Dáil Éireann debate -
Wednesday, 13 May 1992

Vol. 419 No. 6

Written Answers. - Medical Services Entitlement.

Jim O'Keeffe

Question:

85 Mr. J. O'Keeffe asked the Minister for Health whether he accepts that a system of graduated entitlement to medical services would be a fairer system rather than as at present where a family is £1 over eligibility limit for a medical card no GMS services are provided at all; and if he will outline the proposals, if any, he has in this regard.

Madeleine Taylor-Quinn

Question:

105 Mrs. Taylor-Quinn asked the Minister for Health whether he favours a system of graduated support for the cost of primary care for persons whose means exceed the medical card guidelines.

Minister for Health (Dr. O'Connell)

I propose to take Questions Nos. 85 and 105 together.

The income guidelines which are used in the assessment process are not the sole determinant of whether a person receives a medical card. The legislation provides that full eligibility (i.e. the medical card) shall be given to any person who is, in the opinion of the Chief Executive Officer of the relevant health board, unable to afford necessary general practitioner services and prescribed drugs without undue hardship. A person who exceeds the income guidelines is still given a medical card if medical or other circumstances warrant it. Even where the medical card is not issued, the Chief Executive Officer has discretion to give the person full eligibility in respect of a specific service if the circumstances warrant it.

These provisions are intended to ensure that no person will be denied necessary services due to inability to pay, or suffer undue hardship in availing of them.

Non-medical card holders are, of course, entitled to public hospital services at modest cost and to the various schemes providing assistance towards the costs of prescribed drugs.

The number of eligibility categories was reduced from three to two as a result of the Health (Amendment) Act 1991. This followed the detailed analysis of the eligibility system by the Commission on Health funding and their recommendation of measures to simplify the system and make it more equitable. In particular, the Commission found that the were major problems and inequities inherent in allocating non-medical card holders to more than one eligibility category on income grounds. These problems were removed when the new eligibility system came into effect.

A graduated system of entitlement for non-medical card holders would presumably have to be based on income and would thus reintroduce these problems. In addition, it would make the system far more complex than at present and could greatly increase administrative costs because of the increased number of persons to be means-tested.