Dáil Éireann debate -
Wednesday, 28 Jan 1998

Vol. 486 No. 1

Written Answers. - Medical Card Eligibility.

Gay Mitchell

Question:

552 Mr. G. Mitchell asked the Minister for Health and Children the cost of extending medical card eligibility to all people aged over 66 regardless of income; and the plans, if any, the Government have to extend medical card eligibility for senior citizens particularly in relation to a person (details supplied) in Dublin 12. [1358/98]

Minister for Health and Children (Mr. Cowen):

I have had inquiries made of the Eastern Health Board concerning the person in Dublin 12 and understand the health board has no record of an application for a medical card from the person concerned.

Entitlement to health services in Ireland is primarily based on means. Under the Health Act, 1970 determination of eligibility for medical cards 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 to provide general practitioner medical and surgical services for themselves and their dependants without undue hardship. Income guidelines are drawn up by the chief executive officers to assist in the determination of a person's eligibility and are revised annually in line with the consumer price index. It should be noted that these guidelines are higher for persons aged 66 to 79 and higher again for those aged 80 and over. 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 on this basis.

In view of this special provision it is felt that it is not justifiable, on health policy grounds, to extend an automatic entitlement to a medical card to any specific group without any reference to their means particularly in view of the many areas of pressing need in the health services and the limited resources available to meet them. It is open to all persons 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.

Notwithstanding the arrangements referred to above the Government has identified as a key priority in its programme An Action Programme for the Millennium, a review of medical card eligibility for the elderly and large families and my Department has made the necessary arrangements to advance this review with the health boards.

It is estimated that the cost under the general medical services scheme of extending medical card eligibility to all persons aged 66 and over would be approximately £21 million. This figure takes into account potential savings to the general medical services scheme of current payments to such persons under the drug cost subsidisation scheme, the long-term illness scheme and the drugs refund scheme. However, the loss of income to hospitals from the statutory charge and costs such as those for community care services, which are difficult to quantify, would have to be added to the £21 million referred to above. The most recent set of population projections published by the Central Statistics Office in 1995 indicate that the number of persons aged 65 years and over will increase considerably in the future, reaching 495,000 by the year 2011. Furthermore, the extension of eligibility to special groups not covered would clearly increase the total percentage of the population with eligibility. Should the percentage of the population covered by medical cards reach 40 per cent the general medical service, as currently structured, is subject to review with the medical organisations. This would entail significant costs additional to those included in the above estimate. It is not possible to calculate what these costs would be in advance of such a review.