers!
This is a republic, all equal under the law etc, isn't it time to run the professions for the benefit of the consumer rather than the enrichment of the professional?


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## Tommy (1 Mar 2004)

*Re: Re.Press Council*

Hi purple, 

Although I agree more or less with what you say, its also worth noting that increased regulation normally drives consumer prices upwards, due to increased bureaucracy and costs. It certainly has done so in my own field of accountancy (an "open" profession no barriers to entry for most types of work) with in the past 5-10 years.


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## purple (2 Mar 2004)

*Regulation*

Hi Tommie, I do take your point on regulation but surely there is a cost at the moment for self regulation?
Could the membership fees that are currently payed not be used to fund independent regulation? I know that it's not the panacea but it's a start. 
I would have thought that increases in insurance costs, due to a large extent to legal costs, have had a greater impact on your fees in the last few years.
As for your profession, I have found that I can shop around for an accountant and get pretty good value. The cost of tax returns for my wife (a GP of all things!) and our meager investment properties varying by over E1200 from one accountant to another. 
So you guys are will down my "things to rant about" list.


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## tobo (7 Mar 2004)

*Re: Regulation*

Purple said



> I would have thought that increases in insurance costs, due to a large extent to legal costs, have had a greater impact on your fees in the last few years.



This view about legal costs arises because of the most effective propaganda of the insurance industry.  I am a solicitor and over the past 6 years I have  noticed only reductions in legal costs and reductions in the value of awards/settlements.  These are significant reductions in the order of at least 30% in the last 2 years alone.  The hike in insurance costs is more about the profiteering of the insurance companies and the lack of competition in that area.  Please check your facts before making such a wide assertion.


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## purple (8 Mar 2004)

*Re:Tobo*

I stand most humbly rebuked.
It's just that I did read that legal costs accounted for 40% of insurance costs here as opposed to 8% in the UK. This stat was also bandied about on the radio so if it's incorrect don't blame us plebes. I know that this could well be down to structures rather than profiteering but it's still a big slice of the cake. 
Any attempts to change the structures by the government have been, as far as I have seen, rubbished and resisted by the legal profession without any proposals of their own to achieve the same end.
If insurance companies are profiteering than it reinforces my point about the need for proper regulation as you are saying that it's not the lawyers screwing everyone, it's the insurance companies.


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## Tommy (8 Mar 2004)

*Re: Re:Tobo*

Hi Purple





> ...surely there is a cost at the moment for self regulation? Could the membership fees that are currently payed not be used to fund independent regulation?



The point is that all systems of regulation, whether self-regulation or independent regulation, cost money. The heavier the regulation, the heavier the fees paid by members to fund the regulatory requirements, and the higher the cost ultimately passed on to customers in charges. 



> As for your profession, I have found that I can shop around for an accountant and get pretty good value.



That's good to hear. Unlike other professions with standard scale fees for different work categories, there is strong competition in the accountancy market.


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