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Dáil Éireann debate -
Tuesday, 26 Nov 1996

Vol. 472 No. 1

Written Answers. - Social Welfare Benefits.

Cecilia Keaveney

Question:

129 Cecilia Keaveney asked the Minister for Health the help, if any, which can be given to families marginally outside the qualifying rate for medical cards to cover the cost of eye tests and the need for glasses; and if he will make a statement on the matter. [22463/96]

Máire Geoghegan-Quinn

Question:

139 Mrs. Geoghegan-Quinn asked the Minister for Health whether he will issue directions to the health boards in relation to revised guidelines for medical cards in the case of farmers throughout the country who have suffered severe loss of earnings due to BSE problems; and if he will make a statement on the matter. [22562/96]

Joe Walsh

Question:

158 Mr. J. Walsh asked the Minister for Health if he will grant medical cards without a means test to persons with disabilities who are in receipt of a permanent disability allowance; and if he will make a statement on the matter. [22812/96]

Limerick East): I propose taking Questions Nos. 129, 139 and 158 together.

Under the Health Act, 1970, determination of medical card eligibility is the responsibility of the chief executive officer of the appropriate health board. Medical cards are issued to persons who, in the opinion of the chief executive officer are unable, without undue hardship, to provide general practitioner services for themselves and their dependants. Income guidelines are drawn up by the chief executive officers to assist in the determination of a person's eligibility and these guidelines are revised annually in line with the Consumer Price Index. However, 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 considers that the person's medical needs or other circumstances would justify this. Assessment procedures are also a matter for the chief executive officers.
I have given the issues raised by the Deputies very careful consideration and I would of course be anxious that every person in genuine need of a medical card should receive one. It is, however, open to all persons, be they persons on modest or reduced incomes, or persons suffering from disablement, to apply to the chief executive officer of the appropriate health board for health services if they are unable to provide these services for themselves or their dependants without hardship. I am satisfied that health boards give sympathetic consideration to such applications when the circumstances warrant it.

Cecilia Keaveney

Question:

130 Cecilia Keaveney asked the Minister for Health the assistance, if any, which can be given to a family (details supplied) in County Donegal who have three children and one parent in need of eye tests and glasses but who are marginally outside the qualifying remit for the medical card; and if he will make a statement on the matter. [22464/96]

Limerick East): Under the Health Act, 1970, 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 provide general practitioner services for themselves and their dependants.

Income guidelines are drawn up by the chief executive officers to assist in the determination of a person's eligibility and these guidelines are revised annually in line with the Consumer Price Index. However, 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 considers that the person's medical needs or other circumstances would justify this. Medical cards may also be awarded to individual family members.

I have had inquiries made of the North Western Health Board concerning this case and have been assured that the application has been reviewed on hardship grounds. However, as the person's income was substantially over the standard income guidelines, the health board considered that the applicant would not be entitled to a medical card on hardship grounds. Should the circumstances of the applicant change a fresh application would, of course, be treated in a sympathetic manner by the health board.

The following services are provided free of charge by health boards: health examination service, including vision and hearing screening, for pre-school children and national school pupils; all necessary follow-up services for defects discovered at these examinations; dental, ophthalmic and aural treatment and appliances for defects discovered at these examinations.

Tony Gregory

Question:

131 Mr. Gregory asked the Minister for Health if he will review the decision by the Eastern Health Board to refuse a long-term illness card to a person (details supplied) in Dublin 3. [22471/96]

Limerick East): The long-term illness scheme entitles persons who suffer from certain illnesses to free drugs and medicines which are prescribed in respect of a particular illness. As the person in question is not suffering from one of the specified illnesses, she is not eligible for a long-term illness card. The long-term illness scheme has not been extended since 1975 and there are no plans to expand the number of illnesses covered by the scheme, having regard to the fact that the needs of individuals with significant or ongoing medical expenses are met by a range of other schemes which provide assistance towards the cost of prescribed drugs and medicines.

The drug cost subsidisation scheme caters for people who do not have a medical card or a long-term illness book and are not certified as having a medical condition with a regular and ongoing requirement for prescribed drugs and medicines. Persons who qualify for inclusion in this scheme will not have to spend more than £32 in any month on prescribed medication.

Under the drugs refund scheme which covers expenditure by the whole family, any expenditure on prescribed medication above £90 in a calendar quarter is refunded by the health board.

Where an individual or a family is subjected to a significant level of ongoing expenditure on medical expenses, such as general practitioner fees or prescribed drugs due to a long-term medical condition, these expenses may be reckoned in determining eligibility for a medical card. Eligibility for a medical card is solely a matter for the chief executive officer of the relevant health board to decide.

I am satisfied that appropriate and comprehensive support is being provided by the State through the existing range of schemes for people with long-term medical conditions.

Michael Ring

Question:

133 Mr. Ring asked the Minister for Health the reason home helps in County Mayo, who had their wages increased from £1 per hour to £2 per hour, have now had their weekly hours reduced, thereby failing to gain the full benefit of the wage increase and subsequently not providing an adequate level of care to the elderly in our community. [22509/96]

Limerick East): As the Deputy will be aware, section 61 of the Health Act, 1970, enables health boards to make arrangements to assist in the maintenance at home of persons who, but for the provision of such a service would require to be maintained otherwise than at home. This section empowers, without obliging, health boards to provide support services such as home help, laundry and meals.

The Western Health Board has recently carried out a comprehensive review of their home help services which included an assessment of the dependency levels of those in receipt of the service. A framework is now in place to identify low, medium and high dependency levels of clients to which specific hours are committed reflective of their need. Based on their dependency rating the home help client is to receive five, seven or nine hours home help per week. This is in line with the average in other health boards. In addition, this framework has enabled the board to increase the hourly rate of pay to £2 an hour, effective from 30 September 1996. This increase was made possible by the additional funding of £100,000 made available by my Department to the board earlier this year.

The revised framework was discussed with the board's public health nursing staff and a number of existing home help clients to establish their views on the proposals. Those canvassed have expressed unqualified support for the revised scheme.

I am satisfied that this revised scheme has allowed the board to standardise their home help services in line with other health boards and to provide a more equitable service to the elderly in their catchment area.

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