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Why don't we have ACTUAL universal healthcare like the rest of Europe?
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People with certain conditions get all their medicines free for that condition. Not means tested and no pharmacy charge which Medical Card holders have to pay.
https://www2.hse.ie/services/long-term-illness-scheme/long-term-illness.html
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I lived in the UK for over a decade before moving back to Ireland. I needed root canal work while I was there and certainly didn't get it for anywhere near that price. Why? Because it's impossible to actually get an NHS dentist appointment so everyone ends up going private. I had friends in the UK who travelled abroad to eastern Europe for dental work to save money - that was more practical than trying to actually get an NHS dentist.
It was the same with GPs, it costs me 60 quid in Ireland but at least I can actually see a GP when I need to. When I lived in London it was basically impossible without waiting for weeks and weeks. Emergency departments in the UK are completely clogged up with people with non-emergency issues because that's basically the only possible way they can see a doctor these days.
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I also had a family member live and work in Germany and his work contract included his healthcare plan, public health insurance of which his employers made a contribution equal to his own. The rate's might seem high in comparison to private health insurance here but his earnings were also much higher and rent and living more affordable too. (at the time at least) Adjusting for cost of living in Ireland and a threshold level that was sustainable might be workable, an advanced model of PRSI but with a greater range of care.
The cost for first GP visit is 10-15 euro, here we could extend that to everyone as a basic minimum charge and those who can afford private insurance and want it can opt into those models of private care if desired.
edited to add Germany's healthcare was rated in the top 10 until recently, understandably their economy was much better equipped to support statutory public contributions. https://www.expatica.com/de/healthcare/healthcare-basics/german-healthcare-system-103359/
Germany has traditionally had what could be described as the most restriction-free and consumer-oriented healthcare system in Europe, with patients allowed to seek almost any type of care they wish wherever they want it (“stronger on quantity than on quality”). The traditional weakness of the German healthcare system: a large number of rather small general hospitals, not specializing, resulting in mediocre scores on treatment quality seems to be improving – a tendency visible also in 2018, when Germany is sharing 8th place on Outcomes.
Ireland ranked 22nd at the time of this report
https://healthpowerhouse.com/media/EHCI-2018/EHCI-2018-report.pdf
Ireland has been dropping in the Index for one main reason: In 2018, Ireland is alone in last position for Accessibility, with patient organisations steadily giving very pessimistic feedback in the HCP survey. Unfortunately, this was confirmed by the Irish HSE and MoH after the release of the EHCI 2015 report, when they said in a memo that the programme initiated to reduce healthcare waiting times in Ireland aims at a target of no more than 18 months’ (!) wait for a specialist appointment. Even if and when that target is reached, it will still be the worst waiting time situation in Europe. The referendum in May 2018, resulting in allowing abortion in Ireland, helped regain points on Outcomes, where Ireland is doing considerably better than neighbours the U.K.
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Yeah I'd have to wait a day maybe, but never anything more. And it's never for anything urgent, and it's a busy surgery (Ballincollig in Cork) - only open until 6pm, closed on Saturdays.
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The NHS is nowhere near perfect and is devolving, I won't argue otherwise. Even going privately over there did you pay anything like Irish prices though? I'd another mate here who couldn't get any dentist to see them privately here, waited til they visited their family in Spain. In the UK it's bad enough that you may end up going private, here you always go private and it costs more. If you can get in.
Again, your experience isn't familiar to me and doesn't fit at all with people I know where I live. If I ring my GP tomorrow for an appointment it will be a 2 week wait, probably more with the bank holiday etc. likely be the Monday or Tuesday just over 2 weeks later. And again, while being private I'm waiting 5 months for word on an appointment for a consultant. It will literally be a 30 second look to confirm I need what I need and my GP agreed I need over the phone without seeing it, then another month (hopefully) of a wait for a 5 minute procedure. This is all private. If I went public I would be waiting years.
The UK system isn't perfect and they've been running it into the ground for a decade now. Despite that it's still a damn sight better, cheaper and more efficient than what we have.
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Medical cards should enable free gratis medical treatment, prescription medications as required but should limit the number of free GP visits... I see my GP about once a year, when I NEED to... I’m not one of these old hypochondriac specimens like my neighbor at home who if you were to listen to her has been dying for the last 35 years... she is 70 give or take, every few weeks at the GP.... “ no he just told me to keep taking my medication, see the physio and go for my daily walk and there will be a review at my next hospital appointment...
