Irish Health System
Modern, Efficient, Free
health care system is modern and reasonably efficient. It is also free, if you don't
count the taxes that pay for it all. Everyone resident in Ireland is entitled
to free public health coverage. The level of free coverage depends on your
economic health - the poorer it is, the higher your level of coverage. There
are two categories of public health coverage. Once you are resident in Ireland,
you are automatically entitled to one or the other.
Free Means Wait
Free it may be, but you're
also free to wait. Waiting lists for those without private insurance can stretch
into years - even for critical operations like heart operations. There are
tens of thousands of people waiting for their "free" medical services.
Governments are always
promising to clear these infamous waiting lists, but the health service but they seem to be like death and taxes - always with us. Even a quintupling of the health budget by many billions of euro did not clear up the problem. Before, during and after the Celtic Tiger, fairly long waits remain the norm.
To cut down the waits, you need to pay for private health insurance.
I cover the key parts
of the health system in this site. But, the Irish health system is huge -
the nation's biggest single budget expenditure and employer. Keeping up with
all the myriad options, forms, services and offices available would take a
team of people.
Luckily, the Irish government
finally put together such a team. You can access all the in-depth information
you'll need at the government's citizensinformation.ie health section . That said, I haven't been made redundant yet, since you'll want
to know the inside skinny - waiting lists, private insurance comparisons,
the fact that "free orthodonture" is almost unavailable in parts
of the country and so on.
Alternatively, the Health Service Executive - the body which runs Ireland's health service - has an excellent site with the same information and some more specific ways to access individual hospitals, services and forms.
Accessing Medical Services and Pocky's Response
On the site bulletin board I put up this summary of health service access issues. Pocky provided her own blow-by-blow commentary which I include below so that you can see exactly what you face.
Basically, the portal to all health care in Ireland is normally your local GP - General Practitioner. He refers you to a specialist who often enough works with a particular hospital. Normally, the referral would be to a specialist in the large city and regional hospital closest to you.
Pocky: But if you are looking for treatment under the stately system, the GP will refer you to a consultant and you will “line up”. It can take months to get an appointment! Unless you pay the consultant yourself – or have an insurance that covers it – you can not jump the line. Alternatively you can get assigned to a hospital Accident & Emergency ward – or “assign yourself” to one – and wait there.
However, when cancer and advanced cardiac treatment are needed, you will almost certainly be referred to a Dublin or Cork hospital. If a nearby regional hospital has a specialty unit, then you're in luck. And radiology treatment, in particular, is now being offered in many more areas by private hospitals which have come onstream in the past few years.
Pocky: But as they are private – so is the bill for you unless you have insurance covering it.
Scott: The government is now paying for these services IF the private hospital meets the government review process requirements.
You can choose to show up at the door of the best cardiac team in Ireland, which is generally considered to be Blackrock Clinic. Well, actually, you can contact them and they'll give you the contact phone number of a specialist and he/she will admit you. This is a very expensive private facility but if referred to there, then Irish insurance covers most of the cost (depending on your plan).
Pocky: But only if you have Irish insurance cover.
As you can see, Pocky's advice and mine are identical (even if it doesn't look that way): get private insurance if you can. More information on this site's Private Health Insurance page.
The Indispensable Health Site
The major Irish health site is irishhealth.com Besides reporting on issues of the day, they offer well written advice on thousands of illnesses. There are also forums and contact information for many health organisations.
Special Needs and Disabilities
School and Health services are discussed on the Special Needs and Disabilities page.
I called my dependable
local chemist/pharmacist and he tells me that Irish law prevents them from
dispensing drugs without a prescription from a registered Irish doctor. Because
it's Ireland, there is of course some wiggle room. If someone shows up needing
essential medicine, say for high blood pressure, and they can show a box with
evidence that it has been prescribed, then most Irish chemists will dispense
a few days supply. This gives you a little breathing room for meeting an Irish
He was quick to point
out that such liberality does not apply to addictive substances.
He also said to be sure
to bring along a box or information about the generic name of your prescription
medicines. Often the brand names for drugs in the US or Asia are different
than they are for Europe. Chemists here can track the generic name, but sometimes
the brand names defeat them. As a well known example, if you asked for "Bayer"
the chemist might come up empty handed. Give him the generic term "aspirin"
and you're away with a 12 pack.
