Irish Health system - A Swiss perspective

Climber

As an Irish Man living in Zurich, Switzerland, I think it may be interesting to compare my experiences of both health care systems.

Yesterday (Sunday) I woke up feeling like S#@t, pains and aches, couldn't sleep, couldn't eat. So, I went to the local Doctor to get the once over. This Doctor is situated in a small clinic with approx ten other Doctors. She had the facilities to take blood and urine samples, analyse and diagnose them. She also took the usual pulse, temperature, "breath in, breath out" tests as well. The whole process took two hours. I was sent home feeling confident that all necessary tests had been considered and that no further treatment was needed.

Compare this to the Irish situation.

If I visited my local GP (who basically works from his converted Garage) he could have only performed the most basic tests and would have advised me to go to A&E if I wanted any further tests performed. So, I would have spent eight hours in Beaumont A&E listening to drunks arguing and vomiting in the waiting room.

It's obvious to me that the problem with the Irish health care system is the GP's and their unwillingness to modernise. If James O'Reilly achieves anything in his term he should smash this pathetic vested interest and make them operate out of clinics with adequate facilities instead of a converted garage with nothing more than a jar of lollipop sticks!

BKtje

Not all gp's in switzerland work out of a clinic (though a clinic of 2-3 doctors is not uncommon) and in fact it can be very hard to get an appointment on a sunday (or even same day unless very sick) where I live. You also have to remember that health insurance is mandatory and quite expensive.

That said I went to A&E recently due to no doctors being available to see me the same day and I was seen within 30 minutes of arrival though paid 100chf for the pleasure (€85). When my (then) swiss girlfriend had a problem in Dublin it took 9hours for her to be seen.

Overall I agree with you that the Swiss system is better but it is also a lot more expensive so we get what we pay for!

MagicSean

BKtje wrote: »

Not all gp's in switzerland work out of a clinic (though a clinic of 2-3 doctors is not uncommon) and in fact it can be very hard to get an appointment on a sunday (or even same day unless very sick) where I live. You also have to remember that health insurance is mandatory and quite expensive.

That said I went to A&E recently due to no doctors being available to see me the same day and I was seen within 30 minutes of arrival though paid 100chf for the pleasure (€85). When my (then) swiss girlfriend had a problem in Dublin it took 9hours for her to be seen.

Overall I agree with you that the Swiss system is better but it is also a lot more expensive so we get what we pay for!

The crazy thing is that if an Irish A&E were to become efficient and start saving money and treating patients faster they would probably have their budget cut as they would be considered to be overfunded.

Tora Bora

Climber wrote: »

As an Irish Man living in Zurich, Switzerland, I think it may be interesting to compare my experiences of both health care systems.

Yesterday (Sunday) I woke up feeling like S#@t, pains and aches, couldn't sleep, couldn't eat. So, I went to the local Doctor to get the once over. This Doctor is situated in a small clinic with approx ten other Doctors. She had the facilities to take blood and urine samples, analyse and diagnose them. She also took the usual pulse, temperature, "breath in, breath out" tests as well. The whole process took two hours. I was sent home feeling confident that all necessary tests had been considered and that no further treatment was needed.

Compare this to the Irish situation.

If I visited my local GP (who basically works from his converted Garage) he could have only performed the most basic tests and would have advised me to go to A&E if I wanted any further tests performed. So, I would have spent eight hours in Beaumont A&E listening to drunks arguing and vomiting in the waiting room.

It's obvious to me that the problem with the Irish health care system is the GP's and their unwillingness to modernise. If James O'Reilly achieves anything in his term he should smash this pathetic vested interest and make them operate out of clinics with adequate facilities instead of a converted garage with nothing more than a jar of lollipop sticks!

On the plus side for the Irish doctor you portray, he or she, can throw you up on the lift, in order to check you out from underneath.

The Swiss guy, without the garage equipment could not do that.

dissed doc

just for referenelce what is the monthly cost to you for healthcare in zurich, and compare it to your monthly spend when you were in ireland. i would love to see a direct financial cost comparison based on what you pay, each month, there and here.