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Just to add, any investment in the hospital system should be squarely in the area of e-health. As demonstrated by Macedonia apparently, as the most effective way to reduce wait times. It would be an astronomical investment but might have been better spent there than on the monstrosity that is the NCH. Our systems here are incredibly antiquated anyway and are in need of replacement, an overhaul at this juncture could easily bring GPs onboard a national system and inline with plans for reform. The benefits are kind of unimaginable really. (reduced waiting times, better care plans, GPs become primary points of care and reduced dependence on the clerical blackhole, software production and implementation and greater R&D in areas of medical and health care just to name a few)
25th place, 638 points. North Macedonia was the absolute “Rocket of the Year” in 2014, ranking 16th with a score of 700 points, up from 555 points and 27th place in 2013. ... The country has made a remarkable breakthrough in electronic booking of appointments – since July 2013, any GP can call up the booking situation of any specialist or heavy diagnostic equipment in the country in Real Time with the patient sitting in the room, and book anywhere in the country with a few mouse clicks. This has essentially eliminated waiting times, provided that the patient is willing to travel a short distance (the entire country measures approximately 200 km by 130, with the capital Skopje located fairly centrally). It seems that patients have caught on, with North Macedonia receiving high scores for Accessibility, particularly in out-patient care – still some distance to go for inpatient care and advanced diagnostics.
https://healthpowerhouse.com/media/EHCI-2018/EHCI-2018-report.pdf
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This. People are always rabbiting on about how great the NHS is but they know nothing about it passed hearing the Torys bigging it up.
They have waiting lists and trolleys in the UK same as the HSE has.
In fact the numbers are at an all time high in England where there's about 5.5 million people on waiting lists. A few weeks ago british GPs were told not to take bloods because there were no blood bottles to put samples in. Third world stuff.
The Scandanavian countries tend to get social services like healthcare and education right. You get a lot of things "free" but the effective tax rate in Sweden is about 60-70% to pay for it. Good luck selling that here.
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Er, if you look behind that report, you'll see that the people who developed the "think tank" also developed other "think tanks" linked to Swedish conservative politicians and Swedish business and employer groups. Their main objective is to remove the Scandinavian social democratic welfare state and replace it with something much more akin to policies promoted by the likes of the British Conservatives.
Nothing wrong in that opinion if it's what floats your boat, but it's no harm to mention in case anyone might get the idea that what you're quoting is independent or objective, which it isn't.
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The Tories are running it into the ground so the whole system can become a cash-sink generating guaranteed profits for their mates.
They have waiting lists and trolleys. But less than here and for a lot less cost.
5.5 million on waiting lists? That's horrific. That's about 10% of their population. I'm sure ours is much better.... 900k, weird that would be about 18% of our population. Which, and I don't have a maths degree, seems a lot more, which I think is worse? And yet again, that's despite the fact that fully half our population have private insurance. Taking just the uninsured population we have 900k/2.5million or so, roughly 36% of people. England it's about 5.5million/48million or about 11.5%. Which is roughly a third of the rate here.
The blood bottle thing is down to Brexit and supply chains being affected by Covid. By that logic just about every drive thru I've been to in Ireland is pretty third world. I'm not sure if Sony/Microsoft are third world or the companies who supply them with parts or if retailers like Smyths are the ones who are third world since they're having issues too.
Ah, you're going to make a completely extraordinary and obviously ridiculous claim about tax rates elsewhere. Wonderful stuff, pity ya saved an obvious lie for the end of your post.
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I'm not sure which think tank you mean, can you link me to it? I attached references to EHCI report, I was just using it as a benchmarking tool. I'd acknowledge any Swedish political affiliation or power model if it were necessary, while simultaneously recognising the Swedish model of healthcare as being ranked at number 8 on the list. Perhaps it is their way of "providing open and transparent benchmarking and recommendations of strategies for improvement and change" but that doesn't mean that the information is not worth reviewing and learning from. Just in case anyone feels the need to review for themselves I'll leave the link here https://healthpowerhouse.com/
(I don't think Ireland is in any danger of giving up it's "Socially Democratic Republic" status anytime soon.)
