Irish nationals and people living in the Republic of Ireland are often frustrated by seemingly outdated and anachronistic practices in our health system. It’s considered to be underfunded, understaffed and overcrowded. The other thing we all grow up knowing is never go to the doctor without a €50 note in your pocket. But is it time for Irish GPs to digitise payments?
Whenever an Irish resident explains the health system to someone from outside, they can expect a few raised eyebrows. Anyone who has experienced the NHS (with all its flaws) finds the idea of paying your doctor incomprehensible. But for us, it’s an inevitable end to a consultation. “How much do I owe you, Doctor?” never sits easily.
Why do we pay to see the doctor?
It’s all down to the type of health system we have. It is, in effect, free to use and accessible to all, but in practice, it’s a different story. Many people pay for health insurance if they can afford to.
In fact, 40% of the population does so, the highest in Europe. However, people with health insurance still need to pay every time they visit the GP and claim back (some of) the expense later.
Does everyone pay?
Not everyone. Certain people are entitled to a Medical Card, for instance, those with chronic conditions, people on very low incomes, plus the under 6s and over 70s. There are also GP Visit Cards for people just above the medical card threshold. Both these cards provide free GP visits.
If you go to A&E of your own accord, you’ll be charged €100, but this is free if you are referred there by your GP. There are various other charges, but these are often capped, so we never face the crippling bills faced by our American relatives.
What are we paying for?
We are, in effect, paying the GP’s wages. The HSE refunds doctors for seeing patients who hold a Medical Card. This fee regularly sees certain GP practices (as opposed to individual doctors) receiving over a million euros a year.
However, a GP is often based in a practice or health centre. From those payments, the GP may need to pay towards rent, bills, or the wages of receptionists and other medical assistants.
But in essence, when we hand over our money, we are paying for the GP’s time and expertise. Occasionally, they will waive a charge if you have to visit a few times in succession. However, it’s thought the average charge for an appointment, regardless of length, is around €50. Surprisingly, there is no regulation regarding doctors’ fees. Therefore, some people may be charged less or even more than this.
Many patients don’t require a follow-up GP visit but will need a repeat prescription. They can be requested by phone, so an appointment isn’t needed. However, there is usually a charge to write a repeat prescription, at about €20-30.
Are GPs on the way to digitised payments?
Anecdotal evidence suggests that many GPs and health centres now take card payments, whether in person or over the phone. That’s reassuring when you think of the amount of cash flowing into a surgery each day.
Many GPs now band together and work as partners in health centres. The cash payments each day for perhaps five doctors could be considerable. If each doctor sees five patients a day paying €50, that’s €6250 in cash on the premises at the end of the week. There are also additional payments received for prescriptions and the services of nurse practitioners.
The number of doctors working on their own is dwindling. They are usually found in rural areas caring for an increasingly elderly population. It is these doctors that are likely to carry on with cash payments. Their patients are familiar with cash and possibly uncomfortable and suspicious of online transactions. It is easy to stick with the simplicity of cash payments and a system you know. These GPs are also likely to be in geographical areas where broadband services could be patchy and card machines unreliable.
Digital is pandemic friendly
Strangely, it may have taken a pandemic to consider whether paying the doctor in cash is healthy. We might have only considered the cost before. Now we think about transmitting the virus – in a setting where everyone is potentially sick and compromised. It doesn’t make a lot of sense, really. And it reinforces the need for GPs to digitise payments.
We are now all well aware of the dangers of transmitting disease. Paying by cash does carry that risk, especially when we are trying to avoid hand-to-hand contact. However, the Bank of England did some research into whether the Covid virus can be passed on through banknotes. They discovered “the risk of transmission via banknotes is low”.
Hearing that is a relief, but during Covid, many Irish businesses decided not to take a chance and encouraged customers to use contactless. It’s even on the yellow Covid advice signs that are such a familiar sight. We are reminded to “Keep a safe distance, sanitise, use contactless payment where possible”.
Easing the cash panic
Card payments are speedy and simple. They also remove the hassle of having to carry cash. The last thing you should worry about when you need to see the doctor is finding a working cash machine. Of course, GPs won’t demand you produce payment before examining a sick child, or any patient. But people do worry about not having ready cash to hand. It all adds stress in a difficult time.
Of course, changing to digitised payment is not going to remove everyone’s money worries. We are still paying to see the doctor whether it’s by card or in cash. There is a big problem with people who avoid seeing a doctor because they can’t afford the fee. But electronic payment does alleviate the panic about gathering cash before we head to the surgery.
The digital demographic
In the same way that older people may never move away from cash, for other demographics cash is a thing of the past. Young people, in particular, live mainly without cash and do everything online. They have grown up in a digital age and don’t expect to produce cash. They run their work and social lives through their phones. Many have even ditched contactless cards and opt to use payment apps instead, like Apple Pay or Google Pay.
Most people, of any age, have become accustomed to paying by card. The quick tap is now part of daily life. It’s rare to find a business that doesn’t accept cards. If they only take cash, then maybe you should ask questions? Doctor’s surgeries are vital social hubs, performing a crucial role in the community. But in reality, they are businesses, too. Isn’t it time they looked at the advantages of digitised payment?
GPs should consider the benefits
There are many reasons for GPs to digitise payments:
- Security: transactions are safe and reliable.
- Easy accounting: bank statements show clearly the payments received.
- Cash-free: no one wants to handle cash these days, and digitised payment means less cash on the premises and fewer trips to the bank.
- Fraud prevention: not only are customer payments safe, but card payment reduces the collection of 50-euro notes, which are among the most counterfeited.
- Speed: a card payment is quick and simple, freeing up valuable time.
- Safety: digitised payment makes sense in a pandemic and especially in a doctor’s surgery.
- Good business practice: GPs are running a business and anything that makes the business run more smoothly and efficiently should be considered. Once digitised, systems can be easily upgraded to the latest technology.
The overall consensus is that digitised payment is now a way of life and that all businesses should join the party. GPs are more aware than most, that they are dealing with many vulnerable and disadvantaged members of the community. As a result, they will probably keep all options open regarding payment. Many kind-hearted GPs will probably not charge at all when they feel a patient simply doesn’t have the means.
Furthermore, it could be a long time before doctors based in-country practices are able to go digital. For this, they need to be properly served with functional, reliable broadband to enable digitised payment.
But on the evidence of friends and family, many GPs now offer the choice to pay by card or take payment over the phone. When you consider the implications of paying in cash, especially in pandemic times, it’s a wonder they didn’t get there a lot sooner.