TiGeR KiNgS

Seanbeag1 wrote: »

The crazy thing is that if an Irish A&E were to become efficient and start saving money and treating patients faster they would probably have their budget cut as they would be considered to be overfunded.

but they would be overfunded if that was the case.

irishh_bob

Climber wrote: »

As an Irish Man living in Zurich, Switzerland, I think it may be interesting to compare my experiences of both health care systems.

Yesterday (Sunday) I woke up feeling like S#@t, pains and aches, couldn't sleep, couldn't eat. So, I went to the local Doctor to get the once over. This Doctor is situated in a small clinic with approx ten other Doctors. She had the facilities to take blood and urine samples, analyse and diagnose them. She also took the usual pulse, temperature, "breath in, breath out" tests as well. The whole process took two hours. I was sent home feeling confident that all necessary tests had been considered and that no further treatment was needed.

Compare this to the Irish situation.

If I visited my local GP (who basically works from his converted Garage) he could have only performed the most basic tests and would have advised me to go to A&E if I wanted any further tests performed. So, I would have spent eight hours in Beaumont A&E listening to drunks arguing and vomiting in the waiting room.

It's obvious to me that the problem with the Irish health care system is the GP's and their unwillingness to modernise. If James O'Reilly achieves anything in his term he should smash this pathetic vested interest and make them operate out of clinics with adequate facilities instead of a converted garage with nothing more than a jar of lollipop sticks!

despite thier handy gig and protection from competition , GP,s in ireland are the second wealthiest in the world

Climber

dissed doc wrote: »

just for referenelce what is the monthly cost to you for healthcare in zurich, and compare it to your monthly spend when you were in ireland. i would love to see a direct financial cost comparison based on what you pay, each month, there and here.

An interesting point.

I pay CHF 320 per month in health insurance. This is equivalent to VHI plan B with options in Ireland.

So this is about EUR 278 per month.

When I worked in Ireland I paid EUR 110 per month VHI plan B; PLUS THE HEALTH LEVY! Most people don't consider the health levy when making a comparison. This 2% levy was supposed to go directly to the Health system, which it didn't.

Overall, the difference in expense per month is immaterial when considering the difference in quality and value for money between the two countries, which is staggering.

keithclancy

Climber wrote: »

As an Irish Man living in Zurich, Switzerland, I think it may be interesting to compare my experiences of both health care systems.

Yesterday (Sunday) I woke up feeling like S#@t, pains and aches, couldn't sleep, couldn't eat. So, I went to the local Doctor to get the once over. This Doctor is situated in a small clinic with approx ten other Doctors. She had the facilities to take blood and urine samples, analyse and diagnose them. She also took the usual pulse, temperature, "breath in, breath out" tests as well. The whole process took two hours. I was sent home feeling confident that all necessary tests had been considered and that no further treatment was needed.

Compare this to the Irish situation.

If I visited my local GP (who basically works from his converted Garage) he could have only performed the most basic tests and would have advised me to go to A&E if I wanted any further tests performed. So, I would have spent eight hours in Beaumont A&E listening to drunks arguing and vomiting in the waiting room.

It's obvious to me that the problem with the Irish health care system is the GP's and their unwillingness to modernise. If James O'Reilly achieves anything in his term he should smash this pathetic vested interest and make them operate out of clinics with adequate facilities instead of a converted garage with nothing more than a jar of lollipop sticks!

My GP in Ireland was in a Clinic with around 4 other Doctors, he came around to my house and took blood and urine sample and sent them into CUH.

I didn't even have to go to the Clinic, was grand.

Your GP in Ireland sucks.

40 euros is pretty cheap, when in Germany you pay 10 Euros / Quarter if you visit in that Quarter, but my Health insurance is 266 / month for the standard BKK.

In Ireland I had VHI Plan B paid for by my Employer.

murphaph

Comparing health insurance prices etc. between Ireland and Switzerland etc. is pointless as we fund health care completely differently.

Go check out the government spending per capita figures though and see that Ireland spends a lot on health care and delivers a pretty crap service at first point of contact compared to elsewhere.

GPs are a major part of the problem.

Suryavarman

Climber wrote: »

An interesting point.

I pay CHF 320 per month in health insurance. This is equivalent to VHI plan B with options in Ireland.

