Irish Lives Abroad: What is quality of healthcare like for diaspora?
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Aside from housing, there isn't a social issue as contentious in Ireland as healthcare. And access to it came sharply under the spotlight during the pandemic, when overnight, public and private hospitals merged.
Issues in Ireland range from the quality of care given in public and private settings to the waiting list in private and public hospitals. There is also the ongoing issue of trolleys being used as beds in public hospitals, as well the cost of private health insurance and what that actually covers before an excess has to be paid.
With all of that said, less than 50% of Irish people have private health insurance. So for all the talk of Sláintecare, a 10-year reform programme to transform our health system that started in 2018 — where does Ireland lie internationally?
We talk to our citizens abroad to see how much access they have to healthcare and what the quality of the service they receive is actually like.
Of six countries abroad, five have a universal healthcare system, with some of our interviewees describing the care they receive abroad as "great", "hassle-free" and "excellent".
Canada
Gerald Flynn, originally from Limerick, has been living in Ontario, Canada for eight years. He lives there with his wife Meggan, and their 10-month-old baby girl Clara.
"Healthcare is free for all," he says.
"The system is hassle-free, but yes there are waiting lists, so not all good, but much, much better than Ireland’s set up for sure," he adds.
But even with a robust public system, most employers still offer employees extra medical benefits in Canada, says the Limerick native.
"Also most workplaces offer benefits that subsidise your other medical services such as eye care and glasses, dentists, massage, chiropractor and medication," says Gerald.
"That would be pretty standard at most places, some offer more," he adds.
Sweden
Cork woman Eileen Littorin lives in Stockholm, Sweden with her husband Magnus and their two children, David, aged seven and Sophia, aged six.
She says that in Sweden "everyone has access to everything" when it comes to healthcare.
"Healthcare is subsidised here and everyone has access to everything. If you go to the doctor or to see specialists, you pay up to 900SEK, or about €100, and then you pay no more after that for any care or treatment," says Eileen.
"You then get what's called a "frikort" (freecard) and that's valid for a year once you hit the cap of 900SEK," she adds.
There are waiting lists depending on your needs, but they are never significant, she says. "Waiting lists vary depending on what you need, but it's not very long usually," she says, and most importantly health is just health, not separated into care for physical health but not for mental.
"This (the fee and waiting lists) applies to all medical and psychological treatments," says Eileen.
There are private options in Sweden when it comes to healthcare but they are never a necessity, unlike in Ireland.
"There are private options too, of course, which are expensive, but it is not a necessity for anyone," she says.
Maternity care is totally free. "Likewise, having kids for instance, you pay absolutely nothing for the whole pregnancy, birth or hospital stay afterwards," she says.
Dental care is also free for everyone up to the age of 19, she adds.
Prague
Dingle native, Siun Creedon Prochazka, counts Prague in the Czech Republic as home, and lives there with her husband and two children Marketa, aged three, and Alvy, aged nine.
There are two tenets to the healthcare system in the Czech Republic — firstly it's universal and secondly, everyone has to hold health insurance.
Siun breaks down the whole system depending on the issue and what type of cover you require.
"Health insurance is compulsory, two-thirds is paid by the employer and one-third by the employee," explains Siun.
Everyone must carry a medical card.
"You have a medical card that you always have with you and show at every appointment. It’s the norm here for your GP to send you to a dermatologist or a cardiologist, an immunologist or an ENT specialist or a gynaecologist," she explains.
And quite different to Ireland, GPs provide no antenatal care whatsoever in the Czech Republic.
"GPs don’t do pap smears or deal with any gynecological or any pregnancy issues to deal with your medical issue," states Siun.
When it comes to dental care, she explains that check-ups are free, as they are when you visit your GP for a check-up, but there are charges for dental procedures.
Prescription costs are partially covered by health insurance, explains Siun.
And like Ireland, there are waiting lists for medical appointments and procedures in general, but very short compared to here.
"There may be waiting lists although in seven years, I haven’t had to wait more than two or three months to see a specialist," says the Kerry woman.
And again like Ireland, you can access the private system if a waiting list proves too long for your needs, but it is not extremely expensive.
"If you don’t want to wait, you have the option to go private which, depending on the issue, is not likely to be overly expensive. A consultation with a private specialist will be between €50 to €70," says Siun.
Caitríona Rush lives in The Hague in The Netherlands with her husband and two children aged 10 and 7.
She explains the total contrast between the healthcare system in her adopted home versus the two-tier system here in Ireland.
"The healthcare system here is very different from Ireland. There is no public and private, there is one system for everyone," says Caitríona.
And similarly to the Czech Republic, health insurance is mandatory.
"If you are living here you are legally obliged to have a 'basisverzekering', basic insurance. This covers doctors' visits, prescriptions, hospital visits etc., - there is access for hospital visits and some prescriptions," explains Caitríona.
"The basisverzekering costs upwards of €110 per month per person. The cost varies per provider but what you get for your money is exactly the same as it is laid down by law," she says.
For people on lower incomes and children, there are subsidies and support.
"Those on lower incomes can apply for subsidies to help pay it. Children are free up until 18 years. On top of that, you can add on extra 'packages' such as for the dentist, physiotherapy and alternative medicine etc.
"The system works well here, it's not cheap but everyone is treated the same and you don't have the crazy waiting lists that you find in public healthcare," says Caitríona.
Dubai
Ailbhe Storan, originally from Limerick city, lives in Dubai with her husband.
Healthcare in Dubai depends on whether or not you are a citizen of the United Arab Emirates.
"Expats have private healthcare through their employers. By law, the employer must provide at least basic health insurance," says Ailbhe.
However, the employer is not obliged to provide health insurance for their employee's dependents or spouse and this is where costs can come in.
A reasonable health insurance policy costs around 10,000 AED per year, so €2,400. Insurance premiums range from around 5,500 AED per year, so €1,300 for a 30-year-old expat on a comprehensive plan to around 33,500 AED, €8,400 for a family of four on a comprehensive plan. A basic coverage plan for a family of four would cost about 17,000 AED, €4,100.
If you happen to be a citizen, it's a different ballgame.
"Healthcare in Dubai is free for UAE citizens in public health facilities," explains Ailbhe.
But in Dubai, there is no GP service and there are more private medical centres than there are public hospitals.
Portugal
Sonya Coogan, originally from Co Monaghan, lives with her husband and two stepchildren in Lisbon, Portugal — a city that has become increasingly popular as an emigration destination for Irish people.
She describes the healthcare system in Portugal as "excellent" and says the public system is the way to go. But private care is a reality there too.
"Most of the people would go through the public sector way. Then the people with more money, as normal, would have their private health insurance, which I have. It is excellent," says Sonya, who runs the Irish in Lisbon Facebook page.
But unlike holding medical insurance here, there is only a nominal fee for when you visit your GP.
"I can go to the dentist, I can go to the optician, go to the doctor and only pay about €10 every visit just because of the health cover," says Sonya of the benefits of health insurance.
But, she says, the public system is also "excellent" and the waiting lists are not long.
"Even if you're going through the public system, it's excellent. The waiting lists aren't long. You can go into A&E, go into a hospital, get a bed — it's an excellent, excellent system regarding healthcare," says the Monaghan woman.
Sonya gives the cost of her monthly insurance in Portugal versus what she was paying here — she makes a saving of about €500 a year.
"My health insurance is about €65 a month, which is very good compared to Ireland, because I had it before I left, and I was paying about €1,200 to €1,300 a year," she says.