Different Names for Drugs
While the pharmaceutical industry is global in scope, often the same medicines are marketed under different names around the world. Two big examples: Tylenol over here is known as Paracetemol and it's sold under a million different brand names. And Ibuprofen is usually sold under the brand name Nurofen. Viagra is still Viagra!
Often the ingredients list is what you'll need to examine, so be prepared to wrap your brain around all those long pharmaceutical names.
We picked up a book a few years ago called "Nurse's Drug Handbook" which lists all UK/Ireland prescription drugs and their use, contra-indications, etc. We were hoping to use it to translate between medicines, but mostly it just sat on our shelf. It doesn't cover over-the-counter drugs and is difficult to use - like having a German to English dictionary without the corresponding English to German half. Unless you speak the lingo in the first place, it's not much use.
We rely on our pharmacist and our doctor and we're still here to tell the tale.
"Baby aspirin" - chewable aspirin of 75 milligrams dosage - is classified as a prescription drug. That is because doctors have been advising everyone over the age of fifty or those with a family history of heart problems to take a baby aspirin a day to reduce potential clotting.
Because this is advice given by doctors, apparently baby aspirin is a prescription drug item. And it is expensive! Last time I bought 30 baby aspirin here in Ireland it cost me 10 Irish pounds! So, if you're one of the folks like me who takes a baby aspirin a day to ward heart attacks away, you'd be advised to consult with your local physician and possibly bring along a year or two supply of these fairly inocuous little pills.
Incidentally, it is hard to find normal adult aspirin. Aspirin is readily available in soluble form - you open a packet and dissolve the enclosed powder in water or juice. It is also available in a pill that dissolves on your tongue. Or, you can get enteric coated aspirin for treatment of arthritis that dissolves slowly in the stomach.
But, try and get standard issue aspirin tablets and generally you'll be out of luck. If this is important to you, you might bring along a bottle of a couple of hundred of these ancient wonder workers.
Medical Insurance During Your Move
This is discussed in the Checklist section of the Full site.
Pregnancies in Ireland
A report commissioned by the three main Dublin maternity hospitals concluded: "Dublin is the safest city in the world for a mother to have her baby, thanks to the high standards of care here."
Any problems with the system relate not to the hospital experience, though the setup can be spartan. One young mother posted this: "We felt that the medical care was excellent in terms of safety but it was not a hotel hospital like that of the States.... I have heard that the maternity hospital in Dublin (I think it is the Rotunda?) is very much like an American hospital and people really like it. We looked into it but as we were 3 hours away and the waiting list was so long it was not a possibility for us."
Mary reports on her daughter's experience: "Our daughter phoned us about three weeks ago from Dublin (where she has been living/working since last September). She is now 12 weeks into her pregnancy. She is unmarried but because the father is Irish she was immediately taken into the healthcare system. She has been quite impressed and happy with her care. The hospital is the Rotunda in Dublin, just for maternity, they will alternate visits with a family practice physician close to her apartment. They call it co-operative care. She had an ultrasound early due to some bleeding. She attends 'ante-natal' classes. So you see, their state healthcare is not so bad. That is, if you live near a major city."
The more important problem is getting proper care during the pregnancy. Waiting lists for some obstetricians can be huge. Anecdotes of waiting lists stretching 6 months to a year circulate. (A year???? My baby fingers only count to 9.) So, if you're pregnant, or perhaps if some guy just looks cross-eyed at you, make an appointment right away. Your normal doctor/GP may be of some great help in helping you find a specialist.
Hospitalisation - a Word of Reassurance
The overwhelming problems with the Irish health system are the waiting lists and emergency rooms. During the winter flu seasons, there are nearly weekly stories of overcrowded emergency facilities with patients lying on gurneys in the halls for periods up to three days. The underlying problem is lack of beds and there's been a multi-pronged initiative to both add more beds to the system and to free up existing beds which are being used by older patients because of a lack of old age homes and local care facilities. Sounds simple, but the problem remains unsolved after decades of supposed priority.
