Ireland

Welcome to Worldwide Physical Therapy Practice: a focus on Primary Care Physical Therapy

This is a project created by and for the students in the School of Physical Therapy at the University of St. Augustine in St. Augustine Florida. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editor -Michael Adams created the original content for this page.

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Patient Access to Physiotherapy or Physical Therapy Services / Entry Point

• How do members of this country access Physical Therapy services?
• What is the entry point or typical path the patient must follow in order to receive services?
• Do PT's have direct access or are they part of a primary care team?
  
• Physical Therapy In Ireland
  • Note: This information is a compilation of information gathered from internet searches and a phone conversation on Friday November 19, 2010 between myself and Ruaidhri O’Connor who is the CEO of the Society of Chartered Physiotherapists. I have indicated the source of the materials at the end of each quoted section and in the reference section. Additionally please note that there is a controversy in Ireland over the use of the terms “physiotherapist” and “physical therapist”. For proper comparison to the US model the physiotherapist is the closer match to our professional physical therapist. I have included a link to an article discussing this controversy.
    Thank you, Michael Adams PT
• General Information about the Irish Healthcare System.
• Healthcare in Ireland
  “The quality of health care and health care facilities in Ireland is of a very high standard and is similar in structure to that of the UK. In some rural areas, facilities are limited, but access to town-based facilities is not too difficult. The Minister for Health & Children is responsible for policy and concerning the health service and the Health Service Executive (HSE) is in charge of executing the policy. Healthcare in Ireland is predominantly free.
  The State Healthcare System
  Healthcare in Ireland is free and you do not need to contribute to the Irish social security system to receive treatment. Indigenous citizens qualify by birth. Citizens from the European Economic Area (EEA), which consists of all EU member states and Norway, Liechtenstein and Iceland, qualify because Ireland has a reciprocal health agreement with all EEA member states. Foreigners from outside of the EEA must be able to show that they qualify for ordinary residence and will remain resident in the country for at least a year by producing an residence or work permit, proof of property ownership or a valid rental agreement, or in the case of students, proof of college registration. All foreigners from outside of the EU must also show evidence of an Irish bank. If you qualify for ordinary residence, your dependant family members must also qualify in order to receive free healthcare. Citizens do not fall into the above group will have to pay for all medical treatment, although emergency treatment may be given free depending on necessity.
  Category 1: Medical Cardholders
  You must hold a medical card either issued by the Health Board in Ireland or from your home country within the EEA. This entitles you to free medical treatment, which includes doctors’ visits and treatment, prescription medicine, inpatient and outpatient hospital care, dental treatment, eye tests and treatment by an optician, aural treatment and appliances and maternity and infant care. If you come from outside of the EEA, you can apply for a medical card, but it is means tested according to your income. The income limit is changed each year and is measured according to age and family status.
  Category 2: Citizens without Medical Cards
  People who do not qualify for a medical card receive a letter from the Department of Health and Children confirming their entitlement to category two benefits. This means that you must pay for any visits to a doctor, prescription medicine, inpatient hospital care, emergency ward treatment, routine dental treatment, eye tests and treatment by an optician and aural treatment and appliances. Out patient treatment in a state hospital and maternity care is free. All old age pensioners over the age of 65 are entitled to visits by a nurse and, if necessary, occupational therapy.
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  Private Health
  Ireland has two recognised private health insurers, the Voluntary Health Insurance known as VHI (www.vhi.ie) and BUPA (www.bupaireland.ie). If you have private health insurance from your home country, it may be transferable to one of the recognised Irish insurers without penalty. VHI and BUPA premiums are gauged according to a community rating. All members contribute the same amount and premiums do not rise with age. Therefore young people over the age of 21 (with VHI) and 18 (with BUPA) pay more than they would if they subscribed to a risk based system.
  
