UN­DER THE COVER

Oh, for the good old days, says Mau­rice Gueret, when get­ting health in­sur­ance cover was sim­ple and mi­nus the gim­micks

Sunday Independent (Ireland) - Life - - RUDE HEALTH - Dr Mau­rice Gueret is a GP and edi­tor of the ‘Ir­ish Med­i­cal Directory’ Email mgueret@imd.ie and Fol­low him on Twit­ter @mau­ricegueret

Fi­nan­cial jour­nal­ists pre­dict a ‘price war' in health in­sur­ance this win­ter, but I plead guilty to cyn­i­cism. Prices have rock­eted sky­wards since Fine Gael an­nounced the whole pop­u­la­tion was go­ing to be in­sured at some still un­spec­i­fied date in the fu­ture. Of­fers like “In­sure one and an­other child goes free” and “Half-price for teenagers” do not con­sti­tute a ‘price war'. They are gim­micks, aimed, as all health in­sur­ance mar­ket­ing is, squarely at young fam­i­lies who are the main providers of un­claimed pre­mi­ums. For in­sur­ance com­pa­nies, chil­dren's health­care costs a pit­tance in com­par­a­tive terms — pae­di­atrics has never been the spe­cial­ity of choice for med­i­cal money-snif­fers. But then com­pe­ti­tion, if it ex­ists in the Ir­ish in­sur­ance in­dus­try, has rarely been about price. Pol­icy costs are tem­po­rar­ily low­ered to at­tract sheep from other shep­herds, but once the gates close, the di­rect deb­its crank up and pre­mi­ums drift in­evitably sky­wards again. I re­main with the old VHI where I have been an ex­em­plary cus­tomer for decades — un­com­plain­ing and un­claim­ing. But I do pine for the good old days when they had sim­ple plans from A to E and ev­ery­one knew what queue they could stand in. Now they con­fuse me like all the oth­ers. With more than 300 pol­icy types reg­is­tered in Ire­land, you need to be ex­tremely cau­tious be­fore pur­chas­ing or chang­ing health in­sur­ance. I sus­pect most pa­tients have never heard of the Health In­sur­ance Au­thor­ity, which is the reg­u­la­tor of this busi­ness and is funded by a small per­cent­age of ev­ery health pre­mium you pay. Well, if you pay in­sur­ance, and their levy, you should try and get to know them, be­cause it's part of their mis­sion to pro­vide the con­sumer with un­der­stand­able ad­vice that is eas­ily read through woolly eyes. The eas­i­est way to dis­cover how they can help you is via their web­site, see www.hia.ie, but they also have a Lo-Call num­ber, (1850) 929-166, where you can re­quest in­for­ma­tion by post. They can­not tell you what dis­ease might af­flict you in later life — a piece of the jig­saw that would greatly as­sist in choice of pol­icy — but they may en­lighten a de­ci­sion on an an­nual pre­mium that could nearly buy a new car. For our or­thopaedic slot this week I promised to look at stu­dent's el­bow. In fact, we'll look at three el­bow ail­ments so you'll get three con­sul­ta­tions for the price of one. Put your right arm out in front of you, palm up­wards. Now feel your el­bow un­til you have found three dis­tinct stick-out bony bits — one on each side and one around the back. Now you have the sites of three well-known mal­adies of the el­bow. The stu­dent's el­bow af­fects the bit around the back, the bit that you might lean on if study­ing at a desk. It's an in­flam­ma­tory con­di­tion of the bursa (fluid sac) over the hard ole­cra­non, the bony point of the el­bow. Like house­maid's knee, which is caused by too much kneel­ing on a hard sur­face, stu­dent's el­bow tends to be caused by lean­ing for long pe­ri­ods on a hard desk. Symp­toms in­clude swelling and pain over the point of the el­bow — on oc­ca­sion, it can get in­fected too. Golfer's el­bow (in­ner bony bit) and ten­nis el­bow (outer bony bit), though sim­i­lar in cause to each other, af­fect dif­fer­ent sides of the joint. They are both painful in­flam­ma­tion of ten­dons (the stringy bits that at­tach mus­cles to bones) and are usu­ally caused by overuse of the el­bow joint. They are not ex­clu­sive — a golfer can come down with ten­nis el­bow and vice versa. The most dif­fi­cult chal­lenge is a ten­dency to re­cur and be­come chronic, be­cause sports folk tend to be stub­born and don't eas­ily give up ac­tiv­i­ties that cause them end­less pain. Rest is a great cure, but phys­io­ther­apy and joint in­jec­tions have their place in en­ter­tain­ing pa­tients as they wait for over-use in­juries to heal. I have been in­un­dated with your sto­ries of var­i­ous res­pi­ra­tory in­fec­tions dur­ing or af­ter air travel. Prov­ing cause and ef­fect is not easy here, but I'm cer­tain it's an is­sue that air­lines would rather went through the green chan­nel and didn't re­turn. It would be in­ter­est­ing to hear the per­spec­tive of the cabin crew — most of us fly only oc­ca­sion­ally — but they have to put up with pas­sen­gers’ ail­ments and re­cy­cled cabin air all their work­ing days. I must find a good oc­cu­pa­tional physi­cian and ask what the ab­sen­tee rate is like for cabin ste­wards and stew­ardesses. I gather that in the early days of Aer Lin­gus op­er­at­ing the A330 across the At­lantic there were dif­fi­cul­ties with the cabin air sup­ply and pas­sen­gers (and cabin crew) were feel­ing faint. This prob­lem was solved by in­creas­ing ven­ti­la­tion. I have also been re­li­ably in­formed from pilot quar­ters that the air sup­ply to the cock­pit in mod­ern Air­bus air­craft is sep­a­rate to the air sup­ply re­dis­tributed around the rest of the plane. I daren't ask why! And Boe­ing is now tout­ing its new Dream­liner air­craft to air­lines as hav­ing a much bet­ter fil­tra­tion sys­tem than pre­vi­ous mod­els. I'm cer­tain pas­sen­ger air qual­ity will be­come a big­ger is­sue in the years ahead, You'll be able to fly any­where for ¤1, plus ¤200 for pas­sen­gers who re­quire air. Your let­ters with old reme­dies con­tinue to fas­ci­nate me. An ex­cep­tion­ally gifted and per­cep­tive French lady who lives in Dublin wrote re­cently to tell me that I write like Voltaire. And as if that wasn't enough, she gave me a rem­edy too. She grew up in 1950s Provence and ev­ery night her mother would place a necklace of gar­lic cloves around her neck to pro­tect her, not from vam­pires, but from worms. As Voltaire said, “Reg­i­men is su­pe­rior to medicine.”

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