asked the Minister for Health the examination, if any, under way of the feasibility of providing health services that are free of charge for everyone; and whether the implementation of the scheme for the extension of the present limited eligibility scheme to the entire population has been decided upon.
Ceisteanna—Questions. Oral Answers. - Free Medical Service.
22.
The question of providing health services free of charge to all sections of the community has been examined by my Department. I do not think that the considerable cost involved in this extension of entitlement to services would be justified by the need for such a development.
It has been decided to extend to the entire population, with effect from April 1979 the major services which are now available to persons with limited eligibility. The services being made available to persons in the upper income group include: (a) the full range of hospital in-patient services at public ward level, free of charge except for the charges to be made by hospital consultants; (b) subsidies towards the cost of private or semi-private accommodation; (c) specialist diagnostic and treatment services on an out-patient basis in public hospitals, subject to the patients being responsible for payments to the consultants concerned; (d) refund of part of the cost of prescribed medicines.
Is it not a fact that one of the best arguments in favour of the extension of the health service to the entire population is, as the Minister said in his reply to Question No. 21, that where there is a means test, it eventually comes to the stage where it is impossible to exercise it in a just way, because there are unavoidable anomalies in the number and kind of people who become eligible? The eight categories is a typical example of the impossibility of implementing the scheme.
The categories are being reduced to two. They will be very simple categories. In future the two simple straightforward categories will cover all farmers with a valuation of £60 or less, and persons with an income of £5,000.
But there is no general medical practitioner service.
As I said, the general medical practitioner service is administered on the basis of uniform guidelines which are applied throughout the country and there is also the provision that in any case of hardship the chief executive officer has authority to deal with it.
That is the red ticket system.
Is the £60 valuation on a par with £5,000 uniformly throughout the country?
Yes, that is probably the criteria we would adopt, that £60 valuation and £5,000 would be equivalent.
Does the Minister think that £60 valuation is on a par with £5,000, or is uniform; for example, in such areas as Munster would he think a £60 valuation is on a par with £5,000 in Dublin?
That is a question really for the statisticians and economists.
Has the Minister considered having a study carried out into that because the same limit applies for medical cards?
At present the £60 poor law valuation has been settled on for some considerable time——
For many years.
In fact, it was £50 until I increased it when I was Minister for Agriculture some years ago. It has been at £60 for some considerable time now and that has been regarded as the level below which it is reasonable to provide a certain level of services free for farmers.
Would the Minister consider that £60 valuation in Munster is the equivalent of £60 valuation in, say, Connacht or Ulster? There is a case in point. Would he consider £60 in Munster the same as £60 in Connacht?
I am aware of the fact that there are infinite variations between the levels of income which a farmer of £60 valuation will have in different parts of the country.
In view of that great disparity in incomes as a result of the same £60 valuation being applied would the Minister not think it worth while now having a study and perhaps coming up with some more equitable system that would ensure eligibility?
Right through the whole public service that question presents itself and I do not think it has ever been resolved. I think most Ministers who tried to deal with this situation sought around for some alternative system, but in the end they always came back to the PLV which, with all its faults and variations, is at least a readymade and available system.
In view of the fact that eligibility for health services is at stake and that so many people are being deprived of health services in various areas, and others with very considerable income——
I do not think this question will be of all that great significance in the future. As and from April next anybody in the community will have, in effect, all their services free, except the cost of their consultants.
And the general practitioner services.
And the Voluntary Health Insurance Board are going to provide a much improved scheme which will enable even those who will not have limited eligibility in the future to have the services required at very little cost.