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I found the details by reverse searching from the name of the report provider, Health Consumer Powerhouse, and in fairness that didn't take terribly long. Their "indicators" might be picked to suit their purpose, which is to support conservative political parties in marketising public services (in this case, healthcare) - or indeed they might not. Do you know for sure? Conservatism is a valid political view, by the way, but I just wouldn't want anyone assuming that the report was either unbiased or produced by an unbiased provider. It's easy to track who founded the HCP think tank, his previous involvement with the Timbro think tank which promotes conservative, tax-cutting and market-oriented approaches to public service provision in Sweden, and his prior involvement with the Swedish versions of IBEC or other industry and business groups, as well as his time as a local Moderate Party representative (the former Swedish Conservative Party).
I'm not being critical of HCP or the report in and of themselves, as I haven't the capacity to peer-review their work (well actually, I do, but it would take me a wee while and I'd want to be getting paid for it). My point is that unless you know a lot about their credentials and the technical details of the indicator definition and data gathering methodology, it's hard to be sure that their "league tables" are objective and independent. It's not as if it was a large-scale research project written by an academic research team at a university and peer-reviewed by others.
Whether or not you think Ireland is about to change its approach to healthcare, I'm sure you'll acknowledge that it's a known technique in political agenda-setting to present ideas, concepts and report data as objective analyses that are independent of particular political viewpoints, when in fact they are anything but. I'm not definitively saying that this is what HCP are doing, but until one knows that they aren't, it's a useful filter through which to read the data.
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This is very rabbit hole kind of stuff.
"Their "indicators" might be picked to suit their purpose, which is to support conservative political parties in marketising public services (in this case, healthcare) - or indeed they might not. Do you know for sure? "
No, but next time I see Mr Hjertqvist, I'll ask him what he was doing on the night Harriet Vanger disappeared.
I honestly didn't do a Lisbeth Salander on what I just figured was "independent" and "transparent" research, my bad. While it may be affiliated with a Swedish backed team, it's more likely as a result of "The National Board of Health and Welfare (Socialstyrelsen) is a government agency under the Ministry of Health and Social Affairs that compiles information and develops standards to ensure good health, social welfare and high-quality health and social care for the whole population." That's sort of their job, or at least where their tax payers money goes to improve their health services. Imagine if Ireland was only able to provide similar outcomes, due to similar research and development.
Unfortunately we don't have the resources and our tax pennies are constrained to propping up other areas of a flailing system. Such data can also really only be acquired by means of international co-operation and Ireland would not be best placed to obtain it all by itself.
I did a brief google just to check for any references and on first search there was a match for reference to an Irish Examiner report dating back to 2007, so the EHCII report isn't new and has been around a while at this stage. https://www.irishexaminer.com/news/arid-30330224.html (Not that it makes it any more or less "trustworthy", but definitely tried and tested.
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This suggests, though, that the problem in Macedonia was one of information and communication - medical specialists and diagnostic facilities had spare capacity that was going unused because GPs couldn't readily find out about it in a timely fashion. Unless this is also the cause of waiting lists in Ireland, introducing an e-booking system is not going to have the same results in Ireland.
So, the first question is, do Irish medical specialists and/or Irish diagnostic facilities have unused capacity? If and only if the answer to that question is "yes", then the next question is "why is that capacity going unused?" And only if the answer to that question is "because the people who have need of that capacity can't find out about it" does the Macedonian solution look like something that would benefit Ireland. Otherwise you need to craft a solution that addresses the causes of waiting lists in Ireland.
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If you need to see a specialist or a consultant you, ll probably have to wait a year or else hope you can afford to pay to go private so our system is not perfect I think it's important that we have the option to pay for private healthcare
Many people in American go on gofundme a website to seek donations to pay for medical operations that are not covered by medicare which varys from state to state
Every country is experiencing supply chain issues due to workers effected by covid and shortage of truck drivers etc
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That report does outline precisely (and I'll probably go into more detail with it because brain likes to do that at 4am) that the problem is what they lovingly call MDD, or management deficiency disorders. To understand the information and communication element you'd probably have to be familiar with how administration system currently works in the HSE. It's less a question of surplus diagnostic facility capacity and more an issue of gatekeeping and the referral system. I will try my best to unpack that, I know it's long but it does help to give an outline and maybe answer some of your questions on the subject.
refer you to
5.3 Waiting lists: A Mental Condition affecting healthcare staff and administrators?
Over the years, one fact becomes clear: gatekeeping means waiting. Contrary to popular belief, direct access to specialist care does not generate access problems to specialists by the increased demand; repeatedly, waiting times for specialist care are found predominately in systems requiring referral from primary care, which seems to be rather an absurd observation. (there's a figurative map here)
Also visible to the naked eye, there is a striking absence of a financial connection with good waiting time situation in healthcare. This could explain the limited effect of showering a billion euros over Swedish County Councils to make them reduce waiting times. It seems that waiting times for healthcare services are a mental condition affecting healthcare administrators and professionals rather than a scarcity of resources problem.
