The Good, the Bad, and the Ugly

1. The Good, the Bad, and the Ugly Ann Hutchison Wexford Harbor

2. Wexford Town, County Wexford • Located in the South East of Ireland • Also called Loch Garman • Population • County Wexford 149,605 • Wexford Town 20,000 • Originally established by the Vikings in 800 AD • Changed hands many times due to its useful port • County Wexford contains the oldest functioning lighthouse in the world

3. Hook Lighthouse

4. Wexford General Hospital • The original hospital was built in 1840-42 for 5,780 pounds • It’s original purpose was a workhouse built to house 600 inmates • It was then repurposed into Wexford County Hospital which it remained until a new facility was built in the late 20th century • The new facility boasts 210 beds with 4 operating suits • The hospital treats approximately 15,000 inpatients and 9,000 day cases per year

5. The Health Service Executive • The HSE is Ireland’s comprehensive, government funded public health system • The HSE is ran by the Minister of Health (Simon Harris) using the HSE Code of Governance • It is divided into 4 Regional Health Forums and futher subdivided from there • Who can access care through the HSE? • A person living in Ireland for at least 1 year is considered by the HSE to be an “ordinarily resident” and is entitled to health services • Two types of access, with medical cards and without medical cards, is available to residents of Ireland • Medical card eligibility is based on income (or specific situations such as children in foster care) • Patients with medical cards receive all services for free • Patients without medical cards receive some services for free and pay a low fee for others

6. HSE Fee Examples for Patients Without a Medical Card • General Practitioner services are free • Referrals by a GP to a specialist are free • Specialist appointments without a GP referral are 100 Euro • This applies to A&E (accident and emergency) visits as well • Inpatient costs are 80 Euro per night with a max cost of 800 Euro per year • Long stay patients are charged up to 175 Euro per week • Individual payment is the same for public, private, or voluntary facilities • There are yearly limits for all out of pockets costs

7. The Private System • There is also a private health system in Ireland • It follows the model of patients paying for insurance and having higher out of pocket costs for care • The majority of physicians in the public sector also see patients on a private basis • This higher quality care is only available to those affluent enough to pay for it The Cliffs of Moher

8. The Good • The public health system allows access to healthcare for the whole population • Government oversight allows for standardization of care • It also allows for tailored utilization of resources • Yearly caps prevents medical costs from becoming a financial burdens on anyone, especially patients with severe disease • For example, Cystic fibrosis is very prevalent in Ireland • These patients have the same cap as everyone else Eagles Flying Animal Sanctuary

9. The Bad • While access is available to everyone, it is rarely timely • Getting into a GP is reasonable • Getting an appointment with a specialist can take months to even years • When you do get in, it’s possible to get referred to another physician which comes with yet another period of wait time • A simple case of symptomatic cholelithiasis can take over a year to treat • Since the government runs the health system, they decide what supplies hospitals and clinics are allowed to use • This means CF patients may not get the best therapies and oncologists are limited in what chemotherapy options they have to use

10. The Ugly • Ireland is a small country which means health resources can be limited • The government is in charge of how those resources are allocated • For example, there is only one neurosurgery team in the entire country • This means patients must be prioritized and certain people miss out on life saving treatment • Negative attitudes among healthcare providers is a very real thing • Some health professionals justify subpar care by the idea of “the patients aren’t paying for it anyway” Blarney

11. Mr. S • Mr. S was a 63 year old male hospitalized for recurrent cellulitis • His case was straight forward but he was a unique individual • Mr. S was from County Wexford where he lived on a farm • My resident warned me before hand that he was challenging to communicate with • It turns out there is a unique dialect of English spoken by the rural population in Ireland • He was impossible to understand but we communicated beautifully with hand signs • It reminded me that unique culture is everywhere you look, even if you don’t recognize it at first

12. Cultural Competencies • Describe social, political, economic, and cultural factors in the health of individuals and populations living outside the United States. The Gaol • Describe healthcare inequality in the United States and other countries. • Understand the pro and cons of universal health care systems around the world. Johnstown Castle

13. References • https://www.wexfordcorp.ie/ • http://www.workhouses.org.uk/Wexford/ • https://www.hse.ie/eng/about/who/ • https://www.hse.ie/eng/services/list/3/acutehospitals/hospitals/hospitalcharges.html • https://www.hse.ie/eng/cards-schemes/medical-card/ Kilkenny Castle Portrait Hall

14. Blarney