Private A&E is faster . . . but at what cost?

We used to be forced to sit and wait in public A&E rooms but now that more private A&E services are opening are they worth going to?

UP UNTIL a few years ago, the only option if you sprained your wrist or had a cut needing stitches was to attend the Accident and Emergency (A&E) department of the local public hospital and take a seat and wait...and wait...and then wait some more.

Now other options are springing up around the country, as both private hospitals and private health insurers look to make money out of this potentially lucrative market.

In Dublin, there is a range of facilities, including VHI Swiftcare clinics in Swords, Glasnevin and Dundrum, while private hospitals in Sandyford and Lucan now also offer A&E services. More recently, Hibernian Aviva opened its Health Xpress Med Centre in Smithfield, Dublin 7, which offers a walk-in service for minor injuries, illnesses and emergencies.

Across the country, there are also alternatives to a public hospital. The VHI has opened clinics in Cork and Waterford, while in Galway patients can attend the private Galway Clinic, and in Naas, Co Kildare, the Vista Primary Care Campus is due to open a minor injuries department.

The main advantage of attending a private clinic is the reduced waiting times. As public hospitals prioritise patients on the basis of medical need, if you only have a minor complaint – and in some cases even if it is more serious – you will have to wait. Private clinics, however, commit to seeing patients fast. the VHI and Hibernian clinics, for example, aim to have you seen within an hour, while the Galway Clinic promises “immediate access” to a consultants opinion.

You can also make appointments at some hospitals, so if your injury is very minor – for example, you scratched your hand working in the garden and need a tetanus shot – you can ring ahead and schedule a visit.

Many of the private clinics are also consultant delivered, which means that patients attending Galway Clinic, Hermitage or Beacon Hospital for example, will be seen and treated by consultants.

But, while there is no doubting the convenience of attending a private A&E clinic over their public counterpart, such a service costs.

Initial consultation fees start at €100 – about double the cost of a visit to your GP – while everything else, from stitches to crutches, incur an additional expense.

At Beacon Hospital for example, the initial consultation fee is €120 and you will be charged for almost everything else you need. Routine blood tests cost between €30 and €60, while x-rays start at €120. An ultrasound costs between €180-€245, and there is also a €20 charge for crutches.

At VHI Swiftcare clinics, the consultation fee is €115 but if you are referred by your GP the cost drops to €60. X-rays cost between €80 and €100, blood tests are €30-€50, stitches €60-€90 and plastering €60.

Stitches cost between €60-€90 for non-Hibernian members at its clinic, while you will be charged €40 for crutches and €20 for a nebuliser.

By comparison, charges at public A&E departments are less. Although the cost of a visit rose to €100 at the start of this year, if you have been referred there by a GP or if you have a medical card, there is no charge. Moreover, if you are admitted to the hospital after attending casualty you won’t be subject to the fee, while fees also don’t apply to pregnant women or children up to six weeks of age. And, if you have to return for further visits to an out-patient clinic in relation to the same illness or accident, you won’t have to pay the charge again.

Another downside is the restrictive opening hours operated by private clinics. Anyone who has ever attended a public hospital A&E in the middle of the night will be aware of just how busy that time is, but most of the private clinics are only open during business hours and for part of the weekend. For example, Beacon is open from 8am to 6pm, Monday to Friday and all day Saturday, while the A&E service at the Galway Clinic operates seven days a week, from 10am to 7pm. Opening hours at VHI are a bit longer – in general from 8am to 10pm, but it closes at 9pm in Glasnevin and 6pm in Waterford.

The clinics are also restrictive about what type of patients can attend. According to a VHI spokesperson, its Swiftcare clinics are most suited for “when it’s not an emergency but it feels like one”, and they deal with injuries such as sprains, possible breaks or stitches, or minor illnesses. Emergency dental services are also available in Dundrum and Cork.

And, although the private hospitals are able to treat more severe conditions, such as those related to surgical or cardiac events, obstetric patients and those suffering from psychiatric problems are generally advised to go elsewhere, as are patients arriving by ambulance.

