Take Two And Call…..? A Look At Irish Health Care

Caveat – What follows is all entirely my assessment, because nobody, even the Irish Government’s website, can give you a lucid, easy to digest description of what is and is not covered, when, by who, and for how much.

One of the first things you hear from just about everyone when you deicide to move to Ireland is, “Oh, they have free health care, right?  And for a moment you allow yourself to fantasize about drifting lazily into the soft downy embrace of socialized medicine, where the care is good, access ubiquitous, and your out of pocket costs are next to nil.

Not so
What you learn when you get here is something slightly different.  The care appears to be as good as any in the world (or so they say).  And while you can gain access to it, it may take a bit of time for you to work your way through the waiting lists, or to build up enough credit (by paying money into the social welfare system) to be given access to certain parts of the system.  Oh, wait, that’s for the free public system, which you are probably not going to be allowed to use anyways because you make too much money.  So, you’ll have to pay for private insurance. So much for the soft downy embrace.

But you are entitled to some things for free.

Well, sort of
After you’ve been here a while and have torn your hair out trying to get a straight answer, you gradually piece together a few things.  As a resident, you are entitled to a family prescription medicine card that caps your maximum out of pocket costs at €125/month.  That’s not bad, particularly if you are on any hugely expensive drugs. But the drug coverage gets even better if you are being treated for a “long-term illness (such as diabetes, leukemia, hemophilia, Cerebral palsy, and some others).  For these conditions, prescriptions are completely free (even if you are simply resident in Ireland and not a citizen).  At this point I began to feel some soft downiness.  Alas, my lifelong handicap is not considered “long-term”, so my lifts are not covered.  Ahh, well. Some you win, and some you lose.

Nobody Really Knows
But all is not lost. Our Irish friends, and other long-term residents all suggest continuing to try and get things paid for.  Because, this being Ireland, nobody is really sure what will or won’t be covered.  Even if it’s not covered today, the policy could change tomorrow.  And, if you hit the lottery (they’re big on luck in Ireland) and get the right person on the phone, you just might get something covered that is usually not covered.

Here in Ireland nobody really considers this to be dishonest, or illegal, so much as just looking out for yourself in a system that is, at best confusing, and, more than likely, deliberately opaque.  And, in this place, where cynicism is practically a religion, and everyone just sort of goes along trusting that the government will look after them, most people tell you not to worry too much about it.  You’ll be taken care of.

Yet again, I’m forced to hogtie my inner American to keep from screaming, “But where is this all written down?  How do I know anything for sure, if it’s not written down?”  Then, post Quaalude, I think to myself, how much can you really trust U.S. insurance companies and their glossy brochures where it is all “written down”?  When you really need them, they’ll just change the coverage to suit their purposes and cite some arcane sub clause of the main sub clause of the addendum and deny your claim.  So, perhaps a little uncertainty and faith aren’t so bad after all.

The System is Broke(n)
In Ireland, it’s sort of taken on faith that the health care system is skint.  In America we know this for a fact about Social Security.  Here, in Ireland, this is not so much a health care fact as this niggling itch in the back of everyone’s mind.  Nobody will come out and say it, but, in a country with raging unemployment, an economy in recession (teetering on apocalypse), and no money for many basic governmental services, how could health care be anything but flat, busted, broke?

In the news lately we’ve learned that Irish nurses and other health care professionals apparently take more sick days than professionals in any other sector of the economy.  Because the salaries of health professionals are effectively paid by taxpayers, Irish citizens are outraged by these revelations.  But they’re not surprised.  Graft, ineptitude, and fraud are all assumed.  But nobody wants to face the shrieking horror of there being literally not one Euro left to spend on your child’s dialysis treatment, or plastic surgery for a child burnt in a fire.  Sadly, that’s the fear lurking in the back of people’s minds.

It remains to be seen if the system is truly broke, or simply broken.

Personal Services
Because so much of the Irish health care system seems dark and confusing, a lot of people seem to put great stock in their GP (general practitioner).  In this big social system, your personal physician is a face to put your trust in.  She’s a person you can call for advice.  They will actually sit in a room with you and give you advice.  It’s assumed that you will have to pay for all (or most) of their fee in person on the day of service.  But that cash and carry mentality is comforting in its lack of ambiguity.  There’s no lingering obligation.  It’s a very simple relationship.

