Vol. 501 No. 3
47 Mr. Shatter asked the Minister for Health and Children the arrangements, if any, he is making to extend medical card eligibility to all persons over 70 years of age; and the negotiations, if any, he will enter into with general practitioners to address all relevant outstanding issues concerning the implementation of this decision and, in particular, to ensure a continuity of medical care of the elderly who are not presently eligible for the medical card. [5785/99]
Subsequent to the announcement in the 1999 budget, which was in line with the commitment given in the Programme for Government to review medical card eligibility for the elderly, the chief executive officers of the health boards have decided to implement, from 1 March, changes in the income limits for people over 70 consistent with the budget statement.
At present, 80 per cent of persons aged 70 and over, that is, about 231,000 individuals, have medical cards and it is estimated that figure will rise by 30,000, to 90 per cent, at the end of the three year doubling of the existing income limits referred to in the budget.
Negotiations have taken place with the Irish Medical Organisation on this matter. In all, four meetings were held and all outstanding issues in relation to its implementation have been resolved. The principal aspects of the agreement reached with the IMO last Thursday relate to a recalibration of the general medical scheme capitation rate for the over 70s age band, the facility for persons who become eligible for a medical card to opt to remain with their existing private GP and a realignment of the indicative drugs target scheme to take account of the increased drugs costs associated with elderly persons. The issue of negotiations with the National Association of Independent General Practitioners on this or other matters does not arise since they do not hold a negotiating licence. In any event many of the NAIGP members are also members of the IMO.
On the issue of care for the elderly generally, the policy is, to the greatest extent possible, to maintain older people in dignity and independence at home with the support of community care services where necessary and where this is no longer possible, to ensure they have access to the best possible medical or long-term care. This has been the policy adopted by successive Governments since the publication, in 1988, of a report on the development of services for older people, entitled The Years Ahead. Medical care is delivered to a wide range of dependent older people by consultant geriatricians and their teams together with medical officers of community hospitals. This will remain in place.
Could the Minister clarify the arrangements that have been put in place to ensure that elderly people who up to 1 March did not qualify for a medical card and who were being treated by a doctor who was not on the GMS lists will be able to maintain continuity with their existing doctor?
We will come to an arrangement with the IMO in relation to that matter.
Could the Minister detail the nature of that arrangement?
Discussions are already ongoing with the IMO, the representative negotiating body, in relation to how people who are not currently in the general medical scheme can get the benefit of it. We are making some progress on the issue.
Regarding the points raised in relation to the over 70s, in the interest of making sure this was in place by 1 March we and the IMO had no objection, given the numbers involved, to allowing people to continue to be treated by their private general practitioner in those circumstances.
Will the private general practitioner receive the same payment for treating such patients as other general practitioners who are currently part of the general medical scheme? How will the system work in practice?
My understanding is that there will be no differentiation in that respect. I will obtain full clarification on the detail. The important point is that we have come to a resolution.
This point needs to be clarified. The press coverage of the resolution the Minister has come to with the Irish Medical Organisation did not include doctors outside the general medical scheme. It is my understanding that such doctors will not be able to continue to treat an elderly person if that person wants to avail of this new scheme, which is welcome and I compliment the Minister on introducing it. The only indication of any special arrangements were for retired GMOs.
The Deputy should ask a question.
This is an important point. The question is whether a doctor who is outside the general medical scheme – and most of these are younger doctors who have not been able to get into the scheme – and who is treating an elderly person who is for the first time qualifying under this scheme, can continue to treat that patient. My understanding from reading the press coverage is that that is not the case. I am delighted to hear that it may be, but the Minister should clarify whether that continuity of care will be there.
I should not have to tell Deputy McManus that she should not believe everything she reads in the press. The agreement with the Irish Medical Organisation on this issue responds to the situation of those doctors who are not general medical scheme contract holders who could lose some of their elderly private patients who benefit from the increased medical card income limits. One effect of the agreement will be to ensure that a person over 70 gaining a medical card will be able to stay on with his doctor provided the doctor has the relevant experience, which is likely to be the case. It is worth emphasising that the whole matter of general practitioner entry to the general medical scheme was already being examined in a broad sense by a working group set up last year. The terms of the agreement with the Irish Medical Organisation on entry to the scheme are in line with discussions in the working group, and the full details of the operational aspects of the agreement's provisions on entry will be teased out in the next month.
Is the Minister saying doctors who have been operating only in private practice are essentially part of the general medical scheme in the context of their retaining current patients over 70 years of age? Does that mean other patients who attain the age of 70 in the future can remain with their doctors, or that other patients who are currently with doctors who are part of the general medical scheme can transfer to doctors who are not when they attain the age of 70?
I also welcome this scheme, but I ask the Minister to clarify the reason the age of 70 was chosen and whether it is the Minister's intention to reduce that incrementally? In other words, might we see elderly persons over 65 or 66 being brought into this scheme next year? What are the Minister's proposals in this context? Does he envisage ultimately abolishing the means test in the context of the medical card?
No. The commitment in the budget statement is to double the income eligibility limits for all people over 70 within the next three years. There will be a 33.3 per cent increase each year to eventually achieve a doubling of the eligibility limit. There is no proposal to abolish income eligibility limits. That would involve changing the Health Act. I do not believe that is necessary in any event. We simply want to ensure that old age pensioners, particularly those who have small State pensions or other small pensions along with that, who up to now have been rendered ineligible for a medical card will now be eligible in the vast majority of such cases.
Not all 70 year olds will become immediately eligible. This will happen incrementally over three years.
Yes. There will be a 33.3 per cent increase in the income eligibility limit over three years.
