Section 57 of the Health Bill which is the one which provides for the supply of drugs and medicines and medical and surgical appliances is, like many other sections of this Bill, grossly inadequate. It does very little to meet much less cure the principal shortcomings of our existing provisions for drugs, medicines and medical and surgical equipment. So long as we continue the present system of requiring over 70 per cent of our people to pay the full cost of drugs and medicines or medical and surgical equipment, so long will we continue something which is economically crazy and medically untenable.
True, if a person is obliged to undergo a long and expensive treatment and is aware, as he seldom is aware, of a right to plead hardship and to prove hardship, he may now under the Bill receive some assistance, but the nature and extent of that assistance is entirely within the discretion of the local authority. In many cases it is not given; in some cases it is. There is no certainty that two cases will be similarly treated. We in Fine Gael would prefer to see a national health insurance system which would ensure that everybody, without regard to means, would receive drugs and medicines at half cost. The people who at present enjoy drugs and medicines at no cost at all of course would continue to enjoy their drugs and medicines without charge, but the remainder of the community could receive them at half cost. This is medically necessary because if we do not do this we will perpetuate a practice which, at enormous public expense, is crowding our hospitals with people who need not be there.
The reason we are the most hospitalised country in the world is twofold. On the one hand, we have dispensary doctors, particularly in urban areas, unable to handle the huge number of cases which they are called upon to attend. They are obliged to refer people to hospital so that they may be attended to there and so that they may receive drugs and medicines without any difficulty and without any charge. On the other hand, the present high rate of hospitalisation is due to the fact that people are required to pay the enormous cost of modern drugs and medicines for themselves and their families; they keep postponing consultation with their doctors and their illness becomes more acute and as a result they require hospitalisation which could have been avoided if they had had adequate and timely consultation.
Because of the high cost of modern drugs and medicines people not infrequently fail to purchase the prescription prescribed for them by the doctor. Sometimes they will purchase only part of the prescribed medicines and drugs with two very serious consequences. The first consequence flows from the fact that most prescriptions need to be completely consumed if they are to be of benefit. If they are only partially consumed the second state of the patient may be worse than the first. The second consequence is the inflow into hospitals of people who need not be there. It is essential that no difficulty should be put in the way of giving considerable assistance to people who have to undergo long courses of treatment with drugs and medicines. It is seldom, if ever, that the cost of drugs and medicines outside hospitals exceeds the cost of maintaining the person in hospital. If the person is put into hospital the drugs and medicines will also have to be acquired. It is much sounder economy and it is more humane medicine to provide massive assistance towards the cost of drugs and medicines.
I am not unaware that the greatest rate of growth in medical expenses in the last ten years has been under the heading of drugs and medicines. This is attributable to two causes: first more people are availing of their rights to receive assistance in meeting the cost; and, secondly, the prices of drugs and medicines are multiplying beyond all previous experience. Whether that is directly and fairly attributable to the cost of research or to other factors is difficult to determine, but it is fair to query why it is that we in this State are called upon to pay prices for drugs and medicines far in excess of the cost of equivalent drugs and medicines in the Six Counties, Britain and elsewhere. It cannot be due to the fact that the research work is peculiar to Ireland because most of the research work done by the large medicine and drug manufacturers is conducted abroad and the cost of that research is spread across the world, and it should not be proportionately any greater in Ireland than anywhere else. We are aware that our drugs and medicines are subject to an unfair purchase tax which does not apply to drugs and medicines prescribed for animals, but human beings have to pay this unjustified purchase tax. We are called upon to pay between 25 per cent and 100 per cent more for our drugs and medicines than obtains elsewhere.
