Dáil Éireann debate -
Tuesday, 12 Mar 1991

Vol. 406 No. 3

Ceisteanna—Questions. Oral Answers. - Medical Card Eligibility.

Joe Sherlock

Question:

15 Mr. Sherlock asked the Minister for Health if he will outline in respect of the years 1989 and 1990, the number of people who have full eligibility for medical cards in (a) the country generally and (b) the Southern Health Board area; the percentage of the population this represents in each case; if he will consider changing the method of assessing people for eligibility for medical cards from gross income to net income in view of the fact that many people on relatively low net incomes are still excluded; and if he will make a statement on the matter.

Dr. O'Hanlon

The statistical information sought by the Deputy is set out in the tabular statement which I am circulating in the Official Report.

Under the 1970 Health Act, medical cards are issued to persons who, in the opinion of the chief executive officer of the appropriate health board, are unable without undue hardship to arrange general practitioner medical and surgical services for themselves and their dependants. While annual income is of obvious relevance, other factors such as family size, capital available and so on must also be taken into account. Income guidelines are available to assist chief executive officers in the determination of a person's eligibility but these guidelines are not statutorily binding and, even though a person's income exceeds the guidelines, that person may still be awarded a medical card if the chief executive officer feels that this is necessary in the light of the individual's circumstances.

In view of the discretionary powers of the chief executive officers to issue medical cards, I am satisfied that no one is denied essential health services due to inability to pay.

I have already announced that a statutory medical card appeals system is being introduced. When this system is in place any person who feels aggrieved in relation to a decision not to grant a medical card can have the problem addressed under the appeals procedures. Regulations are also being made to provide that a person who would otherwise be eligible for a medical card cannot lose this entitlement solely as a result of availing of the family income supplement and the social employment scheme.

No. of persons covered by medical cards.

	1989	1990
	Persons covered	% Population	Persons covered	% Population
National	1,256,818	35.76	1,221,284	34.86
Southern Health Board	180,112	33.55	172,629	32.15

Mr. Sherlock

Why could the Minister not take the trouble in replying to the question to give the number of people who have full eligibility for health services given that such figures are being given out at different centres? I contend the figure is now below 35 per cent of the national average, whereas in 1987 it was 37.8 per cent? In my health board area it was 37.27 per cent in 1987 and is now down to about 33 per cent. Why is the Minister not giving this information in reply to my question? Will he consider having eligibility assessed on the basis of net income? Under the present system based on the gross income many of the people whose income is under the limit are not qualifying.

Dr. O'Hanlon

I intend to circulate the figures with the Official Report. The number of persons covered at present is 1,221,284 nationally. That is 34.86 per cent of the population. The number of persons in the Southern Health Board area is 172,629 which is 32.15 per cent.

Mr. Allen

A big reduction.

Dr. O'Hanlon

I am giving the percentage for the Southern Health Board.

Mr. Allen

What about last year?

An Ceann Comhairle

Time is fast running out for dealing with Priority Questions. Please utilise it as effectively as possible.

Mr. J. O'Keeffe

People are being denied medical cards because of policy.

Dr. O'Hanlon

There is a wide variation from one part of the country to another. In Dublin 22 per cent of the population have medical cards, while the figure in Donegal is 62 per cent. That is understandable, having regard to the income of people in various counties. Regarding Deputy O'Keeffe's point, an independent medical card appeals system will shortly be in place which will allow an aggrieved person to have a case examined. A medical card will be allocated if that person is entitled to it. There has been a reduction in the percentage covered by medical cards between 1988 and 1989.

Proinsias De Rossa

On a point of order, I draw the Chair's attention to the fact that the time for Priority Questions has expired.

An Ceann Comhairle

I have to agree with the Deputy. The Chair in these circumstances does his best. I seek at times to give a little latitude but I am blamed for that, as I am being blamed now if I exceed even a second of the time available to us. I did my best to ensure that the five questions would be dealt with within the prescribed time. I have failed once again.

Mr. Ferris

I realise you made every effort to ensure these questions would be taken. I would lodge a formal protest regarding the Minister, who ensures that as few questions as possible are taken. This will have to be raised elsewhere.