One of the most characteristic systems for GP gatekeeping, the NHS in the UK, spent millions of pounds, starting in 2008, on reducing waiting and introduced a maximum of 18 weeks to definitive treatment after diagnosis. The patient survey commissioned by the HCP for the 2012 and 2013 Indices did show improvement, much of which seems to have been lost by 2018. This is different from Ireland, where patient organisation survey responses are still much more negative than (the very detailed) official waiting time data. For this reason, after several years of accepting official Irish waiting time statistics, the EHCI since 2015 has scored Ireland on patients’ versions of waiting times.
5.3.1 Why is there no correlation between accessibility and money? Answer: Because it is inherently cheaper to run a healthcare system without waiting lists than having waiting lists! Contrary to popular belief, not least among healthcare politicians, waiting lists do not save money – they cost money! Healthcare is basically a process industry. As any professional manager from such an industry would know, smooth procedures with a minimum of pause or interruption is key to keeping costs low!
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Healthcare just like the utilities previously, is ripe for privatisation, certainly the profitable bits, why do you think certain people who have been the subject of tribunals are so intent on buying private hospitals?
The Public Health Service is poorly mananged, by relatively underpaid and undertrained managers struggling in an under resourced system, any good ones are head hunted paid handsomely by the private sector.
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So not the gubberment. It's not really nonsense and you seem to have great faith in all of those imaginary KPIs. For now there's cheap money to fund it but it will ultimately require higher taxation to pay for such things, especially with the CT hits of the new OECD tax deal. We don't like higher taxes and some people imagine that common pot is never ending.
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I’ve been meaning to google that tax claim for Sweden. Here’s what wiki says.
Sweden has a progressive income tax, the rates for 2021 are as follows (based on yearly incomes):
Sweden Income Tax Rates
Taxable income is reduced by general deductions which means that the marginal tax in practice varies between 7% on incomes just above 20,008 kronor to 60.1% on incomes above 675,700 kronor.[4] For an average salary, on an additional pay of 100 kronor, the employee first pays 32 kronor in income tax (direct, 32%).
for an average salary here, or just above, the rate is ~50%. We probably need a third tier though.
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You literally didn't address anything in my post. We pay enough tax for a good-to-excellent health service as it is.
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And that's a QED on the tax! What's to address? You said nothing apart from list off KPIs out of a management book.
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Yes, it is a QED on the tax, glad I've convinced you of that. I think it's great that you're open to changing your position and conceding that you were incorrect, kudos.
I really would love to know what your angle is here though. Is it that because Ireland's special we should pay twice as much as anywhere else for a similar level of service?
Imaginary KPIs. 🤣 Not really worth arguing with people who won't actually engage in logical debate or use actual information to make arguments. And do you think I'm defending the government or something? Because I did a tiny bit of googling last night and saw stuff about how we have about a third as many Urologists as New Zealand and 15% as many as Denmark. Mental health we're apparently at half the level of staff we should be at. https://www.independent.ie/irish-news/health/one-million-patients-on-public-waiting-lists-doctors-warn-38520498.html
I'm going to take a wild guess that we probably don't have 6 times as many ENT or gastroenterologists or anything else than Denmark. The figures in the article above are likely reflective of many parts of our system.
So there we have it, we spend plenty on healthcare as it is which only covers half our population yet we don't have enough of the right staff. That's on this government, the last government and a few more. And at the end of the day people tend to get what they deserve. As a country we shrug and say "Oh well" and nothing changes. And someone who points out clear an obvious facts is apparently just using made up KPIs straight from the management handbook. I'm sorry for pointing out the terrible value for money we're getting, I clearly love the government. Or something, who knows what you're trying to say.
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And again, I'm not sure what it is you think I'm supposed to engage with, your superior ability to use Google? All you did was point out X,Y and Z is wrong but offer no solutions whatsoever. That’s a gripe and barely even makes the cover page of one of the myriad HSE reports.