Children are also likely to be sent straight from the clinic to the nearest public hospital unless their injury is very straightforward. For example, at Beacon, children under the age of 16 will only be treated for minor injuries, while those under the age of two will not be seen at all. Over at the VHI Swiftcare clinics, infants under 12 months will be sent directly to public hospitals, while Hibernian’s clinic only treats children over the age of four.

So, if you suspect your complaint is of a more serious nature, you may be better off heading straight towards the 35 or so public A&E departments in the country.

Although visits to such clinics can be expensive, if you have private health insurance the costs will be less as all of the main insurers offer some form of cover for visits to private A&E clinics. Moreover, the expenses that aren’t refunded by your insurer are eligible for tax relief.

Vhi Healthcare members are entitled to the same benefits that their plan currently provides under GP visits, physiotherapy visits and the schedule of GP surgical procedures, which allows full benefits at the Swiftcare clinics for stitching of a wound, removal of small lesions and removal of splinters and so on. Also, since January, members of its LifeStage Choices plans get €75 off the initial consultation fee of €115 at the five Vhi clinics. So members of the plans will only have to pay €40 upfront for the consultation, for up to five visits a year. For A&E services at the private hospitals, Vhi members can claim under the outpatient cover element of their plan.

All of Quinn Healthcare’s schemes provide cover for both public and private A&E facilities, including Vhi’s Swiftcare centres, to varying degrees. For example, you could get 50 per cent back on fees incurred of up to €100 if you are on one of their policies such as Healthmanager or Company Care Premium, while members of other schemes such as Essential and Essential Plus will get €20 for each A&E visit towards an overall out-patient excess.

Hibernian Aviva Health members get a €30 discount on the cost of attending its medical centre, while members with day-to-day plans and Everyday plans can also claim another €30 back per visit, bringing the consultation cost down from €105 to €45.

For visits to Vhi’s Swiftcare centres, Hibernian’s “Everyday” policyholders get €30 back for up to 25 visits to the GP or Swiftcare centres, while its “day-to-day A” plan holders can get €30 back for three visits a year, and members on “day-to-day 50” plans can avail of €30 a visit for 15 visits a year.

For the other clinics, Hibernian members can claim back a certain proportion of fees incurred depending on their plan. For example, members covered under its Everyday and Hospital plans are entitled to €60 off three visits to A&E, while members of its “I”, “Me” and “We” plans will receive €20 a year back on A&E visits.

If you have to be admitted to one of the private hospitals, then your health insurance policy normally kicks in and pays for services depending on your level of cover.

'After a wait of 90 seconds we are ushered into a treatment room'

IT'S THE CALL every parent dreads: "Your daughter's banged her head. There's a lot of blood." Drop everything, jump in the car and drive, not entirely legally, to the crèche to find said daughter sitting on a chair with a deep gash just below the hairline, sucking a lollipop as blood races tears down her cheeks.

Stitches are clearly needed and a lengthy wait in Temple Street looms. Until, in a moment of inspiration, we do U-turn and drive to the Swiftcare Clinic in the grounds of DCU.

It's empty when we arrive. After a wait of no more than 90 seconds in a foyer with a healthy supply of children's toys and books, we're ushered into one of at least half a dozen treatment rooms. Less than a minute later, a doctor joins the nurse, injects some local anaesthetic around the wound and puts three old-fashioned stitches in – the cut is too deep for dissolvable stitches or glue. After less than five minutes, a bloodied daughter is sniffling and sucking another lollipop as her daddy pays the bill, €150 – €60 more than a visit to a regular A&E would have cost, in the absence of a GP's referral. To us, it seemed like a price worth paying, when you consider both the speed of the treatment – 15 minutes from start to finish – and the fact that it meant the hard-pressed doctors of Temple Street were not tied up stitching up a straightforward cut and free to treat children in greater need of hospital care.

Conor Pope