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Comparing and Contrasting the Health Systems of Ireland and the United States By Angela DuTremaine November 21 2013

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Page 1: Healthcare compare

Comparing and Contrasting the Health Systems of Ireland and the United States

By Angela DuTremaineNovember 21 2013

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Ireland

• All residents in Ireland are entitled to receive health care through the public health care system, which is managed by the Health Service Executive and funded by general taxation. – A person may be required to pay a subsidised fee for certain

health care received; this depends on income, age, illness or disability.

• Everyone living in the country, and visitors to Ireland who hold a European Health Insurance Card, are entitled to free maintenance and treatment in public beds in Health Service Executive and voluntary hospitals. Outpatient services are also provided for free. – However the majority of patients on median incomes or above,

are required to pay subsidised hospital charges.

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3 Issues to Compare and Contrast USA & Ireland

1. Prenatal and Maternity Care

2. Urgent ER and Outpatient Care

3. Prescription Drugs

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• "Early and continuous prenatal care is essential both before and throughout your pregnancy to help ensure a healthy delivery and healthy baby,”

- Jeanne Conry, MD, an obstetrician with Kaiser Permanente in Sacramento, Calif.

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Prenatal and Delivery Costs in the USA• If you have health

insurance, prenatal visits and any diagnostic tests (such as ultrasounds) will likely be covered. They are generally considered "preventive" care.

• If you don't have health insurance, the average cost of prenatal care is about $2,000.

The costs of childbirth can be steep. The charge for an uncomplicated cesarean section was about $15,800 in 2008. An uncomplicated vaginal birth cost about $9,600, government data show.

Women who have individual health insurance policies often find that maternity care coverage is completely excluded, says Carol Sakala, PhD, director of programs at the nonprofit Childbirth Connection.

Medicaid or group private insurance plans, however, cover almost all pregnancy-related health care costs.

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Please visit this link to the NYTIMES article following one American woman’s experience with the US healthcare system duringhttp://www.nytimes.com/2013/07/01/health/ame

rican-way-of-birth-costliest-in-the-world.html?_r=0

Please visit this link to the NYTIMES article following one American woman’s experience with the US healthcare system during her pregnancy to get a fuller understanding of the challenges and decisions that mothers face.

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Prenatal and Delivery Costs in Ireland• All women are entitled to FREE

maternity, which includes cover for:– antenatal visits, labour & delivery costs

and postnatal care, regardless of whether you have health insurance or not

• Public patients attend their chosen hospital’s community-based clinic, and may or may not see the same doctor on each visit.• To avoid longer waiting times

and have continuity of care with the same provider some couples choose to pay privately within the public hospital system. This can range from 3,000 to 5,000 Euros. They cannot guarantee your provider will be present at birth.

• Ireland has one private maternity hospital, Mount Carmel. Usually considered much more expensive, but their current packages it comes out to be 30% cheaper than paying privately in the public hospitals.

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Infant Mortality Rates 2005• Infant mortality is death of children before age 1.• From this figure you can see that Irelands Infant mortality rate is lower than the United States

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Bottom line for Mothers

• If we are gaging public health by infant mortality, it seems that having free prenatal and maternity care as well as nationwide 6 months maternity leave has improved health outcomes for infant mortality in Ireland.

• It is far more expensive to get medical care for pregnant women in the United States Health System especially for the uninsured.

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The Emergency Room

• The part of the hospital that provides immediate treatment for acute illnesses and trauma.– The most commonly treated conditions include traumatic

injuries, heart attacks, sudden illnesses all needing treatment right away or outside of normal Primary provider hours.

• It is an important department that every country must have to tend to the immediate health needs of the population.

• Now lets compare how each country manages this service…

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Emergency Care in Ireland• If you use Accident and Emergency care or Out-Patient care without being

referred by a GP it is provided at a cost of €100, if you have a referral it is free of cost.

• You will be exempt from the €100 fee if you meet any of the following criteria:– Medical card holders – People who are admitted to hospital as a result of attending the casualty department

(you will then be subject to in-patient charges) – People receiving treatment for prescribed infectious diseases – Children up to 6 weeks of age– Children who have certain diseases and disabilities– Children referred for treatment from child health clinics and school health

examinations – People who are entitled to hospital services because of EU Regulations – Women receiving maternity services

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Emergency Room in USA

• With insurance the average ER copay is around $76 dollars

• For the 49 million Americans who are uninsured their costs can vary greatly from $4 to $18,000.

The US does charge for these services, and there is no standardized fee, if you have insurance you may have have a copay, co-insurance or deductible. You may also have an additional out-of-network charge.

