# When would you need a hi-tech hospital?



## Brendan Burgess

I have recently switched to the Flex 500 Explore System with Laya. 


There is a €100 shortfall per night for a  private room in all private hospitals including the Beacon.

But in the Blackrock Clinic and Mater Private, there is a €200 shortfall per night. 

If I need hospital care, presumably I will go to the hospital where the consultant has some involvement? 

Would I ever absolutely need to go to the Blackrock Clinic or Mater Private as distinct from going to St Vincent's Private? 

Are most consultants attached to some hospitals and not to  others? 

Is there a pecking order in the Private Hospitals. If I don't need hi-tech treatment, is the difference in the standard of the accommodation? 

If I do need to go to the Blackrock Clinic for 10 nights, I can pay the €200 shortfall and the €500 excess and I am still ahead, as I saved €2,900 by switching.


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## STEINER

You certainly have saved well Brendan with your switch.

I believe that a high-tech hospital designation is so differentiated purely to appeal to a niche market who are prepared to pay higher insurance premiums.  You get a higher standard of accommodation and an element of prestige associated with the brand name.  

More expensive health plans cover "certain cardiac procedures" in high-tech hospitals.  This suggests if one has serious complicated cardiac issues then one is screwed unless health insurance pays for it in the Blackrock Clinic etc

However, even if you need a heart transplant in Ireland, the National Heart and Lung Transplant Unit is based at the Mater.  Indeed, this next link about a heart transplant performed at Blackrock mentions supervision from the Mater.

http://www.blackrock-clinic.ie/news...ardiology-team-by-heart-transplant-recipient/

Also, a recent flight with a donor heart to the Mater from today's Irish Times.

http://www.irishtimes.com/news/heal...fer-heart-from-kerry-for-transplant-1.1678411

A cursory look at the Oncology Department in Blackrock is very scant on details regarding the consultants....

http://www.blackrock-clinic.ie/services-procedures/oncology/meet-the-team/

Certain illnesses are not dealt with by high-tech hospitals, eg. bone marrow transplants are carried out in in a specialised unit in St. James.


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## Brendan Burgess

So really there is no medical advantage to the hi-tech hospitals? 

It's just the quality of the accommodation and the brand name? 

Brendan


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## browtal

I understand that there are procedures, particularly relating to the heart, that are available only in these high tech hospitals.
Browtal


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## Brendan Burgess

So what happens to those who don't get to these hi tech hospitals if they need one of these procedures?


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## amgd28

They will get treatment as a private patient in an academic teaching hospital with specialism in that area


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## huskerdu

I am interested in this topic, as I, like many others , have changed to a cheaper plan and no longer have coverage for many of the private and hi-tech hospitals. 
 I could not come up a good reason to keep the coverage. I am happy to attend the cheaper private hospitals, or the private wing of public hospitals, if I use my PHI to have a procedure. 

 One thing that people need to realise when doing this, is that they to be more in control of their use of private consultants. 

 In the past, many people went to the consultant that their GP sent them to without question. GPs recommend consultants for many reasons - reputation, or they went to college with them / play golf with them etc. 

 My parents, and many others of their generation still act like this, and would not dream of questioning the GP and are scared to reduce their PHI, as a result. (What if I HAVE to go to the Blackrock clinic because Dr Paul says so ? )

 Now, if a GP says that I need to see a consultant and suggests someone, I have to ask - where does that consultant practice ? How much does she/he charge ? If I have a procedure, will it be covered by my PHI ? If not, demand a referral to someone else.


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## Brendan Burgess

There was an interesting discussion of the topic on boards.ie in 2011

Hi-tech hospitals


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## arbitron

I don't think there are any specific rules to define high-tech hospitals, but I suspect it is a combination of the facilities, accommodation, and the procedures they offer.

High-tech hospitals are Blackrock Clinic, UPMC Beacon, and Mater Private Hospital.  They each have particular strengths - BRC has advanced cardiothoracic surgery and other procedures, Beacon has very specialised radiotherapy/radiosurgery facilities and cardiology procedures, Mater Private has cardiothoracic unit and high-tech imaging.

BRC & Beacon have A&Es, Beacon accommodation is modern and high standard, etc. etc.  All 3 have fully-staffed ICUs with in-house doctors covering ICU overnight.

I have also heard Galway Clinic referred to as high-tech.


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## laois1

I think most of these high tech procedures and tests are fully available in the public system. Having an emergency department or a nice room doesn't mean high tech. Some of these private clinics are in financial difficulty. Only in recent years have we heard them advertise on radio constantly for business such is their need to fill beds and generate revenue. I would like to hear what procedures are exclusive to them. I would anticipate that these a few and far between. Advanced radiotherapy is available in public centres. These clinics have to try to appeal to the masses or more of them will face closure like mount Carmel.


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## arbitron

The vast majority of tests and procedures are indeed available publicly, the problem is the waiting time.  In fact, many of these are outsourced to private hospitals for this very reason, viz. NTPF and similar programmes.

Ultimately I don't think it matters that the procedures are available publicly: the high-tech label is only used to compare private hospitals.  So if you compare Mount Carmel with Blackrock it is clear that Blackrock is much higher spec.

Another reason they may be considered high tech is that so many of these specialised tests/procedures are in the one place, whereas in other hospitals (be they private or public) you may be in Hospital A which can do Test 1, but for Test 2 you need to go to Hospital B.  In BRC, MPH, Beacon you'll find most of the procedures can be done on site.