As for engagement I believe our problems have far less to do with money than how the whole thing is structured at present. Start moving on ways to fix the basic holes there instead of airily waving at speed and cost and other fancy stuff will give us a better functioning health system.
My position on the tax is unchanged. I really haven't and I genuinely do not believe that Irish people would be prepared to agree to the amount of tax other countries use to operate their systems but each to their own.
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..yes, and theres nothing extractive about the insurance industry!!!!
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Yes and 111 will get you a queue skip for the hospital - great service, we've had to use it a few times.
For urgent issues, you ring in the morning and you'll have an appointment for later that day - we did exactly this today, appt is at 16:00. Granted you're likely to be on hold for 30+ mins when you call but that's just the way it is.
I've had to wait a few weeks for a fungal toe appt in the past but I'm hardly banging the door down for that one. I had some minor non-critical surgery in 2019, from GP visit to slice and dice was <3 months.
Now they did mess me about when I was trying to get my knee sorted a few years ago, so they're by no means perfect but after a decade here I know that's the exception as opposed to the rule. People around here love to throw out the 3-4 week GP wait time line and I just have never seen it. However I do agree there should be nominal a charge for GP visits but I'm guessing a lot of the regular users of the service are benefits people who would have to be exempt from the charge were it to exist.
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Yes, you are correct that Irish people don't like paying more tax.
They were asked to pay 160 pa for water, and marched on the streets over that.
Now, regarding healthcare, we already overspend on healthcare, relative to the age profile of our population.
We spend as much pp as older countries, which means we overspend pp, for our age profile.
So we don't need more spending.
Slaintecare would be a re-allocation of spending: thousands of people drop health ins, pay a bit more tax to replace lost insurance income to hosps.
Taxes are higher in other countries, yes, as they have older populations, or a different welfare state, etc.
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...and again, we re still not talking about the highly extractive elements of the insurance industry, yes there are wastes and inefficiencies in the public element of our system, that need to be addressed, but.....
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Co. Tyrone. GP only takes calls before 09:30. Start dialling at 09:00 and keep redialling and praying to get through. Same day appointments only and if you don't get through you have to try again next day. Even then it's only a telephone consultation unless you can convince the receptionist you're at death's door.
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Economies of scale will come into play here, I fear. That is a massive market which can be used to drive down costs of a whole raft of expenses.
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Maybe every GP practice is different in the UK (or maybe things have changed in the past 10 years), but that wasn't the case when I was a student in London from 2011-2014. We could only make an appointment on the day we actually wanted to see the GP. I needed to see a GP near the end of my first year at college and when I rang up around 9am they said they were booked up for the day. I asked could I schedule an appointment for the following day and was told no, and that you could only make an appointment on the day you want to go in, so I had to make sure I was up and phoned them as soon as they opened the following day.
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And a heath insurance in Holland cost about a 150 euro a month for everyone No medical card or similar Same prize for everyone , young old , employed unemployed No thanks
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GP's in this country are (in my experience) some of the laziest and most useless health professionals in Europe.
They are literally nothing more than 65 euro a pop gatekeepers for consultants and if they could actually do their job the hospitals wouldn't be so overburdened. I've had them roll their eyes at me for having the temerity for mentioning more than one ailment in a visit because they might have to spend more than the 15mins that they've allotted to your care to bilk 65 quid out of you for a consultants letter before moving on to the next sucker in the waiting room.
My folks will only go to their GP in Portugal because he’s brilliant, and of course he is, because he’s required to spend a month a year in the local hospital on his expertise and in A&E. Training is also mandatory so he’s up to speed and was able to instantly identify the medication that was (mis) proscribed to my mum as the cause of symptoms she’d been complaining about to doctors for years. Her GP there then prescribed an alternative medicine that her consultant here had never even heard of. That tells me everything I need to know about the scam that is the Irish healthcare system.
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"If Ireland taxes like Swedes, the wealthiest will pay a little more, and everyone else will pay quite a bit more. The poorest will pay a lot more." - No chance that gets by here. People want more and better free services and they want Denis O`Brien, Dermot Desmond and Bono to pay for it.
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Well those weren’t the numbers I saw in the Wikipedia article, although I should probably go directly to the source.
(This is income tax. The rich mostly avoid that.)
