Facing difficult choices: precarious workers' access to healthcare in Ireland

Sinead Pembroke21/03/2018

Imagine you have an excruciating backache that won’t go away. What if you have a virus that you need a prescription of anti-biotics to cure? Or what if you experience other symptoms that are alarming that you worry might be something more serious? For those of us who can, we wouldn’t hesitate to go to our GP. But for many precarious workers, they are financially precluded from doing so.

TASC’s report on the social implications of precarious work, investigates the effect this type of work has on the personal lives of people. The report, which will be launched in April, looks at the effect of such insecure work on health and accessing healthcare, but also housing and family formation. The results are based on 40 interviews with precarious workers, aged 18-40 who live in Ireland and work on a temporary, part-time/irregular hour and/or self-employed basis.

Our report found that for the majority of our participants, there was a financial barrier to accessing GP, dental and other primary care services. While there are means-tested medical cards and GP cards that do give access to a number of primary care services for free, most precarious workers fall outside of the eligibility criteria. This means that they have to pay the GP fee and the cost of any medication or treatment that they need, which is costly, especially for someone who has no guaranteed income.

Sickness is not an option

The majority of our participants admitted that they avoided going to the doctor out of financial concern. For those who avoided going to the GP, this often resulted in their health deteriorating further. It is not just the cost of seeking medical treatment, but the loss of wages that creates a situation where illness is a major financial burden for precarious workers. Elaine revealed that the last time she was ill:

between the doctor’s appointment, the antibiotics and the four days off work, it was approaching 600 euros that I will never see back again.

And when a person on a precarious contract has a recurring or chronic health condition, then accessing healthcare services becomes a long-term financial burden that cannot be avoided. Often participants with chronic conditions such as asthma recounted the difficult decisions they had to make in order to afford medical treatment. Barbara revealed:

I remember the feeling of, “shit what am I going to do, I don’t have enough money to do me for the next week?!” I didn’t even have 40 euros a week to buy food; my limit was 40 euros a week. It would have had to come down to one or the other: food or inhaler.

It was also evident that financial barriers to accessing primary healthcare services had serious consequences for female reproductive health. Paula revealed that,

I used to be on the pill but you have to go back every six months to see your doctor again, which is 60 quid. So I’ve come off that. That’s since I started part-time.

Dependency on family

The majority of participants relied on a network of people, such as parents or a partner for financial support. This was particularly pertinent when it came to accessing healthcare services. Participants described numerous incidences where they were forced to pay for private healthcare services, such as tests, because the symptoms of their condition became too acute to wait for public services. 

Health insurance was not an option for precarious workers we interviewed. Furthermore, Lifetime Community Rating legislation (2015) further prejudices those who cannot afford health insurance, because those aged 35 years and over who do not have health insurance and who decide to take a policy later in life, pay more for coverage. Therefore, the Lifetime Community Rating is prejudiced against those who cannot afford health insurance.

Ultimately, the privatization of healthcare services privileged those with intergenerational dependency. However, as a consequence of this predicament, those who received financial support for their health expenses admitted they would prefer this not to be the case. Sara revealed:

At the age of 31, having such a low income, you already feel a little bit less successful in the traditional way. So trying to maintain some kind of independence is really important—just for a sense of self-worth.

Precarious work creates a scenario whereby people’s ability to live an independent life, something normally associated with being an adult, is severely restricted.

Universal healthcare needed to reduce health inequalities

If we compare a precarious worker in Ireland to a precarious worker in the UK, there is one fundamental difference: people in the UK have access to universal healthcare that is free at the point of entry and paid for by taxes. In Ireland, we do not have that security. Therefore, Irish precarious workers face double precarity; contractual and health precarity.  This has major implications for health inequalities in Ireland because it places precarious workers at a disadvantage. If we want to reduce inequality, we need to introduce universal healthcare that is paid for by our taxes and free at the point of entry.

 

Posted in: HealthInequality

Tagged with: healthHealth Insurance

Dr Sinead Pembroke

Pembroke, Sinead

Dr Sinéad Pembroke is a researcher at TASC on the Social Implications of Precarious Work project. She was an Irish Research Council (IRC) Postgraduate Scholar and completed her PhD in Sociology in University College Dublin. Sinead worked as a Postdoctoral Research Fellow in Trinity College Dublin developing an evidence-based educational resource for self-disclosure strategies for people with epilepsy (How2Tell). She also worked as a Research Fellow in University College Dublin on an Irish Research Council-funded project, “The Magdalene institutions: Recording an oral and archival history”. Sinéad has also worked on numerous health-related projects including co-authoring a report for the WISE UP Programme for Women Living and Working with Social Exclusion for the Irish Family Planning Association (IFPA).


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