Two-tier Health System

[truthseeker]

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.

 

[Yachtie]

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.

 

[Gordanus]

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.

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.

 

[Yachtie]

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.

 

[truthseeker]

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).

 

[Complainer]

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.

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.

 

[Purple]

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.

 

[roker]

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?

 

[Purple]

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.

 

[truthseeker]

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.

 

[orka]

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.

 

[Complainer]

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.

 

[orka]

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.

 

[truthseeker]

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.

 

[Purple]

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.

 

[Firefly]

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?