MY first visit to my new GP was quite interesting.  He gave me the usual spiel about exercise and weight loss.  I was then told that my customary alcohol intake (1-2 drinks twice a week) equaled six units a week.  I remarked that I hoped I was still below average in Ireland.  He told me that if I consumed 20 units a week I’d still be well below the national average.

Later he too told me to plan on getting supplemental (private) insurance.  He explained that, while I could get by without it, it will drastically shorten waiting periods when seeing consultants and specialists.  It seems that without it, I’m still entitled to a certain level of health care, but, exactly what that is, he couldn’t say.  He simply said, “Get the insurance.”

So, I’ve got my prescription card, my GP, and private insurance.  I’m covered, but for what, and for how long?  Who knows?  For now I just go along and hope for the best.  Perhaps I’m slowly learning to fit in here in Ireland.

Things to look forward to in upcoming posts:

The First Three Months

About Glenn Kaufmann

I'm an American freelance writer, photographer, and web publisher. I specialize in writing about travel, food, arts, and culture. I also write dramatic scripts for stage and screen. I'm based in Ireland.
This entry was posted in Bureaucracy, Health Care, Irish Life & Society and tagged , , . Bookmark the permalink.

13 Responses to Take Two And Call…..? A Look At Irish Health Care

  1. Rodrigo Maldonado says:

    Mr. American in Dublin,

    This is a great summary piece of the health care system in Ireland. Things here in the USA and the rest of the world are collapsing, so I wouldn’t be so surprise of the “uncertainty” flavor that your post transmitted. Like with the lawyers, the best doctor is the one you will never need. Greetings from the Midwest.

    Chileno

  2. Enda H says:

    Hey,
    Just a heads up: part of the reason why the government are a little ambiguous on the health insurance front is because it’s currently ambiguous! Total reform of the health system was a key policy point for Fine Gael in March. As you are probably aware, the old government were slaughtered in the last election in March and the new Programme for Government (http://tinyurl.com/6hp33sf) promises that “A system of Universal Health Insurance (UHI) will be introduced by 2016, with the legislative and organisational groundwork for the system complete within this Government’s term of office.” Thus the current uncertainty.
    Best,
    Enda

    • Enda, so noted. However, that’s a bit ridiculous don’t you think? How helpful is it for the government to say we’ll introduce a solution to the problems with the health care system by 2016? Isn’t that a bit like asking a drowning man to hang in there while you go off and shop for a bathing suit to rescue him in.

      • conguill says:

        I think it is more akin to telling a drowning man that you can only do so much to help him and he may drown because you are (slowly) putting in place a system which will be much more effective for drowning men generally in the future.

        It is not ideal but the current system is dysfunctional and some turbulence is involved in reforming any system, especially one as sprawling and with as many vested interests (consultants, nurses’ unions, bureaucrats’ unions, local politicians looking to keep local hospitals in place even when they do not make sense etc., civil servants) as the Irish health system. The role of Minister for Health is often viewed as a poisoned chalice for ambitious politicians.

        The hope is that in five years you will be writing a blog post on how radically improved the health system is. Time will tell.

  3. Mothman says:

    What on earth are you talking about here: “Oh, wait, that’s for the free public system, which you are probably not going to be allowed to use anyways because you make too much money. So, you’ll have to pay for private insurance”? I think you’re confused between the means-tested GMS, PRSI cover and OPTIONAL private insurance. And you can say what you like in that condescending, arrogant American-abroad tone of yours but although people here may have to wait they will not be denied access to healthcare because of inability to pay.

  4. Dee says:

    Wow, condescending much? I’d take the Irish healthcare system over yours anyday. I know that if I have a heart attack here, I’ll be picked up by ambulance (free), taken to A & E (free), get treated (free), spend x number of nights in hospital (free), get follow up care (free) and mediation (free). I have a medical card to cover all these things. Even if I didn’t it would cost me €75/night up to a max of €750 per annum. Meds would be €120 max per month. All irrespective of if I earned €20k/annum or €200k/annum. And you won’t be bankrupted if you can’t pay it. How much would that cost me in the US?

    While it might be very useful, you do not need health insurance here. You will get good care without it – you might wait a little longer but you’ll get it. Also, insurance here costs the same for everyone. Mine is €800 (per annum!) for a healthy woman in her 20’s. The same for my parents in their 50’s and my uncle in his late 60’s. And they won’t try and wiggle out of paying for each little thing. You need to go into hospital? Roll up to the local private hospital with your policy number, sign a form, get treated and a few weeks later a receipt from the insurance company arrives in the post (personal experience x 4). No waiting weeks for authorisation. Same with an MRI. Get your referral letter, make your appointment, give your policy number, turn up (personal experience x 2).

