asked the Minister for Health if he will give details of the increases in eligibility limits for medical cards sought by the health boards; and if he will indicate the increase he proposes to sanction.
4.
Ceisteanna — Questions. Oral Answers. - Medical Card Eligibility.
3.
asked the Minister for Health the date or dates on which he received applications for increases in the eligibility limits for medical cards from each health board.
5.
asked the Minister for Health the number of requests he has received from (a) the members and (b) the officers of health boards for an increase in the eligibility limits for medical cards; and if he has made any decision on the matter.
6.
asked the Minister for Health the criteria on which the present limits for medical card eligibility are based.
With the permission of the Ceann Comhairle, I propose to take Questions Nos. 3 to 6 together.
An adult person, together with his dependants, is eligible for a medical card if he is unable without undue hardship to arrange general practitioner services for himself and his dependants. In practice, the chief executive officers of health boards fix income limits to guide them in deciding on eligibility for medical cards. Allowance is made for a married person and for every dependant and, in addition, allowance is made for certain fixed outgoings such as rent and rates.
Revision of these guidelines normally takes place annually. The last revision took effect from 1st January last and account was then taken of expected changes in money values during 1974. A further revision is not intended at present and I have received no proposals on the matter.
Would the Minister say if there are any guidelines issued to the health boards in order to ensure uniformity?
Yes. The guidelines are the same for every health board now as agreed by the chief executive officers.
Would the Minister make allowance for particular cases where a unique type of disease is involved as in a case I had recently where a disease appeared for the first time in 25 years? It was a special case but the health authority, the Eastern Health Board, did not attach any significance to it. Would the Minister not instruct the health authorities to pay special attention to diseases of this kind?
The chief executive officers have power to consider cases of hardship, and I presume the Deputy is suggesting that the case he has in mind is one of undue hardship. It would not be normal for me to interfere with the discretion of the chief executive officer. But, if he thinks it is a very special case, I would certainly be prepared to refer it to the chief executive officer. That would not necessarily mean that the whole family might be covered by a medical card. But, if there is a special case—with a special member in the family—a card could be issued in respect of that one person.
I thank the Minister for his comments.
Did the Minister say there was uniformity and, if so, is he aware that some health boards have granted allowances in respect of travelling, which does not apply to some other health boards? Furthermore, in the cases in respects of which he has said he would make provision for a medical card to be issued to an individual, would he issue a directive to this effect to health boards as they will not accept it at the moment?
I am aware—even in my capacity as a Deputy—in my particular health board that the CEO does admit all cases which would be deemed to be of undue hardship on an individual. The guidelines include not alone the income aspect of it but, as I said in the original reply, allowance is made for outgoings on a house, such as rent and rates and also reasonable expenses necessarily incurred in travelling to work. My information from the CEOs is that this happens.
If I may say so, it is not allowed by the Eastern Health Board. May I ask the Minister if he would issue a directive to the Eastern Health Board that, in the case of an individual circumstance — one person being chronically ill—a medical card could be issued to that individual?
I would have no hesitation in doing that if that is the practice but my understanding has been that all the CEOs act in accordance with what the Deputy says does not happen in his district.
The Eastern Health Board will not do that.
I will get in touch with the CEO and remind him of what was acted upon by all the CEOs.
Would the Minister not recommend to the health boards that the guidelines be raised? Would the Minister agree that £20 for a man and his wife is unrealistic at the moment for a health card? That is what obtains in the Western Health Board anyway and if there is uniformity that must obtain all over the country, which is completely unjust?
The £20 for a married couple is uniform. I would not say that I was entirely satisfied even with the guidelines as laid down but there is the question of cost. I do not mind admitting that. There has been, I think, a significant improvement in the number of medical cards issued since April, 1973. The percentage increase related to the whole population, I think, since the 30th April, 1973, since when there was an increase in cover of 3½ per cent of the whole population, now stands at something like 34.7 per cent.
Would the Minister agree to send an instruction to health authorities and the CEOs of health authorities that, in the case of families where a particular member is suffering from a particularly unusual disease—as in the case I mentioned earlier — this particular member be granted a medical card without necessarily including the rest of the family despite the financial arangements and situation of the rest of the family?
As I have said before, it is possible and CEOs are well aware that if there is undue hardship or chronic illness in respect of one member of a family, they have the authority to issue a medical card for that person.
Would the Minister agree to send a circular as a reminder?
Next question.
Is it not a fact that when representations are made on behalf of a particular case, the CEO will make a human approach? As a member of a health authority and a health board, I know that this is the position.
The Deputy is making a statement rather than asking a question.
I would certainly accept that any member of a health board or, perhaps, any member of this House should have any representation he makes to a CEO considered because, with the best will in the world, the investigator, who is usually the home assistance officer, may miss some vital information that would have an effect on the ultimate decision given by the CEO.
I want to say——
No, Deputy, we must pass on. You may not make a statement.
I want to say that the Minister is well aware that all these cases are treated on their individual circumstances.
Question No. 7, please.
And they are treated in a humane way.
The Deputy is continuing to make a statement. Question No. 7.