Farm Ireland

Friday 19 January 2018

More must be done to address the cost of private healthcare and medical workers' training

John Shirley

I recently had occasion to go to a specialist for an ultrasound scan on my abdomen. The episode got me thinking about the cost of health in this country. I did not think about the treatment fee but got a shock when the hospital receptionist asked me for €255 even before I got near the scanning consultant.

When I did meet the good doctor, the conversation went like this.

Me: "Is that the same scanner that is used to confirm pregnancy in my sheep and cows, and for which I pay about €3.50 a cow and less than a euro a head for sheep?"

Doctor: "Ah, you farmers are always haggling. Sure, farmers are rolling in money -- and look at the grand way of life you have."

Me: "I hope that your knowledge of medicine is better than your knowledge of farming."

Doctor, as he moved the probe around: "You're full of wind, it's hard for the scanner to focus on anything."

Me: "You are not the first person to make that observation!"

Happily, apart from the excess wind, the doctor found nothing untoward.

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But I began to do sums. Four scan patients an hour at €255 a time equals €1,020 an hour. Thirty hours a week and you nearly have the annual average industrial wage in that one week.

I asked Dr Dan Ryan, of, to find out about ultrasound scanners for humans versus farm livestock. He had worked on scanning humans while in the US and he confirmed that it was essentially the same scanner that was used on both. Again, the same scanning principle is applied for units measuring fat and muscle depth, for instance in the Tully Beef Performance Test Centre.

I related my scanning experience to others and they came back with their own stories of private consultants. Post-cancer check-up visits, which took less than five minutes in the actual company of the consultant, cost €180 a visit. Post-hip-replacement check-ups were at €90 a visit. Private medicine in this country does not come cheap.

Neither does the Public Health Service. In spite of the €15bn budget allocation for health, dissatisfaction is widespread and we are nowhere near getting the universal healthcare that is enjoyed by the French or the British. Surely Ireland too should have a health system where a patient is treated on the basis of need rather than ability to pay.

I remember once being in the company of a group of doctors and consultants and being fascinated with the chat around the table. It was all about who was sending clients to whom from down the country. The talk was more about money than medicine. Minister for Health Mary Harney was seen as enemy number one as she tried to get consultants to sign up exclusively for Public Health Service contracts, even though she was offering an annual salary in the region of €200,000.

Another interesting insight into the politics and realities of the health service comes from a friend who worked for the HSE and then joined a private clinic. With the HSE, the waiting list was long and, by the time some patients were treated, their condition was either chronic or self-cured. An effort was made to speed up patient throughput to shorten the waiting time but my friend was subsequently instructed to slow down and stick to the quota of patients. Then this medic joined a private clinic. Here, patients were being encouraged to continue for more treatments that were medically justified. So, neither system is perfect.

Whether it's drugs, a visit to your GP or a consultant visit, the cost of health in this country is extraordinarily high. Rates are more than twice those in Spain. Health insurance costs are soaring way ahead of inflation. And, because the VHI works on a rate of cost plus a percentage, it has no real incentive to keep costs down.

For almost a decade, Ms Harney has been trying to tackle the power of the medics. The Irish Medical Council now has a majority of non-medics on its 25-member board.

Lack of competition seems to be the issue on the ground. We are not training enough doctors and there are insufficient consultants in the system. A period of hospital internship is a key part of training to become a consultant. I'm told that many of the hospital interns are from abroad and are working in Ireland on a time-limited visa. Staying on in Ireland to set up in consultancy is not an option, even if they wished to jump on our gravy train.

Tension between the medical profession and Government is nothing new. On the IMO website I spotted these lines: In 1957, relations between the Irish Medical Association and the Department of Health were at an appallingly low level. Doctors of all grades were "lambasted" as ultraconservative, incompetent money grabbers. It was said that the IMA was not a trade union or excepted body and it had no authority to negotiate terms or conditions of service. To add to the disharmony, William Doolin, editor of the Journal of the Irish Medical Association, wrote in July 1960: "For nearly 2,000 years, divinity, law and medicine have been bracketed as the three learned professions, and how any man with even a glimmer of history in his mental make-up could advocate a descent from that high position is incomprehensible."

Irish Independent