You are right about private hospitals being in financial difficulties. Mater Private have announced almost 100 lay-offs, Whitfield Clinic is in NAMA, Cork Medical Centre never got off the ground, etc.  Mount Carmel was known to be in trouble for a long time and was probably the most precarious of the bunch.

The insurance companies have (quite rightly) become much stricter over the last few years and have cut payments drastically.  On the bright side, Blackrock is actually doing well.  Beacon was in major trouble until a few years ago, then was taken over by UPMC (American non-profit hospital group) and has really turned itself around.


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## laois1

I'd still like to know exactly what makes these hospitals high tech. I'm not interested in a stylish room. What are the procedures exclusive to these clinics ? So far no one has been able to answer this including on this thread. Years ago PET CT was only available in blackrock, but now it's in James's etc. I still stand over my assertion that I would rather be in an ICU of a public hospital where there are specialist registrars available 24hrs a day. In many private clinics the doctors or medical officers that you will see when your consultant is not there (which will be most of the week if they have a public contract elsewhere) are not on a recognised training scheme and are just plugging a gap in their career when they are off doing research or have failed to pass exams on a recognised training scheme or failed to get a job in the public system (which is the only place to get recognised training ). I understood that UPMC was linked to Beacon hospital from day one of its opening ? I was not aware that their debt had been sorted at all,  the last time I read about it it was far higher than that owed by Mount Carmel (but correct me if I'm wrong and there has been a debt arrangement). I know of many cases over the years where patients undergoing elective surgery at these clinics had to be transferred to public Hospital ICU beds when things went wrong, despite having so called ICUs on site.


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## arbitron

As a general disclaimer, I have current experience of both public and private systems but unfortunately do not have expert knowledge on high-tech hospitals.  From discussions with colleagues, my understanding is that high-tech is a term created by the health insurance companies to describe hospitals such as Blackrock, Mater Private and Beacon which have certain facilities that other _private_ hospitals do not offer.

To build on your example, we can't compare PET CT in BRC to PET CT in James' as that is comparing private to public - if BRC was the only private hospital with PET CT then it could be legitimate to designate it as high tech, but again I understand that this is a term defined by the health insurance companies, so it could include any number of criteria.

I will make some enquiries and if I can find out definitively I will report back.

Whether people prefer to be treated in a public teaching hospital, private teaching hospital, high tech private hospital, general hospital, smaller private hospital, etc. etc. is entirely a personal decision to make based on what the patient values.  Without hard numbers it is difficult to compare apples to apples.

There are some units in major public hospitals that are of excellent quality and other units within the same hospitals that are not up to scratch (per HIQA reports).  I don't think it is useful or fair to generalise.  I certainly have my own list of procedures that I would prefer done in certain hospitals.

There is a big difference between minor elective procedures and emergency surgery, there is also a significant difference between planned admissions to ICU and emergency admissions to ICU.  My experience is that in _some_ private hospitals the ICU service is as comprehensive (if not moreso) than many public hospitals.  This may come as a surprise because it is a relatively new development.  Another point to consider is that in private hospitals, most shifts are maximum 12 hours and European Working Time Directive compliant so the NCHDs are better rested - sadly, the same cannot be said for most public hospitals.

UPMC ran the cancer services in Beacon Hospital when the hospital was owned by the original consortium and operated by Triad.  There were financial difficulties and Triad pulled out.  At one stage Johns Hopkins were considering taking it over.  Instead, about 5 years ago UPMC bought a controlling share and took over the running of the entire hospital.  They have steadily worked to reduce losses and are due to be in the black in the near future, per public accounts and media analysis.

As for the non-consultant hospital doctors (NCHDs) in private hospitals, you are correct that they are generally not on training programmes; however that is changing and varies widely between hospitals.  For example, Mater Private cardiology, oncology and anaesthetics registrars (senior NCHDs) are on public training programmes.  The Bons in Cork has interns on training programmes.  The Beacon has several in-house doctors who are actually on the consultant register but are employed to provide cover for their specialty across the hospital and support other consultants (similar to the US system).

Private hospitals are now attracting some of the highest calibre NCHDs, mainly because of HSE working conditions and administrative restrictions on non-EEA doctors.  On the bright side, there are plans afoot to harmonise training programmes across public and private hospitals.  I am concerned that current government policy will continue to drain consultants from the public to the private system.  This will cause huge problems for the public system.


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## RainyDay

Thanks arbitron for a very useful post. Could you please expand on this point?


arbitron said:


> For example, Mater Private cardiology, oncology and anaesthetics registrars (senior NCHDs) are on public training programmes.



Does this mean that consultants in the Mater Public are training doctors in the Mater Private?


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## arbitron

Hi RainyDay,

The Mater Public (MMUH) registrars in cardiology and oncology do part of their training in the Mater Private (MPH).  At MPH they are under supervision of consultants working in a private capacity.  As far as I know these consultants also have public appointments at MMUH.

Anaesthesia registrars cover MPH as part of the Cappagh rotation.

The advantage for the trainees is that they get experience in procedures and treatments that they would not be able to access in the public (and better working conditions), the advantage for MPH and patients is that they get high quality registrars, and the advantage for the consultants is that they have extra support.  Salaries for work done at private hospitals is paid by the private hospitals.


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