So this is about EUR 278 per month.

When I worked in Ireland I paid EUR 110 per month VHI plan B; PLUS THE HEALTH LEVY! Most people don't consider the health levy when making a comparison. This 2% levy was supposed to go directly to the Health system, which it didn't.

Overall, the difference in expense per month is immaterial when considering the difference in quality and value for money between the two countries, which is staggering.

I worked out if you were to take the amount that the Irish government spends of healthcare as a percentage of total expenditure and consider it as a percentage of the taxes you pay, somebody on €40,000 per year would spend €154 per month on healthcare per month through taxes. If they were then to buy the VHI health insurance you mentioned it goes to €264 per month. Sounds like we're getting a bit of a raw deal.

nice_guy80

I agree about the GPs

on the issue of the shortage of junior doctors, one has to look no further than the irish medical organisation ( I.M.O. ) who have for years ensured that limited entrant placements in medical colleges was kept low to ensure the availability of doctors was scarce so as to keep their greedy pricing structures in place.
this was facilitated by the likes of mary harney and micheal mairtin when they held the health portfolio. expecting james o'reilly who has his big nose in the G.M.S. scheme trough to the tune of 400, 000 euro per annum to change this happy system is expecting a little too much.
sick greed from them all while ordinary people die...........when will we learn?.

so the GPs, through the IMO are maintained the status quo - keeping numbers qualifying small so there is big demand and so the inflated salaries are maintained and the state has no option but to pay the prices the GPs demand

If the government were serious about reform they would look to increase the number GPs being trained, open up the sector to competition - promote real competition between doctors' prices, and cut out the influence of the IMO over the profession

AlekSmart

BKtje wrote: »

Not all gp's in switzerland work out of a clinic (though a clinic of 2-3 doctors is not uncommon) and in fact it can be very hard to get an appointment on a sunday (or even same day unless very sick) where I live. You also have to remember that health insurance is mandatory and quite expensive.

That said I went to A&E recently due to no doctors being available to see me the same day and I was seen within 30 minutes of arrival though paid 100chf for the pleasure (€85). When my (then) swiss girlfriend had a problem in Dublin it took 9hours for her to be seen.

Overall I agree with you that the Swiss system is better but it is also a lot more expensive so we get what we pay for!

A very interesting and informative thread here.

I would be interested in hearing from the Swiss based folks on the breakdown of how many Swiss residents are paying into their Health Care scheme in relation to the numbers who have full and free access to it's facilities without having to contribute at all ?

irishh_bob

nice_guy80 wrote: »

I agree about the GPs

on the issue of the shortage of junior doctors, one has to look no further than the irish medical organisation ( I.M.O. ) who have for years ensured that limited entrant placements in medical colleges was kept low to ensure the availability of doctors was scarce so as to keep their greedy pricing structures in place.
this was facilitated by the likes of mary harney and micheal mairtin when they held the health portfolio. expecting james o'reilly who has his big nose in the G.M.S. scheme trough to the tune of 400, 000 euro per annum to change this happy system is expecting a little too much.
sick greed from them all while ordinary people die...........when will we learn?.

so the GPs, through the IMO are maintained the status quo - keeping numbers qualifying small so there is big demand and so the inflated salaries are maintained and the state has no option but to pay the prices the GPs demand

If the government were serious about reform they would look to increase the number GPs being trained, open up the sector to competition - promote real competition between doctors' prices, and cut out the influence of the IMO over the profession

doctors in ireland have always been shown far too much deference by both politicans and regular citizens , time was the most important people in the parish were the priest , the doctor , the school principal and the guard , only the doctor has maintained status

dissed doc

nice_guy80 wrote: »

I agree about the GPs

on the issue of the shortage of junior doctors, one has to look no further than the irish medical organisation ( I.M.O. ) who have for years ensured that limited entrant placements in medical colleges was kept low to ensure the availability of doctors was scarce so as to keep their greedy pricing structures in place.

