Facebook
Twitter
YouTube
Inequalities in the Health Service
What can we do to help prevent this?
The Irish health system is a "uniquely" unequal mix of private and public provision and funding. This mix often means that those who can afford to go private get a better service. Private patients also get seen more quickly than those who cannot afford to pay for a private doctor. Service level also depends on where you live. There are often major inequalities in access to health care according to social class. This is sometimes called the Inverse Care Law. It means that the greater the need of the population for health services, the less likely they are to get them.
Background:
There has been an increase in funding in the health service, but it is still underfunded compared to other developed countries.
There are four types of people who use health services in Ireland:
1. Medical cardholders
Your eligibility for the medical card is determined on the grounds of income and medical need. Medical cards holders are entitled to free GP care, free medication and free hospital care.
2. People with private health insurance
Insured people pay General Practitioner (GP) fees as well as fees for medications up to a certain amount each month. They gain access to private care from hospital consultants through referrals from their GP, which is later reimbursed by their insurance company.
3. The uninsured
Those without insurance or a medical card must pay for all services and medications.
4. Those with no entitlements
These are people who are unable to pay and have difficulties in accessing some essential health services. These include people who have entered the country legally. but whose status may have changed e.g. workers without documents, those who are applying for residency on the basis of parentage of an Irish born child, students and those whose legal status is called into question.
The public-private mix
Everybody is entitled to hospital care. Despite this, almost 50% of the population have private medical insurance. The long hospital waiting lists for appointments has reduced slightly in recent times,but still the people who can afford to pay for treatment receive it more quickly. The most obvious inequalities in waiting lists for public patients are for outpatient appointments with a specialist; elective surgery and specific treatments e.g. multiple sclerosis or diabetes.
Over 70% of the population must pay for medical care, including seeing a GP and attending Accident and Emergency (A&E). People without insurance or medical cards must pay €55 per night and up to €550 maximum to stay in hospital (2005 figures). The number of people with private health insurance has been rising because people feel that it will give them a better chance to get access to health care. There are concerns that consultants may spend more time with private patients, leaving public patients waiting for longer.
Geographical inequalities
Where you live shouldn’t affect your access to health services, but this is indeed the case in Ireland. It is harder to get certain services depending on where you live. Services are not provided equally throughout the island. People who lived in Cork and Dublin in 1997 were more likely to have coronary artery bypass grafts than people living in other counties for example. There are also inequalities in the distribution of primary care. There are fewer GPs working in the most disadvantaged communities. Health services are of poorer quality and are less accessible to disadvantaged populations.
Primary Care, Continuing Care and Public Health
Some groups in society have more contact with these services than others and they include: children, older people, people with disabilities, women of childbearing age and people with chronic illness. These services need to look at holistic health. They are crucial for prevention, early intervention and ongoing care. They can increase people’s quality of life and reduce more expensive health care services later in life.
Inequalities in health services experienced by specific groups
Some groups in Ireland are disadvantaged in that they cannot access services as easily as other people. Women are more likely to access health services throughout their lives than men are and this sometimes results in an increased risk of illness for men. Low-income earners are less likely to seek services, as they are too expensive. Homeless people and travellers can have difficulty registering with a GP. Many people use A&E departments instead of having to find or pay for primary care, which is quite inappropriate for themselves and inefficient for the health services.
What can we as young people do?
- Lobby to have full medical cards available to all young people under the age of 18 as well as students in full time education.
- Young people should look for and take opportunities to help with planning and improving services.
- Lobby government representatives to get serious about promoting health - it would be good for all of us.