  Private health patients can choose the hospital of their choice, depending on the level of their insurance cover.
  Doctors
  There are a high number of doctors per head of population in Ireland. GP’s are responsible for general health, prescribing drugs, treating serious illnesses, and providing preventive healthcare and health education and you cannot attend an Irish hospital without a referral from your doctor, unless your case is an emergency. Medical cardholders are sent a list of ‘approved’ doctors and can register with any doctor on the list. If you are treated by anyone other than an ‘approved’ state funded doctor, you will have to pay the fees yourself. To register with a doctor, you make a contract between the two of you. You can change to a different doctor, but beware of the reason you give for your change, as many Irish doctors are reluctant to take on patients who have had a disagreement with their previous doctor.
  Most of the doctors in the country operate from a single or two-man practice. If you register with a doctor in a group practice, you can be treated by one of the other doctors in the practice, when your own doctor is absent.
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  Hospitals
  There are not many state hospitals in Ireland, but they do contain the latest technology and staff are highly qualified.
  There are four classes of hospital; the general hospital located in major towns provides in and outpatient care and emergency treatment. Areas that are more rural are served by district or regional hospitals, which offer maternity care and general care but they do not have emergency facilities; district hospitals offer less facilities than regional hospitals. Specialist hospitals are mostly based around the capital, Dublin and specialise in certain kinds of illness or disease.
  You may specify the hospital at which you wish to be treated, but there is no guarantee that your choice will be met.
  Hospital accommodation consists of wards containing six beds. Some of the wards are mixed sex wards. There are also private and semi private rooms available containing up to four beds, but these are usually reserved for intensive cases or patients who are prepared to pay.”
  http://www.europe-cities.com/en/633/ireland/health/
• 
  The four forms of reimbursement for physical therapy services in Ireland.
  VHI Healthcare www.vhi.ie
  
  http://www.quinn-healthcare.com/
  
  http://www.vivashealth.ie/
  
  http://www.revenue.ie
  http://www.iapt.ie/our-services/reimbursement:-services
• Patient Access to Physiotherapy or Physical Therapy Services / Entry Point According to O’Connor the patient that needs physical therapy services can access the system in two ways. First the patient can self refer to a private physiotherapist and either pay cash or use one of the health insurances. The other method is for the patient to use public health system. In that case the patient will need a referral from the physician. When the public system is used there may be up to a one year wait for services. (1) “The Health Service Executive (HSE) (Irish: Feidhmeannacht na Seirbhíse Sláinte, FSS) is responsible for the provision of healthcare providing health and personal social services for everyone living in Ireland, with public funds. The Executive was established by the Health Act, 2004 and came into official operation on January 1, 2005. It replaces the ten regional Health Boards, the Eastern Regional Health Authority and a number of other different agencies and organisations. The Minister for Health and Children has overall responsibility for the Executive in Government. The HSE is Ireland's largest employer with over 100,000 direct employees, and another 40,000 in funded health care organisations. It has an annual budget of over €14 billion, more than any other public sector organisation.” http://en.wikipedia.org/wiki/Health_Service_Executive
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  Primary Care Services
  “Primary Care services mean all of the health or social care services that you can find in your community, outside of the hospital setting.
  Primary Care includes GPs, Public Health Nurses and a range of other services provided through your Local Health Office.
  Health Centres- find your public health nurse at your nearest health centre, along with Dental Services, Community Welfare and other services
  GP Out of Hours Services - need a GP or family doctor outside of business hours?
  Local Health Offices - access a wide of services like physiotherapy, OT, child protection, aids and appliances etc
  A Primary Care Team (PCT) is a team of health professionals who work closely together to meet the needs of the people living in the community. They provide a single point of contact to the health system for the person.” http://www.hse.ie/eng/services/Find_a_Service/PrimaryCare/
  Ruaidhri O’Connor indicated in our call that at this time there are over 140 primary care teams in Ireland and they are working to develop more. (1)
• “These professionals include:
  • GP and Practice Nurse
  • Community Nursing Service – Public Health Nurse, Community Registered Nurse
  • Occupational Therapist
  • Physiotherapist
  • Social Worker and Home Care staff
  • Home Help/support staff
  The Primary Care Team members also link with other community-based disciplines to ensure all health and social needs are provided for: These include:
  • Speech and Language Therapy
  • Dieticians
  • Mental Health Services
  • Counsellor/Psychologist
  • Chiropody
  • Dental
  • Ophthalmic Services
  It is proposed that there will be 530 Primary Care Teams in operation by 2011 each serving a population of approximately 8,000 to 12,000.”________________________________________http://www.hse.ie/eng/services/Find_a_Service/PrimaryCare/
  Private Care There are independent physiotherapists operating in Ireland. A patient may visit the physiotherapist directly without the need for a physician referral as long as they are not using the national health insurance system. (1)
• 
  Therapist Preparation :
  Degree/Credentialing “Physiotherapy is a four-year, Level 8
  university degree course designed in the main for school
  leavers, whereas physical therapy is a three-year Level 7
  degree course from a private college, designed for mature
  students and adult learners. Physiotherapy training focuses
  primarily on hospital work whereas physical therapy is
  designed for conditions seen mostly in private practice.
• Physical therapy training concentrates on the use of manual
  (or hands-on) techniques exclusively, whereas physiotherapy
  incorporates electrical modalities where available,
  such as interferential, ultrasound, tens, laser and other
  non-manual treatments. Physical therapists are trained with
  a view to a longer client consultation, allowing a more
  holistic approach and a treatment, which by virtue of its
  hands-on nature, may be more client-centred. Physiotherapists require a "hospital type apprenticeship" on graduation whereas physical therapy education prepares for work in private practise. Health cutbacks or a ban on recruitment within hospitals can therefore adversely affect new physiotherapy graduates. Physical therapists, on the other hand, can easily commence in private practise but face a different challenge in establishing their business and becoming self-employed.
• In the Republic of Ireland, Physiotherapy is available as an undergraduate course in four universities,, Trinity College, University College Dublin, Royal College of Surgeons and University of Limerick. Courses are four years in length with clinical practice in the final two years. Students are required to complete 1000 hours of clinical practice before graduation.”http://en.wikipedia.org/wiki/Physical_therapy_education
• “In order to work as a qualified Physiotherapist in Ireland you must be state registered with the Irish Society of Chartered Physiotherapists
  Those who qualified outside the EU are required to obtain a UK Naric equivalence of their qualification. The UK Naric states the degree equivalence in accordance with British/Irish Bachelor Degree standard.
  In accordance with EU Directive No. 89/4 members who have been accepted with the Irish Society of Chartered Physiotherapists would be eligible to practice as a Chartered Physiotherapist in the Irish Public Health Services.
  All overseas applicants should apply for registration well in advance of the date on which they wish registration to begin. It is never possible to grant registration immediately on receipt of an application. A minimum of 8 weeks is usually required.
  The Overseas Assessment Sub Committee (OASC) strongly advises you to apply for registration while you are still resident in your country of training and before you arrive in Ireland.”
  http://overseasphysicaltherapist.com/foreign-physical-therapy-career/ireland-physical-therapists-jobs.htm
  