That is not strictly all true. I agree that the IMO has not worked to increase raw numbers of training posts (although strictly speaking there are plenty of training positions but vastly underresourced by a factor of 4 or 5 for specialists), but we have more medical graduates per capita than pretty much any other european country. No-one wants to stay because it's crap to work in Ireland - and making people stay just because they are doctors while letting engineers or computer programmers do what they like isn't very ethical is it.

this was facilitated by the likes of mary harney and micheal mairtin when they held the health portfolio. expecting james o'reilly who has his big nose in the G.M.S. scheme trough to the tune of 400, 000 euro per annum to change this happy system is expecting a little too much.
sick greed from them all while ordinary people die...........when will we learn?.

The GMS is 50k per year for around 1000-1500 patients, unlimited visits. People with medical card use hospital services around 6 times more than those who have to pay.

so the GPs, through the IMO are maintained the status quo - keeping numbers qualifying small so there is big demand and so the inflated salaries are maintained and the state has no option but to pay the prices the GPs demand

What is not being said, is that the cost mentioned above is most likely paid by a much wider spectrum of the population. In Ireland, up until 2-3 years ago, almost 50% of the working population paid net zero tax at all.

If the government were serious about reform they would look to increase the number GPs being trained, open up the sector to competition - promote real competition between doctors' prices, and cut out the influence of the IMO over the profession

Competition is the wrong word. There are absolutely no restrictions on any EU doctor setting up as a GP or if qualified as a specialist in another EU country from opening competitive specialist services, outside the HSE. You don't need the GP training scheme to open a GP clinic. People just don't want to because health care is not a priority in Ireland. Sorry, *paying* for healthcare is not a priority in Ireland.

dvpower

Climber wrote: »

An interesting point.

I pay CHF 320 per month in health insurance. This is equivalent to VHI plan B with options in Ireland.

So this is about EUR 278 per month.

When I worked in Ireland I paid EUR 110 per month VHI plan B; PLUS THE HEALTH LEVY! Most people don't consider the health levy when making a comparison. This 2% levy was supposed to go directly to the Health system, which it didn't.

Overall, the difference in expense per month is immaterial when considering the difference in quality and value for money between the two countries, which is staggering.

Private health insurance is mandatory in Switzerland, so the difference between what someone who doesn't have private health insurance pays here and in Switzerland is pretty large.

thebman

dissed doc wrote: »

That is not strictly all true. I agree that the IMO has not worked to increase raw numbers of training posts (although strictly speaking there are plenty of training positions but vastly underresourced by a factor of 4 or 5 for specialists), but we have more medical graduates per capita than pretty much any other european country. No-one wants to stay because it's crap to work in Ireland - and making people stay just because they are doctors while letting engineers or computer programmers do what they like isn't very ethical is it.

That depends on how much of a deficit is incurred training each I would think.

Usually you are pretty unemployable without experience in the industries you mention and would probably find it hard to get a job in another country as a foreign graduate I would think.

Climber

dvpower wrote: »

Private health insurance is mandatory in Switzerland, so the difference between what someone who doesn't have private health insurance pays here and in Switzerland is pretty large.

Correct. Private health insurance is mandatory. If you are earning a low wage in Switzerland there are subsidies provided by the Gov to help you pay for the insurance.

I think mandatory private health insurance is the way to go. It will make people appreciate the value of their health (I shudder in fear that there are still people living in Ireland that don't) and smash up the GP Monopoly.

I read somewhere that more than 70% of A&E admittances are NON-trauma related. Therefore 70% of people visiting A&E have not been in an accident nor is it an emergency! The reason for this is the pathetic GP infrastructure.

nesf

Climber wrote: »

I read somewhere that more than 70% of A&E admittances are NON-trauma related. Therefore 70% of people visiting A&E have not been in an accident nor is it an emergency! The reason for this is the pathetic GP infrastructure.

Eh, things like a bad case of pneumonia or a suicidal person wouldn't be traumas but both are very much things that should bring you to A&E. And that's just off the top of my head, there are many, many more non-trauma cases that should bring a person to A&E.

keithclancy

Climber wrote: »

Correct. Private health insurance is mandatory. If you are earning a low wage in Switzerland there are subsidies provided by the Gov to help you pay for the insurance.

I think mandatory private health insurance is the way to go. It will make people appreciate the value of their health (I shudder in fear that there are still people living in Ireland that don't) and smash up the GP Monopoly.

