Public Treatment After Repatriation

tcs

This is more of an "advice on Health Care System" question than a medical one but wasn't sure where else to post it... Feel free to re-route to better forum if there is one.

A friend's sister was involved in a serious accident abroad about 5 weeks ago but has improved in leaps and bounds since - first they didn't think she'd survive and the Irish Embassy was onto the family to get out there ASAP. Then she came out of the coma and they suspected brain damage but she got the all clear. She's had a number of operations - a kneecap removed and an operation for a neck fracture but all in all it looks as though she's on the mend & is due home in a week. She's a very lucky girls & can already do a number of small things for herself - can brush her hair, wash her face etc. & has taken her first steps. It does look like there'll be a bit of physio required to get her going though.

Before she went travelling, her plan was to be away for some time, so her health insurance has lapsed and she'll be seeking treatment on the public health care system. Her travel insurance covered her expenses so long as she was abroad but now that she's coming home, she's on her own and it seems that she's not guaranteed admission into hospital here. Is that for real? What should her family be doing?

DrIndy

Talk to the embassy. They know the ins and outs of taking people back home and they should pay for the cost of her coming home too if she or her family cannot afford it, such is the duty of an embassy, to look after its citizens.

Depending on her specific needs will change where she should go for treatment. In my experience with patients being transferred in from abroad, it doesn't matter what insurance class they are affecting their re-entry as remember most irish people have health insurance so private beds are as much in short supply as public ones.

Generally, you are transferred to the hospital which is within the catchment of where you live, unless there is ongoing specific needs which only certain hospitals can provide.

What exactly were the nature of the injuries? What country is she in? I can gather she is over the acute phase and is in rehabilitation now. The NRH (national rehabilitation hospital) in Dun Laoghaire preferentially take people who are younger and have good potential for rehab, which seems to be the case as she is improving very well after 5 weeks.

However, I don't know if the NRH take admissions directly from overseas as they have very specific criteria and like to assess themselves before accepting someone. They also have a waiting list for patients but are very good at prioritising people who really need it as rehab when started as early as possible has the best outcome. There are other rehab centres located regionally which are also very good albeit without the fame, success and expertise as the NRH - but have a much shorter waiting time.

So it may be the case that she has to be transferred to an acute hospital for rehab before specialist transfer and this can be tricky as big hospitals are reluctant to take people who are essentially waiting for transfer justifiably when they have huge waiting lists for essential cancer surgery and a queue in A&E. If you live outside a major city, regional hospitals are generally much faster about accepting people back as they have less bed crises as major hospitals.

I cannot emphasise the importance of lobbying your local TD to intervene in this case and to start this as early as possible. Politicians may be a maligned race - but their job is to help their constituents and in general are very good indeed at doing this. There is a degree of urgency for her to come home if the country she is in is not a well developed one which doesn't have the same level of healthcare as here.

I hope this helps, post me more of the nature of the injuries and extent as well as where she is and I may have a little more insight.