  
  
  
  Specialization Yes, there are areas of specialization that a physiotherapist can apply for, such as musculoskeletal, through the Irish Society of Chartered Physiotherapists. The physiotherapist must apply for membership through the society by submitting proof of course work toward the specialty. The society reviews the data and can grant the specialization. (1)
  Professional Associations
• 
  Irish Society of Chartered Physiotherapists http://www.csp.org.uk/The Irish Society of Chartered Physiotherapists is the professional body representing over 3000 members in Ireland. The Society was founded in 1983 following a number of developments in the profession including the establishment of a university degree qualification. Over the years there has been an increasing public demand for the services of the Chartered Physiotherapist and it is the role of the Society to ensure that this demand is met by the highest standards of care.
• 
  Payment System
  Category One eligibility is the complete works - a 'medical card' which covers all ordinary and hospital costs. It also covers dental, opthalmic (eye) and aural (ear) services and appliances like glasses and hearing aids. Maternity and infant care services, including visits to doctors before and after birth are all covered. Prescribed drugs and medicines are also free.
  You'll qualify for a medical card if your total income is below a certain threshold. There are various adjustments based on age and number of dependents.
  There are extra allowances for children under 16 and for travel and housing expenses. People who have a higher income than these allowances may still qualify for a Medical Card if the the Health Board considers that they are unable to provide adequate health care to themselves and their families.
  A medical card would normally cover the applicant and his/her dependent spouse and child dependants. A plastic card (similar to a credit card) is issued. All people over 70 are entitled to a medical card regardless of means.
  The full ins and out of the programme are available on the government's information site: citizensinformation.ie Category Two Coverage
  Everyone else in the Republic qualifies automatically for Category Two eligibility. Every resident of Ireland is entitled to all in-patient hospital services in public wards and all out-patient public hospital services subject to an annual maximum charge of a few hundred euro. Accident and emergency departments are covered if you have a referral note from your doctor. If not, they are subject to a charge. Maternity and infant care services such as doctor visits are covered for up to six weeks after birth.
  The full panoply of exceptions and exemptions is available on Citizensinformation.ie hospital charges page.
  http://www.movetoireland.com/movepag/medcover.htm
  There are currently three private insurance providers in Ireland: the Voluntary Health Insurance Board (VHI), Quinn Direct and Hibernian Aviva.
  Although all Irish residents (and EU-citizens as well) are entitled to free public health care, you might want to consider buying private health insurance, as it provides much quicker access for non-emergencies.
  Private Health Insurance is widely used in Ireland. About half of the Irish population is covered by this form of health insurance. All private health insurance providers are registered with the Health Insurance Authority which is the country's independent regulator for private health insurance.
  With the exception of some Restricted Membership Insurers who provide insurance only to a particular group of employees, the three Irish Open Membership Insurers VHI , Quinn Direct and Hibernian Aviva are obligated to accept all applicants regardless of their age, sex or risk status.
  The main benefits of private health insurance are the following:
  • semi-private and private hospital accommodation
  • in-hospital consultant services
  • additional cover including overseas, psychiatric, out-patient and maternity benefits
  http://www.justlanded.com/english/Ireland/Ireland-Guide/Health/Private-Health-Insurance
• "Health care in Ireland" redirects here. For health care in Northern Ireland, see Health and Social Care in Northern Ireland.
  