I read somewhere that more than 70% of A&E admittances are NON-trauma related. Therefore 70% of people visiting A&E have not been in an accident nor is it an emergency! The reason for this is the pathetic GP infrastructure.

AFAIK if its like the German System its Normalised, so you pay the same percentage regardless of you age/circumstances.

If anything the Mandatory insurance in Germany is excellent and the Private Insurance (once you earn over the threshold) is not.

thebman

nesf wrote: »

Eh, things like a bad case of pneumonia or a suicidal person wouldn't be traumas but both are very much things that should bring you to A&E. And that's just off the top of my head, there are many, many more non-trauma cases that should bring a person to A&E.

Yes but many people go because they drank too much or have a cold.

I know of more than one person who have been in their 20's or early 30's that have gone to a hospital instead of their GP for what was only a common cold that a bit of lemsip would have kept the symptoms down until it passed but they were convinced they were dying.

We need to stop those people going to hospitals in this country for those things. Alcohol poisoning requires hospital treatment sometimes but the person shouldn't be getting into that state in the first place. We need to come up with a good way to ensure alcohol abuse stops.

Climber

We need to stop those people going to hospitals in this country for those things

I agree with you. The problem is that there is no other place to go.
This is the point I'm trying to make

nesf

thebman wrote: »

Yes but many people go because they drank too much or have a cold.

I know of more than one person who have been in their 20's or early 30's that have gone to a hospital instead of their GP for what was only a common cold that a bit of lemsip would have kept the symptoms down until it passed but they were convinced they were dying.

We need to stop those people going to hospitals in this country for those things. Alcohol poisoning requires hospital treatment sometimes but the person shouldn't be getting into that state in the first place. We need to come up with a good way to ensure alcohol abuse stops.

I agree, that's why A&E has to cost so much without a doctor's letter unfortunately.

murphaph

keithclancy wrote: »

AFAIK if its like the German System its Normalised, so you pay the same percentage regardless of you age/circumstances.

If anything the Mandatory insurance in Germany is excellent and the Private Insurance (once you earn over the threshold) is not.

Depends on which private insurance one has. The advantage of private insurance is that it is generally cheaper (for young people with no prior illnesses). What I dislike are people who take out this cheaper insurance to save money in their 20's and 30's and then weasel their way back into the public system in their late 40's just as their private premiums begin to skyrocket.

nesf

murphaph wrote: »

Depends on which private insurance one has. The advantage of private insurance is that it is generally cheaper (for young people with no prior illnesses). What I dislike are people who take out this cheaper insurance to save money in their 20's and 30's and then weasel their way back into the public system in their late 40's just as their private premiums begin to skyrocket.

It costs the same to have private health insurance here regardless of age and/or prior illness. It's why the VHI was so ****ed with its older member base.

Mucco

OECD 2009 figures:
Total health expenditure per capita, US$ PPP
Switzerland: 5144
Ireland: 3781

murphaph

Mucco wrote: »

OECD 2009 figures:
Total health expenditure per capita, US$ PPP
Switzerland: 5144
Ireland: 3781

Does this include all the undeclared €50 GP visits we make?

Nonoperational

What blood tests did the GP perform in the surgery?

Jim2007

Climber wrote: »

As an Irish Man living in Zurich, Switzerland, I think it may be interesting to compare my experiences of both health care systems.

Fortunately for you, your experience of the Swiss system is limited! As a 20+ years veteran of the Swiss system, I can tell you a different story.

First of all the consultation fee that Swiss doctors are allowed to charge is too low to give them a salary in line with hospital doctors. To get around this most GPs have been doing their own lab work, as there was great flexibility in what they could charge for it. This of course leads to a very expensive service and as a result a decision was taken some time back to disallow new GPs from doing this. The consequence is that as doctors retire, no new GPs are coming into the practice and this has resulted in many people being forced to use the A+E department, as they are unable to find a local GP. In my area alone we have over 3,000 people who are unable to find a GP!

In my case I'm a diabetic, so the authorities are required to provide a GP - the best they could do was one that is over 45 miles away. It takes the best part of a day, every time I have to visit him.

