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 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/
Kilkenny Castle Portrait Hall

14. Blarney