asked the Minister for Health if he considers that applicants for medical cards should be assessed on net take-home pay rather than assessed on their gross income; and if he will make a statement on the matter.
Ceisteanna — Questions. Oral Answers. - Medical Card Applicants.
2.
Under the provision of the Health Act, 1970, medical cards are issued to persons who are unable without undue hardship to arrange general practitioner medical and surgical services for themselves and their dependants.
It is a matter for the chief executive officer of the appropriate health board to determine eligibility in individual cases. To assist this process and to ensure uniformity of decisions in different health board areas, income guidelines have been adopted. These guidelines are based on gross income. If guidelines were based on net income without any expansion of eligibility, it would be necessary to reduce the guidelines. This would tend to favour persons with larger incomes.
If the current guidelines were applied on the basis of net income, a considerable expansion of eligibility would result. This would cost in the order of £15-£16 million. In any event, I find it difficult to understand the purpose of the Deputy's question since his party's manifesto proposes to cut health expenditure by no less than £68 million including the imposition of prescription changes on the very medical card holders the Deputy refers to in his question.
In addition, the resultant increase on the numbers covered by medical cards might make it necessary to re-negotiate the fees payable under the scheme and this would also add considerably to the extra cost involved. I do not therefore, consider that applicants for medical cards should be assessed on net take-home pay.
I want to assure the Minister that we are a party with a human approach to such matters. I suggest that the Minister read our policy document——
A question, Deputy, please.
In view of the appalling hardship existing in homes today, especially on those who are unemployed, would the Minister consider removing the gross income stipulation in the eligibility guidelines and allowing community welfare officers some discretionary powers in making assessments? I am not advocating additional costs on the health boards. What I am seeking are more discretionary powers for community welfare officers which can be done only by the removal of the gross income stipulation. Would the Minister accept that and give such powers to community welfare officers who are fully aware of the position obtaining in homes today?
In the case of individual applications where particular hardship arises, where people might exceed the gross income guidelines, a chief executive officer and a programme manager delegated by him have power to issue medical cards in such exceptional circumstances. However, we must retain the general guidelines which are uniform and which assist people's eligibility throughout the country. I might point out to the Deputy that his own party proposals in relation to medical card holders — that for every prescription issued they would have to pay 50 pence — would result in a cut of approximately £5 million in payments by medical card holders and another £4 million on drugs. I think the Deputy should go back to his party and tell them they cannot have it both ways.
Right-wingers cannot have it both ways.
I do not think that is an answer to my question — a Minister making certain statements without reading policy documents on matters such as health.
We cannot discuss policy documents here. There will be an adequate opportunity some time in a more suitable place for that sort of thing.
I am aware the Minister will have every opportunity of producing his own policy document when the time comes. I am asking the Minister — for heaven's sake let us leave politics out of this for the moment — would he agree to delete the words "gross income" from the appropriate guidelines and give more discretionary power to community welfare officers who are the most appropriate people to carry out such assessments?
I will make the point to the Deputy that he is much longer in the House than I have been. Since 1970 community welfare officers have not issued medical cards. They are issued by chief executive officers, by programme managers and delegated officers. CWOs have no such function, never had and are unlikely to have.
One more supplementary——
I must move on. We have moved very little in 15 minutes.
This is misleading because community welfare officers make the assessment and the Minister knows that.
The Minister did say that the chief executive officer was responsible for deciding the guidelines for medical cards. Will he say why an official of his Department wrote on his behalf to the health boards telling them they were to apply the guidelines rigidly?
They have been asked to make sure that people who are not eligible do not get medical cards. It is quite interesting that in some areas we can carry out a sudden review and on one such occasion in one county the number of persons eligible dropped from 65 per cent to 58 per cent, all within the guidelines.
Rigidly applied.
No, not rigidly — the same number of people in the country today have medical cards as did four years ago.