Another issue is the generic drugs - yes we have them, but everything is repackaged by local suppliers rather than being bought direct from the manufacturer/distributor and as a result there is very little difference the prices of the original drug and the generic one!

Another thing to consider is that insurance policies are Kanton (= county) scoped, meaning that you must attend hospitals and consultants within your own Kanton. This means that people in the border areas often have to travel long distances for treatment. In the case of my father-in-laws's brother, he had to stay at hospital on the other side of the Kanton after have a heart problem, but worse it was in the French speaking part of the country and he comes from the German speaking part, so he had great difficulties in communicating with the staff there!

Back in Ireland, my mother (RIP) and my aunt both had to have chemotherapy in the last few years, in the case of my aunt she was put up in a near by B+B, so that she could easily attend the hospital during the treatment, my mother was picked up by ambulance and brought the 25 miles each day for treatment. Compare this to my 80 year old, Swiss father-in-law, who is expected to attend a city hospital for the same treatment - he must make a 2.5 hour trip each by public transport, involving a train, a tram and a 15 minute walk, each day at his own expense. He clearly can't do it alone, so someone in the family has to take a day of work each day to go with him....

When it comes to health insurance, it is true that you can not be refused basic health insurance - but there is a long list of exceptions, mainly things that should have been diagnosed as a child, such has autism spectrum disorders. These are not covered by insurance, but should be covered by the Kanton authorities in stead. However if they were not diagnosed before the child reached 14, you're screwed - no insurance over and limited Kanton support. The result is that many adults are not getting the treatment they need or deserve because the simply can't afford to pay for it themselves.

Another interesting development is that if you have a series condition and have private insurance, you may not be given a private room - the reason, they don't have enough staff to cover all the wards, so their hope is that if you take a turn for the worst, your mate in the other bed will raise the alarm! The lack of nursing staff is one thing that strikes me every time I visit someone in a Swiss hospital - you can walk entire floors and not meet a single member of staff!

The good news is that almost all hospitals have an A+E dept, the bad news is that if you don't live in one of the big cities, it will be closed at night! When my son was very small we had occasion to rush him to the local hospital (5 mins away) at mid night, only have to wait about 20 mins for someone to come and open the place up, turn on the lights etc... and then another hour for a doctor to actually arrive!

There are many other stories of colleagues experiences of the Swiss health system, but the bottom line is that it is very expensive, some parts are definitely better than Ireland, but taken over all is no better than most other systems operating in Europe.

Jim (Switzerland)

Jim2007

AlekSmart wrote: »

A very interesting and informative thread here.

I would be interested in hearing from the Swiss based folks on the breakdown of how many Swiss residents are paying into their Health Care scheme in relation to the numbers who have full and free access to it's facilities without having to contribute at all ?

Well there is no public health system over here, so the answer is zero! Health insurance is mandatory - there are random checks to ensure that you have done this, if not then one will be taken out for you by the authorities and back dated to the date you should have taken one out! If you are considered destitute and I really mean destitute then the local community will pay for a basic insurance policy for you.

The result of this is that very often low income families and old people are under insured - to keep the premium low they under take to pay a very high portion of the annual medical cost themselves - say CHF1,500 to CHF2,000. And of course because the have to pay such a high portion themselves they often opt not to go for medical treatment, when they really should.

Jim.

PS - Dental work is not covered by standard health insurance and rarely even by private insurance.

Jim2007

Climber wrote: »

Correct. Private health insurance is mandatory. If you are earning a low wage in Switzerland there are subsidies provided by the Gov to help you pay for the insurance.

No the government does not come in to it. If you are considered destitute your local community will pay for a basic restricted insurance policy, but only if you are a Swiss citizen or a C permit holder.

Jim.

Jim2007

gpf101 wrote: »

What blood tests did the GP perform in the surgery?

Well I can't comment on the OP's experience, but I can give you an idea of the scale of operations: Most surgeries have a staff of about 10 to 12 people, say 2 doctors, a receptionist, 2 or 3 nurses and 4 or 5 lab techs. The lab area can take up anything from a half to two thirds of the office space and they are usually able to give you a work up equal to that of most hospital labs!

Jim.