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I'm in Germany and pay over €700 a month for myself for one of the cheapest plans, kids are extra on top of that, a few hundred each. If you are full time employed, the employer would cover around 50% of that, otherwise you pay the full amount. I have to cover the first €600-700 per annum on that plan and then I can claim back some of the costs over that amount. Have never gotten remotely close to ever making a claim!
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Re German system:
Approx. 15% of your salary at source, this is then matched by your employer at a slightly lower rate, meaning the real cost is approx. 27% on public meidcal insurance. That covers basic medical care, doctors visits, on ward hospital stays ...... prescriptions are capped at €5 per item. Certain things are only available if you pay privately, perfect example is a filling. Basic amalgam fillings are free, however 95% of dentists refuse to use them. A composite filling costs approx. €50-100, inlays €700 - 1200, professional teeth cleaning approx. €100. Lactose / fructose tests - carried out free of charge if you enter hospital overnigth, costs €60 - 80 if you go privately and it is over and done in 2 hours. Doesnt always make sense however that is how the system works ... had my eyes opened when I went over to work for a few years and ended up employing 30-40 people.
Private insurance is only available if you are self employed, a civil servant (subsidised at 50% by the government) or you earn approx. €70k plus per year and opt out of the public system. If you are privately insured you will pay all medical costs upfront and be reimbursed at a later date. If you stay away from doctors or hospitals for a year and have bills below €700-900 you get rewarded by the insurance company in the form of fee refunds, leading to more serious illness or a lack of screening amongst privately insured. 1k per month is cheap .... I have a workmate who is paying nearly €1600 for himself and two kids, he knows by 2023 he will be hitting €1900 as his daughters are hitting teenager years.
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Frequently the people on benefits, because it is free, misuse the system more. That goes for everything that is "free"... it will be abused
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Seems like a bonkers system. People avoiding health checks so they can get refunds for no claims because the price is so exorbitant defeats the purpose of having health insurance. The HSE is as dysfunctional as a health service can get but there's definitely a degree of rose tinted glasses when people talk about foreign health services. Most of the ones that are functional, people are paying though the nose for access to them which is something Irish people aren`t prepared to do.
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the public health insurance rates in DE are as follows:
- The public health insurance rates charged by the Krankenkassen are 14.6% (plus 1.3% average supplemental premium) of your monthly income up to a maximum salary amount of 4,837 Euros. This means that the average monthly premium on the market for 103 public Krankenkassen can be up to 770 Euros.
Government Health Insurance System (GKV)
Most German residents (approx. 73 million people) are members of the government health system. If your gross salary is less than 64,350 Euros per year, or 5,362 Euros per month in 2021 then membership in the GKV is mandatory. The government health insurance scheme is administered by 103 Krankenkassen and they charge the same basic rate of 14.6 % plus a possible average supplemental rate of 1.3 % of your eligible gross salary with a cap set at a maximum monthly income of 4,837 Euros (2021 figures). If you earn more than this income threshold which is set each year, you do not pay a higher insurance premium. Assuming a maximum monthly health insurance premium of 770 Euros as an employee earning at or above the income threshold you are therefore a voluntary member and your own contribution will be approximately 385 Euros with your employer paying the other 385 Euros. The general minimum period of membership with any Krankenkasse is presently 12 months. You can switch government health fund providers by giving two months’ notice after 12 months membership or if a supplemental premium is increased. As a voluntary member of the GKV you can opt out at any time with a 2 month cancellation notice if you prefer a private health plan and have been accepted by the insurance company of your choice.
You seem to suggest it's 15% ee + 15% er, whereas it is 15.9% in total, split between ee and er.
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The Gp's are not the gatekeepers, they are just sending requests to a system who determines what happens to that request. The HSE is the gatekeeper of healthcare in Ireland.
The idea of a GP making a direct booking is a bit radical because it eliminates that need for a guided tour around the HSE mulitverse and actually means that the patient has the option to choose from a number of availabilities, even if they might need to travel further distances to obtain it. It gives more options and clears backlog and opens up opportunities to develop hubs designed for particular specialties while bringing GPs back into the fold and enabling them to do a better job. Having access then to results just as instantaneously gives them more control over their patients care and the ability to process it more effectively and efficiently. It might also justify any minimal basic GP based fee as it would increase their provision of care.
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Probably been said already but while HSE receives funding similar to UK etc now, it didn't for basically 70s-90s.
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Because our systems favours the rich and poor.
If you are working earning average salary, you will spend a lot on everything.
