asked the Minister for Health if he will withdraw the letter sent to the health boards instructing them to be more vigorous in their applications of guidelines for general medical service cards.
Ceisteanna—Questions. Oral Answers. - General Medical Service Cards.
21.
I presume that the Deputy's question relates to a letter dated 30 April 1985 which issued to the chief executive officer of each health board above the signature of a senior officer of my Department. That communication related to the various initiatives which health boards might pursue in order to ensure that expenditure on the general medical services scheme in 1985 would be commensurate with the finances available. The letter in question indicated that proper control by the health boards of the numbers covered by medical cards could make a significant contribution to cost containment and recommended vigorous implementation of the published guidelines for eligibility, but in accordance with agreed and standardised procedures.
In other words, and as the text of the letter made explicitly clear, applicants for medical cards whose incomes exceeded the appropriate income guideline figure would be issued with a medical card only where it was clear that hardship would otherwise arise. This recommendation was, of course, in complete accordance with the appropriate statutory provision, namely, section 45 (1) of the Health Act, 1970. Similarly, the letter noted that effective ongoing review procedures should be placed in operation to ensure that medical cards did not continue to be held by persons who were, in fact, no longer eligible to hold them.
I can see no grounds why I should now ask my officials to withdraw the letter in question or why the health board administrations should be requested to ignore its recommendations. Indeed, were I to do so, it would, in effect, amount to explicit ministerial approval for the idea that persons ineligible for medical cards should be issued with them or should continue to hold them. It would also suggest that careless and loose application of the published income guidelines for medical card eligibility would suffice in the future.
In any event, and as the Deputy will be well aware, the determination of eligibility for medical cards in individual cases is entirely a matter for the chief executive officer of each health board.
I am referring to a letter dated 12 December 1985. Arising out of the last comment made by the Minister that it was a matter for the CEO, does he stand over the statement that any increase in demand for cover should be offset by the uniform rigorous application of the guidelines? Does he accept that there must be discretion on the basis of need and that a rigorous application of the guidelines will cause undue hardship to a number of people?
The information available to me—I have looked at all the counties where medical cards have been issued—is that there has been no reduction by and large. To take the Deputy's own county, in 1984 there were 12,244 medical cards, representing 42.59 per cent of the population. In 1985, it was 11,999 medical cards representing 43.8 per cent of the population. What has happened in a number of counties is that it has been computerised and is carried out on a regular——
Does the Minister agree with the statement that there should be rigorous application of the guidelines irrespective of need?
There should not be any excess allocation over and above the guidelines. Thirty-seven per cent of the population are covered by medical cards. That represents almost four out of every ten people. I did not have anything to do with the 1982 issue of medical cards but in that year 37.19 per cent of the population had medical cards. In 1985, 36.7 per cent had them. The reduction is largely accounted for by the fact that, by Government decision, I do not issue medical cards to students irrespective of their income.