  
  The HSE is responsible for providing health and personal social services to everyone living in Ireland.
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  v • d • e
  The public health care system of the Republic of Ireland is governed by the Health Act 2004,[1] which established a new body to be responsible for providing health and personal social services to everyone living in Ireland - the Health Service Executive. The new national health service came into being officially on 1 January 2005; however the new structures are currently in the process of being established as the reform programme continues. In addition to the public-sector, there is also a large private healthcare market.
  In 2005, Ireland spent 8.2% of GDP on health care, or US$3,996 per capita. Of that, approximately 79% was government
  All persons resident in Ireland are entitled to receive health care through the public health care system, which is managed by the Health Service Executive and funded by general taxation. A person may be required to pay a subsidised fee for certain health care received; this depends on income, age, illness or disability. All maternity services are provided free of charge and children up to the age of 6 months . Emergency care is provided at a cost of €120 for a visit to the Accident and Emergency department.
  Everyone living in the country, and visitors to Ireland who hold a European Health Insurance Card, are entitled to free maintenance and treatment in public beds in Health Service Executive and voluntary hospitals. Outpatient services are also provided for free. However the majority of patients on median incomes or above, are required to pay subsidised hospital charges.
  The Medical Card - which entitles holders to free hospital care, GP visits, dental services, optical services, aural services, prescription drugs and medical appliances- is available to those receiving welfare payments, low earners, those with certain long-term or severe illnesses and in certain other cases. Many political parties support extending the availability of the Medical Card to eventually cover everyone resident in Ireland - they currently cover 31.9% of the population. Those on slightly higher incomes are eligible for a GP Visit Card which entitles the holder to free general practitioner visits. For persons over 70 years who are not entitled to a medical card or GP visit card they instead receive an annual cash grant of €400 up to a certain income.
  People who are not entitled to a Medical Card (i.e. 68.1% of the population) must pay fees for certain health care services. There is a €100 A&E charge for those who attend an accident and emergency department without a referral letter from a family doctor (a visit to which usually costs €50-75). Hospital charges (for inpatients) are a flat fee of €100 per day up to a maximum of €1000 in any twelve month period, irrespective of the actual care received. Specialist assessments and diagnostic assessments (such as X-rays, laboratory tests, physiotherapy, etc.) are provided for free. If a person cannot afford to pay hospital charges, the HSE will provide the services free of charge
  Many hospitals in Ireland, such as Connolly Hospital at Blanchardstown, are operated directly by the HSE. There are also hospitals run under a voluntary basis by organisations. Some are teaching hospitals (such as University College Hospital Galway) operated in conjunction with a university. There are also many private hospitals.
  Hospitals in Ireland generally offer a full range of healthcare including accident and emergency services.
  [edit] Waiting lists
  The public health system, despite massive expenditure in recent years, has some problems. An ongoing issue is the "waiting lists" for those requiring, in some cases, serious operations.
  In 2007[3], 76% of inpatients were admitted to hospital for operations immediately, 11% had to wait up to one month, 4% had to wait up to three months, 1% had to wait up to six months and 4% had to wait for over six months for operations.
  For outpatients, 23% were seen on time, 44% were seen within 30 minutes, 18% waited more than an hour and 7% waited two hours.
  The National Treatment Purchase Fund was set up in 2002 for those waiting over three months for an operation or procedure, and as a result over 135,000 patients on waiting lists have been treated so far. The NTPF involves the government paying for public patients to be treated for free in a private hospital in Ireland, or sometimes abroad if necessary. The NTPF has reduced waiting times for procedures to an average of between two to five months (with the average in 2009 being 2.4 months[4]), compared to between two and five years in 2002.[5]
  [edit] Health centres
  [edit] General practitioners
  Primary healthcare in Ireland is mostly provided by general practitioners (GPs), who generally operate as sole traders or in health centres with other GPs and sometimes nurses. Most GPs also offer house visits to their patients, with there being emergency "out-of-hours" GP services available in all parts of the country. GPs generally charge on a per consultation fee basis, usually charging anything up to €60. People with Medical Cards or GP Visit Cards are exempt from charges. Many GPs also provide services to those with Hepatitis C and maternity and infant services for free. Those with private health insurance can, depending on their plan, get their GP costs paid for or refunded ("cash back"), either fully or partially by the insurance company. People can also claim tax relief for GP visit costs.
  Those without a Medical Card or private health insurance are able to receive medical services for free or at a subsidised rate from the Treatment Benefit Scheme - as are their dependants - which brings into account the compulsory Social Insurance Fund (PRSI) contributions they have made. People can also claim tax-relief on medical expenses that are not covered by the State or by private health insurance. Those with private health insurance also get tax credits, which are passed directly on to the insurance company and lower the customer's premium.
  Visitors to Ireland who hold a European Health Insurance Card do not have to pay anything for emergency treatment from a general practitioner or specialist, emergency dental, oral or aural treatment, inpatient or outpatient hospital treatment or prescription medicines. Those who need dialysis, oxygen therapy or other such treatments, can arrange for it before their visit.
  [edit] Satisfaction with the health service
  Private health insurance is available to the population for those who want to avail of it. Vhi Healthcare (which is owned by the government), Quinn Healthcare, and Aviva provide health insurance, among other services. In 2005, 47.6% of people were covered by private health insurance.
  The regulatory body for private health insurance is the Health Insurance Authority.
  The Hospital Saturday Fund (HSF) is also available to give customers cash towards a range of every day health care costs.
  Confusion Over The Titles Physical Therapist and Physiotherapist
  “Irish physiotherapists are warning that people who call themselves “physical therapists” are not always members of the profession.
  