Without insurance your cost will likely be at least one months rent ($871) according to recent data collected by the NIH. (See next slide)

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Emergency Room in USA contd..This chart demonstrates the greatly varying cost of ER visits in a cross-sectional study of the 2006–2008 Medical Expenditure Panel Survey of 8,303people. Analysis was limited to outpatient visits with non-elderly, adult (years 18–64) patients with a single discharge diagnosis.

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Bottom Line for Emergencies…

• With any standard fee for services for services or conditions the cost of a visit cannot be predicted and can vary greatly in the United States. In some cases insurance does cover a visit for a certain copay.

• In Ireland, the ER rarely sees certain ailments since everyone has access to free or subsidized preventative care. The cost for ER is the predictable 100 Euros.

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• Drugs that require a medical prescription before they can be obtained

• 70% of Americans take prescription drugs, more than half of Americans are on at least 2.

• US Drug companies are on the Fortune 500 list every year, making them one of the most profitable industries in the world.

• Because of this industry of developing new drugs US drug costs are high, to pay for research and development.

• Prescription drugs are a huge medical expenditure for all health systems.

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Drug cost in the USA

• Prescription drug costs vary greatly.• Many insurance companies can offer copays of

$12, $30, or $60 etc..for one prescription.• States offer Medical assistance plans that

reduce copays to $1.00, $3.00, or 0. Some state plans pick up the copays after the primary insurance has been billed. About 31% of Americans are covered by government health plans.

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Click on the link below to read about the findings of the annual Consumer Reports

Prescription Drug Poll. It illustrates the hardship of high drug costs in America.

• http://www.consumerreports.org/cro/2012/09/sluggish-economy-forces-americans-to-cut-corners-to-pay-for-medications/index.htm

• Consumers with insurance spend an average of $63 per month, out of pocket, for prescription drugs, while uninsured people spend an average of $91 out of pocket

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Drug Cost in Ireland• All residents are entitled to either free or subsidized approved

prescribed drugs and medicines and certain medical and surgical aids and appliances.

• Medical card holders (low income households) in 2014 will pay €2.50 per item, up to a maximum of €25 per month per person or family.

• Certain people do not pay prescription charges:– People who qualify for the Long Term Illness Scheme. – People using the Drugs Payment Scheme.– People who have a Health Amendment Act Card. – Children in the care of the HSE who have their own medical card. – There is no charge to patients participating in the Methadone Treatment

Scheme. • People not covered by the medical card or any of the schemes listed

above should have to spend a maximum of €144 a month if they are in the Drugs Payment Scheme.

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Who qualifies for the Drug Payment Scheme?Just be a registered resident!

• Under the Drugs Payment Scheme you have to pay a maximum of €144 a month for approved prescribed drugs, medicines and certain appliances for use by yourself and your family in that month

• The scheme covers – the person who applied, his or her spouse/partner and

children under 18 years or under 23 if in full-time education. – A dependant with a physical or mental disability/illness

living in the household who does not have a Medical Card and who is unable to fully maintain himself/herself, may be included in the family expenditure regardless of age.

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Summary

• The 2 sector health system in Ireland is vastly different from the United States.

• We do not yet have an established public health benefits plan for all our citizens.

• The variation in cost for drugs, services, and benefits can be cause for financial hardships for Americans.

• Though they have care without cost or at low cost, Irelands system leaves you with less choices and some waiting in line, unless you opt for paying with private insurance.

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References• Brennan, Patrick. "Irish Health Insurance - News." Irish Health Insurance -

News. 2013 Irish Health Insurance, 18 July 2011. Web. 20 Nov. 2013. • Caldwell, Nolan, Tanja Srebotnjak,, Tiffany Wang, and Renee Hsia. ""How Much

Will I Get Charged for This?" Patient Charges for Top Ten Diagnoses in the Emergency Department." PLOS ONE:. PLOS, 27 Feb. 2013. Web. 22 Nov. 2013.

• "Emergency Health Services." Emergency Health Services. The Citizens Information Board, 23 July 2010. Web. 20 Nov. 2013.

• Feature, Heather HatfieldWebMD. "How Much Does It Cost to Have a Baby? Hospital Costs, Baby Supplies, and More." WebMD. WebMD, Mar.-Apr. 2013. Web. 19 Nov. 2013.

• Rosenthal, Elisabeth. "American Way of Birth, Costliest in the World." New York Times 30 June 2013: n. pag. Print.

• "Sluggish Economy Forces Americans to Cut Corners to Pay for Medications." Americans Cut Corners To Pay For Drugs. N.p., 01 Sept. 2012. Web. 21 Nov. 2013.