Thursday 23 November 2017

Beat long waiting lists and big medical bills

Insurance can help avoid public health delays and cover expensive private treatment, writes Louise McBride

Cartoonist: Tom Halliday
Cartoonist: Tom Halliday
Louise McBride

Louise McBride

When my son was two, I discovered he was hearing things as if he was underwater. This was because he had fluid rather than air in his middle ears - a condition known as glue ear. His speech was not coming on as it should have for a child of his age as a result - and he had suffered more than a dozen painful ear infections. I had two options: wait and see if it would clear up naturally - or the surgical insertion of grommets.

At that young age, hearing is crucial for the development of speech. I waited a couple of months and arranged another hearing test - only to find it was persisting. I figured that any further delays could hold my son back in playschool - and, later on, in school. Reluctant as I was to have him under general anaesthetic at such a young age, I made an appointment with a hearing consultant to explore the option of grommets. A few weeks later he received grommets in the Hermitage Clinic in Lucan. His speech has come on in leaps and bounds since, the ear infections cleared up, and he is able to interact with the world as he should. He is five now and his hearing is fine.

The total cost of my son's treatment that day came to €1,420 - and thankfully, I had private health insurance which covered most of the bill.

Had I waited for my son to be seen publicly, I would have waited at least six months - and perhaps a year or more. Maybe the glue ear would have cleared up of its own accord by then; maybe not. Like any parent with a child who is suffering, I didn't want to take the chance and wait. Had I waited any longer to resolve the problem, my son could still be playing catch-up with his speech today.

It is not a life-threatening condition - yet getting it treated early made a big difference to my son's daily life. The same is true of the many people who are waiting years for treatment in the public health system - as highlighted in RTE's recent Prime Time documentary, Living on The List. This documentary found that people are waiting months and sometimes years for treatment for a range of conditions, such as cataracts and scoliosis - where an individual's spine curves to the side.

"Unless you've got a life-threatening condition, you could be waiting months or over a year to get seen publicly for routine surgery - especially for orthopaedic procedures," said Dermot Goode, health cover analyst with totalhealthcover.ie. "People often assume that children get special treatment for elective treatment [where a medical emergency is not involved]. They don't. Children often have to wait six months or more for tonsillectomies. The wait time for a child's MRI scans can be up to three months - and it's something similar for an urgent colonoscopy [which examines the inner lining of your large intestine]."

There are about 2.5 million people in this country who don't have private health insurance. These people will have to rely on the public health system if they become ill - unless they have the money to hand to pay for the treatment themselves. The bill for a stint in hospital however could run to tens of thousands of euro or more. Here are some of those bills:

Mastectomy: €10,000

A mastectomy, one of the procedures used to treat breast cancer, involves the removal of a breast. "The cost of getting a mastectomy in a private hospital as a private patient can be anything up to €10,000," said Barbara Sheahan, head of health and dental with healthinsurancehelp.ie. "For example, it could cost €400 for the initial consultant's appointment, €4,500 for the procedure, €1,000 for an anaesthetist, and €2,500 for a two-night stay in a private hospital."

Hysterectomy: €8,000

A hysterectomy - which involves the removal of part or all of the womb - is not always medically necessary.

Some women consider hysterectomies when they have decided not to have any more children - particularly if they suffer from menorrhagia. A hysterectomy may be medically necessary in certain circumstances, such as if a woman has cervical cancer. You could have to wait a year-and-a-half for a hysterectomy as a public patient, according to Sheahan.

"The length of time you have to wait will depend on how urgent your procedure is," said Sheahan. "The public hospital waiting list at the moment for a hysterectomy is anything from 12 to 18 months."

Without private health insurance, you could face a bill of €8,000 if treated privately - once you take the cost of the procedure and hospital accommodation and care into account.

You can expect to pay around €3,000 for a hysterectomy as a private patient, according to Sheahan. "That €3,000 would include the consultant fee, pathology fees, histology fees and the anaesthetist bill," said Sheahan.

Hospital accommodation costs could be as high as €5,000. "A hysterectomy usually requires a four- to five-night hospital stay," said Sheahan. The cost of a private room in a public hospital is €1,000 per night; the cost of a semi-private room is €813 a night. You cannot visit a consultant and then opt to be treated publicly - once you attend a consultant, you are opting to be treated as a private patient," said Sheahan. "A lot of consultants will refuse to take private patients who don't have private health insurance, even if they are willing to pay the bill."

Tonsillectomy: €3,000

A tonsillectomy is a surgical procedure to remove the tonsils. It is often used to treat breathing problems and rare diseases of the tonsils - and it can also be used to treat chronic and recurring tonsillitis. It could cost about €3,000 or more to get a tonsillectomy if treated as a private patient in hospital - assuming an overnight stay is required.

Spinal fusion surgery: €12,000 plus

RTE's Living on the List documentary highlighted cases where those on public hospital waiting lists have been waiting years for treatment for scoliosis. Spinal fusion surgery can be used to treat scoliosis. Yet at more than €12,000, the cost of such surgery is often prohibitive for those who don't have private health insurance. "The cost of this surgery will vary - depending on whether or not implants are needed," said Goode.

Life-saving tests

Public patients face waits of up to a year or longer for life-saving tests which can help detect - and act on - serious health problems early. Should you wish to undergo such tests privately, the bill could run to a few grand - depending on the test. You can for example expect to pay about €2,500 for an angiogram - a procedure which detects blockages in heart arteries, according to Goode.

Other common big-ticket bills

Many elderly people suffer with poor hips and knees - and as these are not usually deemed medical emergencies, the wait for treatment in the public health system can run into years.

The same is true of children waiting for orthodontic treatment. Should a patient wish to be treated privately, a hip replacement could cost €15,000, while a total knee replacement could set you back €17,500, according to Goode. The bill for a set of braces for a child could come to €2,700. There are many people on waiting lists who need surgery for cataracts, gallbladder problems or hernias. A cataract operation is likely to cost between €2,000 and €2,500. The bill for a laparoscopic cholecystectomy - which is surgery to remove the gall bladder - could come to €6,000. Surgery to repair the hernia could cost €5,000.

Many people without private health insurance simply don't have the cash to cover bills like this and so are unfairly facing year-long waits for treatment as a result. As well as impinging on their quality of life, these waits can sadly turn manageable problems into unmanageable ones.

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