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You didn't write the report so I don't think there's any need for you to get defensive about it. I was simply pointing out that the people who produce it don't necessarily have an independent and objective view of the issues it covers. This is quite common in policy agenda-setting; the world is full of "think tanks" from all shades of political opinion whose job it is to get policy messages out there. There's a veneer of independence about the stuff they produce, but it is generally obvious where they're coming from on the political spectrum.
"rabbit hole stuff". Honest to Jaysus.
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This x 1000
While I couldn’t be classed as poor or close to being...medical card holders and I say this having been one for a couple of years when I had an LTI... they have to contend with waiting lists.....but that’s it.
people earning an average salary have to put up with waiting lists, the same list and then paying for the privilege..
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I am living here in Germany well over 10 years.... closer to 15..... and have not had the experience you are describing. Medical is around 13/14% of my salary and overall in Germany I take home 55% of my salary. 45% goes away on taxes and medical insurance and pension. But I pay little to no "stealth taxes" after that. In fact one of the reasons I can not move back to Ireland is I simply could not earn enough money to live the quality of life I do here.... with the quality of schooling, medical, and public facilities that we live with here. We would take a serious quality of life hit if we ever moved home in pretty much every area of our lives.
Firstly I never put my hand in my pocket for money when visiting a GP or any other doctor or even therapist. At least not now. There was some years ago a fee of 10 euro for your first and only your first visit to a doctor in a given period. But that was done away with. There was no fee after that. So basically it was 10 euro for one visit or 50 visits. Which sort of incentivised more visits I guess... which might be why they did away with it? Perhaps it was costing more money than it was bringing in.
I have never paid for a doctor and had it "reimbursed" later though as you describe above. Not just a GP but any doctor. When I approached 40 for example I went to have my eyes checked by one doctor.... my ears nose and throat by another (HNO doctor they are called).... a full dental checkup by another.... an all over check of my skin for cancers by another.... and a full workup including blood work by my GP...... all in one week and it cost me not a penny.
Recently I had an issue that I was a bit worried about. I went to my normal GP and got the full work up done again. Nothing paid. And I was not entirely confident in the final result so I went to three other doctors in one day without any appointment for second opinions. Again not a penny spent.
Our children are automatically covered on my partners medical insurance so once again when we take them for their check ups or for any reason.... again never had to pay a penny. Never had to wait long for an appointment either. There are so many options here you can usually just walk in off the street. Perhaps if you are fixated on one particular doctor and that doctor is very popular.... you might have to wait days or weeks for an appointment? But for me it has been unheard of. There are also certain mandated checkups all kids are meant to get at specific times during their development. Each numbered specifically. We have gone to pretty much all of those. Again not a a penny.
Appointments exception is: For some reason the particular city I live in does have a lot of appointments for Therapists. But all the surrounding cities don't so really getting an instant appointment just entails a 20 minute drive. Not particularly sure why my city has such a backlog.... whether its a lower number of therapists per capita.... or a higher number of issues per capita..... or a higher uptake of therapists per capita.... I never looked into it. But it is strangely booked to the brim here.
Our daughter at age 3ish got a mild enough viral infection years ago too. I remember getting similar infections when I was a kid in Ireland and the doctor gave me something for the diarrhea and told my mum to feed me on Flat 7up. Here in Germany they put my daughter on a drip in the hospital and kept her for observation for two nights. Again.... not a penny paid.
My son around the same age sucked on a bottle of super glue so just in case it closed off his air ways suddenly we rushed him to the hospital. Got seen instantly by a nurse. Then told a doctor would check further if we wanted but we might have to wait a couple hours. Which we did. All good, not a penny.
I take myself and my two kids for Dental checkups 4 times a year.... and we all get a professional teeth clean each twice a year.... again all covered on the medical. As someone pointed out the basic filling is paid for too. Better quality materials you pay a nominal cost for. I once opted to be put "Under" for a group of dental procedures all happening at once too and was asked to pay for that as I opted for it rather than it being medically recommended. However I have a very cheap additional dental insurance which I had never used so just for fun I sent them the invoice for the anesthetics and because I had never claimed anything at all on that additional insurance they paid out on the invoice as "good will".... including the cost of the higher grade filling material which I had also opted willingly for....... which I was genuinely surprised by as it was about 80% of all the contributions I had made to that insurance until that date. So I almost broke even on them paying an invoice they had no basis for needing to pay. Really happy with that at the time as I had genuinely written off that chunk of cash as gone.