    The Irish health system has its flaws for sure – waiting times, overcrowding, lack of step down facilities etc. But no one needs to worry about having to pay for life saving treatment. You just get it. The thoughts of the American system where you can die because you are poor is just, well, sickening. How can any just nation allow people to suffer because they don’t have the money to see a doctor or buy medication?

    Also, you, as an American, can turn up in Ireland, establish ordinary residence and gain the same healthcare entitements as your new neighbour who was born here and lived all his life here. Generous huh? Would I get the same in the US?

    While the guidelines may not be clear or readily accessible online, they are there. Visit your local Citizen’s Information office or HSE health centre. Your GP and pharmacist will help too.

  5. Everything mentioned above just about covers, over, under, around and through the Irish Healthcare system. My husband and I have vacationed for a couple of months in Ireland for the past 15 years, and tho’ expensive if not citizens, such as is our case, we have found honesty in all our business dealings. Enda Kenny seems to be an honest PM, for a change, Mostly we’re not happy to have to pay for the use of our TV for only 2 months use, and tho’ we’re Sr, Citizens in our 80’s, we dont get free travel, or any other perks the OAP’s do in Ireland. Get to know a few OAP’s, they’ll put you right every time. Obviously we must love Ireland, or we would not keep going back. Right?

  6. I as an Irish citizen agree wholeheartedly with the author’s points. The Irish system is inherently corrupt. There is no real equalizing standard in how decisions are made as regards what is covered and what is not. It is inefficient. The HSE is a huge mamoth institution that is impossible.
    The government recently submitted plans for a childrens hospital to one of their own departments when the plans violated the governments own guidelines. Then complained when their own department turned down permission for the hospital. Areas like oncology are a disgrace.

    It is NOT condescending at all it is truthful and direct.

    If i had a suspicious mind i would say you were in this for FG and were government cronies;-) and that two faced Enda Kenny grrr oh and every political party in Ireland has it’s crooks…that is the general feeling of the nation…they have all lost our trust everyone
    To the author i say well done for saying your piece and dont let others sway you from your own opinion. To much is excused by Irish citizens.

  7. owen says:

    you must think you are unique as an american in dublin that you have to document everything.
    im sure your wife is well compensated in her job so you can be carrie bradshaw . it’s amazing how everyone is a ‘writer’ these days .

    • Owen,

      Thanks for reading the blog, and for taking the time to comment.

      That’s an interesting perspective, and might be remotely valid if not for the fact that I’ve been a working professional writer for more than a decade now. I’ve got well over 200 published articles in print in magazines and newspapers around the world, ranging from major airline inflight magazines to a few “little” newspapers you might have heard of, such as the Irish Times.

      By the way, in proper English we spell them, “American” and “Dublin”.

      Cheers,
      Glenn

      • Conguill says:

        You are too polite, Glenn.

        Whether you are a professional writer is irrelevant to the points made by Owen. He makes no comment on your experiences or conclusions, only snide remarks in your wife’s salary and your right to express your opinions. Does he feel we are all served better if some experience poor care but keep it to themselves?

        Keep writing it as you find it and don’t let this sort of nonsense deter you (I suspect it won’t). I may not always like it but I will respect you for it.

  8. Ivan 'The Mexican' says:

    Hola Glenn!,

    I really liked what DEE said 🙂 … I am Mexican and I will move to Dublin next month (I just got a job there after several months of Skype interviews, so only waiting for my green card to arrive).

    I am very interested in all those processes to get medical assistance in Ireland (hoping that I will never need it, though). If Dee or someone else could write more tips and details, please do it.

    (By the way, I do not like how USA ppl use that word: American). I am American too, but from Mexico.. you Should use some more explicit word to describe your country… because, well.. America is not only USA.. it is composed by 35 countries, and USA is only one of them 😛
    But Nevermind if you wanted to say that you are from America continent (like it is Well used by Europeans when they say “I am European” though).

    Thank you for all your other posts, I’ve learned a lot before my departure!. I will miss my mexican food and nice weather (25ºc all year in my city)… but I am sure that Irish people is really nice! (like mexicans). Can not wait to make new friends over there!

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