Deirdre Clune
Question:9 Ms Clune asked the Minister for Health and Children if he will provide a medical card to all persons over the age of 75 years. [2086/98]
Other Questions. - Medical Card Eligibility.
Richard Bruton
Question:40 Mr. R. Bruton asked the Minister for Health and Children the plans, if any, he has to extend medical card cover to new categories, in particular to all pensioners and children with a disability; and the timeframe within which he hopes to extend this cover. [2103/98]
I propose to take Questions Nos. 9 and 40 together.
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 66-79 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 as a general rule, 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 office 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.
I am glad to hear that the Minister is considering extending medical card eligibility to elderly people because they tend to use general practitioner services more frequently and a trip to a doctor and a prescription can cost between £30 and £40, an expense which would not have been anticipated by people when making plans for their retirement. It is something I would like to see. We have free travel for elderly people.
These expenses arise frequently and I would like to see the scheme extended. Many people over 65 years can afford travel expenses but there is a principle involved. What would be the cost to the Department of extending the scheme to all persons over 75 years?
In the Midland Health Board, the board with which I am most au fait, it is the practice whenever possible — I am sure the same procedure is followed by the directors of community care in other health boards — to give a medical card to elderly people who need medication and who may be just outside the income guidelines. This is done at the discretion of the chief executive officer. The scheme is means tested and if people are well outside the guidelines then obviously there is a problem. Bearing in mind the commitment in the programme, I have asked chief executive officers to look at the implications of this proposal and how the scheme can be improved.
I would be very slow to move away from the principle of a means test as the inclusion of people who can well afford to pay their medical expenses — these are a minority of the elderly population — would deprive others from receiving a medical card. However, we must address the issue from the point of view of the elderly and larger families for whom the loss of a medical card is a disincentive to re-entering the workforce. Obviously this impacts on tax policy as well as health policy. I have asked chief executive officers to look at the financial implications of this proposal and to ascertain how much can be done during the lifetime of this administration.
What age has the Minister in mind when he refers to the "elderly"? Is there a variation between health boards as regards the eligibility criteria for a medical card?
I support the points made by Deputy Clune. On free schemes and medical cards for the elderly, is the Minister aware that more money is spent in assessing and processing applications than is paid to recipients? The net cost of widening the definition of the "elderly" would be significantly different from the gross cost and I ask the Minister to give favourable and sympathetic consideration to giving all elderly people a medical card.
In reply to Deputy Belton, I am referring to people who are 66 years and over. As this area is governed by guidelines only and chief executive officers are given some discretion, some chief executive officers may be more appreciative of the need for a medical card in certain circumstances. This discretion should be left with chief executive officers. The chief executive officer of the Midland Health Board is well aware of the strong representations made by representatives of the Longford area on behalf of the elderly. Deputy Belton can be assured that he receives the best possible hearing.
There are strong representatives in the area.
I am well aware of that. In reply to Deputy Bradford, I agree that sometimes people who should not be reviewed are reviewed. This takes up administrative time and effort. I will raise the matter with chief executive officers to see how this can be minimised.