I presume under any scheme the Minister might propose that a national list of prices for drugs and medicines will be drawn up. I think it is important that the Department of Health should take much greater care about the cost of drugs and medicines. It appears there is a great deal wrong here. It is because of the excessive prices and the lack of State assistance for the great majority of our people that we have the ridiculous position of having a health pyramid turned upside-down. Ninety-five per cent of our Health Bill relates to hospitalisation because we have a crazy system which pushes people into hospital in order to relieve the case burden of the doctor and in order that the people may get the drugs and medicines they would be unable to get free if they were not in an institution As medicine can do more and more for us it becomes more expensive, but it is cheaper in the long run to pay for this kind of care outside the hospitals and institutions.
Section 57 is not going to achieve the necessary reduction in demand for hospital accommodation. The section repeats once again the Fianna Fáil fable that hardship is not caused to people in the middle income group or in the upper income group in regard to medical expenses. I think it is true to say that there are very few cases in which the cost of providing drugs and medicines does not cause hardship and does not cause a lowering of family standards even for a short time. A prescription may cost 30/- or 40/- and taking that amount of money, even out of a middle income pay packet, in a week causes some lowering of standards, and if this is repeated for a month it means a serious loss. It has to reach almost crisis proportions before any relief is given under the heading of income tax if a person is paying income tax. There are many families who are not regarded as being entitled to a medical card and who are not regarded as suffering from continuous hardship which would justify assistance in meeting medical costs, and they suffer real hardship. Very often necessary family expenditure has to be postponed in order to pay for urgently needed drugs or medicines; or a competition arises between necessary expenses and, I am sorry to say, all too often the expenditure which suffers is the health expenditure. This is something which should not arise in any Christian community. Necessary health expense should be the first priority; it should not conflict with any other reasonable family expenditure.
There is also a danger where inadequate subsistence is provided for expensive drugs and medicines that people will resort to home cures which may accentuate the difficulty and will certainly not relieve the disability but which will result in ultimate very heavy expense. This is something we should all be trying to avoid.
The section also requires that people who are not entitled to full eligibility must prove hardship before they receive assistance. We consider this to be degrading and we also believe that it increases illness. This is the kind of thing which prevents a person—as the Voluntary Health Insurance Board says —being ill with ease because you cannot be ill with ease if you are concerned about the tremendous cost. Requiring people already ill, or their families, to process their family circumstances through the local authority and the local health board is something people should not be called upon to do.
The section is, of course, welcome to one extent in that we hope it will do away with the appalling conditions that people have had to endure in urban dispensaries where they are obliged to attend at an early hour in the morning to get their medicines within stated hours. The result is that mothers with young families have to bring their children along to the dispensaries, wait for two or three hours and not get a prescription, and then have to come back again on another day.
At least, it is proposed to allow the drugs and medicines to be supplied through the ordinary retail chemists. We consider that that is an advance, but we express some concern about the inadequacy of the consultations to date with the pharmaceutical profession. We know that there has been some, but we would urge upon the Minister to bring these consultations to a conclusion as quickly as possible in order to ensure that we do not again experience what we experienced in 1953, that is, the machinery for the operation of a health service without having the personnel willing and anxious to operate it. It is essential that we have the full confidence and co-operation of everybody— doctors, nurses and pharmacists—and we will get that only by having adequate consultation.
That, Sir, is our general observation on the section. It is a disappointment. It could have achieved more. We believe that it has been wrongly conceived, that it was conceived on the basis of the false premise that hardship is not caused to most people in the provision of medical aid. That, we are satisfied, is wrong.
The reason why the Department take this view is that the figures on which they make this wrong conclusion are 18 years out of date. If I am right, they base it on a household inquiry made in 1951-52. The cost of drugs and medicine has developed in an entirely different way over the last 18 years and the development of the techniques and knowledge of medicine has also changed immensely over the last 18 years. We think it is utterly unworthy that we should now be bringing in a Health Bill, which the Minister believes will operate for the next 20 years, on the basis of information which is even already out of date, which might even have been inaccurate in 1951-52—I am not going to argue that; I am not in a position to argue it, not having made the necessary analysis—but, it is fair to assume the basis has little relationship to our present day problem.