The recession has led to an increase in the number of people delaying a necessary visit to their GP purely for economic reasons, writes MICHAEL KELLY
PATIENTS WITH chronic illness who delay a visit to their GP for economic reasons risk a potentially serious deterioration in their condition, according to Dr Mel Bates, a spokesman for the Irish College of General Practitioners (ICGP).
The organisation was responding to a recent survey which found that nearly 60 per cent of GPs believe patients are delaying visits to their doctor as a direct result of the economic downturn.
“It’s important to emphasise that this is a general survey based on a gut-level response from doctors,” says Bates, “and it’s far too early to say that this is a major problem.
“I think that the cost of GP visits is a problem all the time for some private patients though it is reasonable to suggest that it gets worse in a recession.
“We know that medical card holders visit their GP six times a year on average while private patients visit just two times per annum. The accepted wisdom is that both groups should visit four times a year.”
At particular risk, according to Bates, are those private patients with chronic illnesses such as asthma, hypertension, heart disease and diabetes.
“They may feel that the disease is stable (in their mind) at the present time.
“I don’t think that people make a conscious decision not to go to their doctor but it is very easy to put off a visit, just like it’s very easy to put off getting enough exercise.
“There is a large element of preventative treatment with these illnesses so where a patient puts off a visit to a doctor for financial reasons, they are not getting the level of care that they need. The result of that is that you get increased admission to hospital, or the patient is ultimately presenting at their GP with a more serious degree of illness.
“The economics of this however mean that as incomes drop the medical card list increases so all of this may be a moot point.”
Medical cards are currently available to those whose weekly gross income is less than €184 for a single person and €266.50 for a married couple or a lone parent with dependent children. A GP Visit card which covers the cost of visiting a GP only, may be available to those whose weekly income is €276 for a single person and €400 for a lone parent with dependent children.
As incomes drop, there has been a huge surge in the number of people eligible for these cards.
According to Dr John Latham, a GP at the Liberties Primary Care Team on Heytesbury Street in Dublin’s inner city, the number of private patients on their books has dropped while the number of medical card patients has increased.
“It’s difficult to say whether the decrease in private patients is because there are more people qualifying for medical cards, or simply that the downturn is forcing them to put other bills ahead of their medical needs. We certainly have private patients who find the €50 fee, which hasn’t changed in three or four years incidentally, quite hard to deal with.”
Assuming the HSE continues to absorb the mammoth increase in those seeking medical cards (a major assumption as the public finances continue to deteriorate), two sectors of society remain particularly challenged by the cost of healthcare. A spokesman for the Society of St Vincent de Paul believes that many people on the GP Visit Card are struggling to pay other costs associated with a visit to a doctor.
“What we do hear of anecdotally is people who go along to their GP and then find it very difficult to finance the medication which the doctor prescribes. Even with the Drug Payment Scheme, you still have to pay out €100 a month yourself,” he says.
The second vulnerable group, according to the ICGP, is those people who are above qualification level for a medical or GP Visit Card but for whom a doctor’s fee (typically between €45 and €65) remains a large portion of their weekly income.
“People think that this is a black or white issue,” says Bates. “That either you need a medical card or you don’t. But there are people just above the medical card threshold for whom a GP visit is very expensive.”
A simple fix to alleviate this problem would be to widen the eligibility criteria – this, according to Bates, is highly unlikely in the current climate.
Doctors themselves have so far resisted any interventions aimed at reducing their fees. “Doctors have responded to genuine hardship in the past and they will continue to do so in the future,” says Bates. “I have patients for example on three-day weeks and I responded to that in my own way. GPs are doing that up and down the country. They can reduce their fee or they can charge the standard fee and not charge for other investigations.”
Private patients face a terrible dilemma in balancing health needs with economic realities, according to the Consumer Association of Ireland’s chief executive Dermott Jewell. “People are faced with a horrible decision and instead of seeking the care of their GP they are staying at home and trying to get well. What really worries us is when people are driven to a source of information, perhaps online, that may not be reputable or reliable.
“The government needs to acknowledge that there is a problem. Once that’s achieved we need the key stakeholders to sit down and address it as a matter of extreme urgency.”
Though patients are essentially free to “shop around” for GP services, the amount of choice is limited, according to Jewell.
“If a person is ill, the last thing that they need is to have to shop around for a doctor. A lot of GP practices are closed off and are not taking new patients anyway,” he says.
“That said, I think the simple act of displaying their prices for people to see would certainly help.
“There was a campaign some years back trying to get doctors and dentists to do that and there was a terrible furore.
“All elements of society are being asked to take a reduction in pay, so I think we need that kind of response from everyone who provides a service, even the vital services which doctors provide.
“We see situations where one doctor charges €45 for a visit while another doctor is charging €60 – why is there such a huge difference?”