Once in that precious hospital bed, though, few have a bad word to say about the nurses and working staff.
Except... the spread of drug resistant hospital infections has multiplied in the past few years. A late 2005 audit found that 91pc of hospitals fell below necessary cleanliness and safety standards. There followed a push on get the hospitals and their staff to literally clean up their act. Hospital hygiene has improved, but this is still a major problem.
The Irish Health website maintains a database rating all the hospitals in the nation on their cleanliness.
Cheri shared this on the site bulletin board:
"I was hospitalized two years ago during my first visit to Ireland. I had injured my leg at work and an infection was brewing (unknown to me). During my travels the problem became evident.The infection was diagnosed right away and I was admitted on the spot - indefinitely! I have absolutely no complaints about the care that I received (even the food was great!). The cost for a weeks stay in the hospital was so low that when I turned the receipts into Kaiser they didn't pay right away... they could not believe that I'd been cared for such a low cost. The charges in the US would have been at least 4 times the cost! I finally assured them that there were no more bills coming in and they cut me a check."
CJ adds her words of reassurance:
Last week was the first time we had to visit the hospital here in Kerry as Irish residents. My daughter is fine now, but had an accident which required a trip to the ER (or the A&E as they call it here). We waited about 90 minutes to be seen and then another 15 for an x-ray.
After she was checked out, I was told she would have to be admitted for observation. She is only 3 years old, so I stayed overnight. She was in as a public patient, in other words, she was in the children's ward of six beds to a room.
I was nervous about how the Irish healthcare would measure up to the US sytem. I was very pleased and satisfied with her level of care. The doctors and nurses were wonderful and did their best to make us both comfortable during our stay. I was able to stay with her. They had recliners for the parents to sleep in right next to the beds.
I did not mind, but just so everyone is aware, there are not a lot of 'extras' in hospital like in the US. She was not given a hospital gown to wear or any toiletries. I was able to get toothbrushes, soap, etc. in the gift shop at a higher than normal rate, but that is nicer than not being able to brush!
There were several ward bathrooms in the hallway and the nurses showed me one where I could take a shower and have clean towels. There was a cafeteria for my meals. We stayed two full days and the cost was 120 euro.
And my daughter is doing great too!"
Health Service Executive Areas (formerly Health Boards)
While the Department of
Health sets overall policy and doles out the money, it is the regional Health
Service Executive Area which actually run the hospitals and day to day operations. It is via
the regional health services that you get the info you need about health clinics
and local services, set up appointments to have your kids' eyes examined and
the like. Each of the web sites also has a job section for those of you in the medical profession.
Health Boards were the bad old way that the national health service was run, they tell us. Billions of euro and many studies later, salvation was promised by the renaming of these Health Boards and a reshuffle of bureaucratic deckchairs.
Now, try and follow this. A few decades ago, local Health Boards were set up to give more control to locals in their health care spending. So, you had local Health Boards overseen by the Department of Health.
Then the local Health Boards were superseded by the new Health Service Executive (HSE). So, now there’s the Department of Health and the Health Service Executive.
Hospitals now are controlled by the National Hospitals Office (NHO). There are ten hospital networks based on the old regional health board structure. Then, there are 32 local health offices, one for each county. The local health offices (LHO) report to Primary, Community and Continuing Care (PCCC), a directorate of the HSE. Regional HSE offices interact with national HSE headquarters and also the NHO, LHO, PCCC and the local regional hospital network.
Remember, the temporary HSE regions are now defunct. So are the old regional Health Boards. The new HSE regions replace the temporary ones, which were the same as the old health boards.
There you go. Is that clear?
Now that it’s all sorted, it’s a mystery why expenditure on administration is rising roughly three times faster than expenditure on nurses, doctors and hospital beds.
And just to confirm the problem, in 2009 an HSE survey revealed that there were 49,000 administrators for 62,000 front line workers. That's nearly one chief for every indian. No wonder tens of billions of additional funds haven't produced a notable upswing in health services.
The Health Service Executive Website is a good starting point to "Find a Service" - the top button on this comprehensive site. You don't have to understand the ins and outs of the red tape - just start the ball rolling and the legions of secretaries and paper shufflers will sort things out.