  Since its establishment, WCPT has always asserted that the titles physical therapist or physiotherapist, and abbreviations and translations of these, are the sole preserve of persons who hold recognised qualifications approved by national professional associations which are members of WCPT.
  
  But in many countries, either the name physiotherapist or physical therapist (or both) is not protected by law, meaning that others can legally use the terms to describe what they do. This is the case in Ireland, where although the name physiotherapist is protected, physical therapist is not.
  
  “In the Republic of Ireland the titles of physiotherapist and physical therapist cannot be used interchangeably because a group calling themselves ‘physical therapists’ are not physical therapists/physiotherapists as defined by WCPT,” says Karen Gunn, President of the Irish Society of Chartered Physiotherapists. “These physical therapists are not eligible for membership of the Irish Society of Chartered Physiotherapists and are not permitted to work in the National Public Health Service in the Republic of Ireland.” (7)
  In my phone call to Ruaidhri O’Connor, CEO of the Irish Society of Chartered Physiotherapists, he specifically reiterated that this controversy is continuing his country. The governing bodies are trying to clear this issue up. (1)
  
• References
• 1) O’Connor, Ruaidhri. CEO of the Irish Society of Chartered Physiotherapists. Person phone conversation on November 19, 2010.
  2) http://www.europe-cities.com/en/633/ireland/health/
  3)http://www.iapt.ie/our-services/reimbursement:-services.
  4) http://en.wikipedia.org/wiki/Health_Service_Executive
  5)http://www.hse.ie/eng/services/Find_a_Service/PrimaryCare/http://www.hse.ie/eng/services/Find_a_Service/PrimaryCare/ http://en.wikipedia.org/wiki/Physical_therapy_education
  6) http://overseasphysicaltherapist.com/foreign-physical-therapy-career/ireland-physical-therapists-jobs.htm
  7) http://www.wcpt.org/node/30236
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Therapist Preparation

      Degree/Credentialing

• What is the education process to become a Physiotherapist or Physical Therapist in this country?

      Specialization

• Do clinicians specialise in certain areas of care and if so how?

Professional Associations

• What are the professional associations associated with Physiotherapy or Physial Therapy in this country?

Information about the Patient Community

• What is the population these PT’s serve?
• What are the major causes of morbidity and mortality in the population served?

Social/Cultural Influences

• What is the influence of the family on a patient's health status?
• What are the typical patient's living conditions, family dynamics, and cultural back ground?

Delivery of Care

• Is delivery of care provided in a timely manner?
• Special methods? Home health etc
  

Type of Health System

• Is it a national health system with universal access?
  

Payment System

• What methods to patient use to pay for service? (Insurance, bartering etc.)