I remember my brother in Ireland talking about the costs of his wife giving birth in the hospital. Again the births here cost not a penny and nerry an invoice either. Just handed over the medical card on the way into the labour ward and job done. Even when we opted for a more complicated water birth in one case.
Think the last time I ever had to pay anything to a doctor for anything was in Ireland when I was hit with a moderately surprising bill for having an ingrowing toenail removed. And I was 6 months on a waiting list for that so in the end I just went and had it done by an incompetent GP who managed to make the entire thing agony for me :( He could not even get the anesthetic to take properly so in the end he ripped off the nail and cauterized it while I had about 40% feeling. Not the top experience of my life :(
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also in Germany. We pay a fortune in compulsorary medical insurance but the magic smart card then takes care of nearly everything.
To go to the GP I just go to the GP and wait in the waiting room. The health insurance card is swiped and everything gets paid by magic (from the €15,000+ that myself and the wife pay between us in medical insurance yearly)
Our child needed a spot of speech therapy. There was a bit of ringing around but we got a place with free spots and he had weekly sessions for a few months for nothing starting pretty much straight away.
I once needed a CAT scan on the ankle, I got an appointment at a private diagnostics clinic within a few days and again only needed to swipe the card (and again, the 15 grand we pay in insurance covered it)
For Physio treatment I have a vague recollection of having to pay the guy a €20 in registration fees or something, but otherwise the card covered the bulk of the cost for a few months of treatment.
When I hear irish based people complaining, I only think of the 15 grand YEARLY in cash that we would have if we werent paying medical insurance and if you look at it, the €50 here or there for a gp visit or €200 for a one off consultant visit, is not actually all that dear compared to what people abroad pay for their medical cover !!
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oooooooooo I forgot about speech therapy. Thanks for reminding me.
My daughter came across as "shy" in kindergarten here. In the end we brought this up with doctors and so forth (not a penny) and they diagnosed her with a social condition called "Selective Mutismus" which basically means a social inability to communicate in certain contexts and situations. She was very verbose with us in private and took to both languages really well.
They sent her to a developmental doctor then (also free) who tested her to make sure she had no learning difficulties or similar. He concluded she was significantly above average intelligence and development so no problem there either.
SO in the end to help with this they brought in a special learning teacher who normally would work with children with learning difficulties to visit her once a week in Kingergarten one on one. And also a speech therapist who would normally work with kids with actual physical or other speech impediments. Also once a week one on one. For two years.
They worked wonders with her getting her to speak more openly and confidently and all of it "free" covered on the medical insurance. Weeks of one on one care for two years with two diverse medical professionals.
As above I probably pay 10k a year on medical insurance. So I guess how valuable that works out depends on what you get out of it. If you spend 15 years paying it and never needing to go to a doctor once you might feel hard done by. And in fact the first years I was in Germany I used almost nothing. I might have taken a week off here or there with an illness and of course the Medical Insurance ensures my company still pay my salary for that time. But mostly I did not use it until we had kids and I started to age. But certainly using it quite often in the last 5/6 years.
What would two years of once weekly visitations by two distinct child therapists have cost me in Ireland? I have literally no idea! But would be interesting to know.
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Well I wasn’t lying about the experience I had. My family over there do have private insurance though, so maybe that matters in terms of reimbursement. And the doctor was popular, so it took about a month to be seen. He was a specialist
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Don't think anyone suggests you were lying :) Just saying I have never experienced what you describe myself. There could be all sorts of explanations for your experience that I have not considered or know about.
For example I am in West Germany. For all I know they do things differently in East Germany. I honestly do not know.
And perhaps Private Insurance works differently to public as you say. Again I do not know. I was warned against opting for Private once I started earning enough to qualify for it (which I only started earning enough in the last 2 years for the first time) because of the difficulty in getting back to public if you need to. I have not yet been given a reason FOR going private. I have only heard ominous rumblings about why its a bad thing.
I have heard, but never experienced myself, that popular or over subscribed doctors only take on new patients who are privately insured. I do not know why they do this or what their incentives are. Having never experienced it myself I have not felt compelled to look into it.
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thanks for the detailed information.
FYI, the cost for maternity care in Ireland is zero, as it is tax-financed.
Your brother may have chosen to go private.
I recall reading about the 10 euro a quarter fee that you mention.
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