Vol. 503 No. 5
9 Proinsias De Rossa asked the Minister for Health and Children the plans, if any, he has to extend the number of chronic care patients, including asthmatics, onto the medical card; and if he will make a statement on the matter. [10467/99]
Entitlement to health services in Ireland is based primarily 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 have been drawn up by the chief executive officers to assist in the determination of a person's eligibility and these 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, a medical card may still be awarded if the chief executive officer considers that the medical needs or other circumstances would justify this. Medical cards may also be awarded to individual family members on this basis.
In common with previous Governments, this Administration does not feel it is justifiable on health policy grounds to extend an automatic entitlement to a medical card to any specific group without any reference to their means or, in the case of children, to their parents' means as a general rule. 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.
Those who do not hold medical cards are entitled to a broad range of health services, including an entitlement to public hospital and public consultant treatment, subject only to modest statutory charges and out-patient services free of charge. There are a number of schemes which provide assistance towards the cost of medication.
It is a pity that the Minister tends to go back in history. I am aware that this was not done by previous Governments. Does the Minister agree that we have reached a point where we should look more closely at the needs of people with chronic illnesses, such as arthritis, diabetes and asthma? Although there are difficulties regarding the definition of asthma, there is a problem where some people who suffer from chronic asthma do not qualify for a medical card.
Does the Minister agree there is a need to consider the general medical scheme in terms of investing more money to keep people out of hospital? I welcome the improvement in relation to people over the age of 70 because it recognises the fact that some people in society have greater needs and must be judged differently. For example, diabetes is recognised as a long-term illness and people are placed on a long-term illness book. Supports are already in place and, therefore, the principle does not have to be conceded.
I ask the Minister to consider whether it is possible to continue to extend the encompassing nature of the GMS or the long-term illness scheme. I would settle for that in certain circumstances. Such changes would mean that more people with chronic illnesses are included. I am sure the Minister is aware that some people are badly affected by the demands placed on them, such as the need to visit a doctor, and occasionally individuals end up in hospital unnecessarily as a result. It makes good sense financially and in terms of managing long waiting lists because if a person can get free hospital care, it does not matter if he or she is waiting three or four years to access it.
The Deputy is imparting more information than she is seeking.
I hoped it would be of benefit to the Minister.
That is not the purpose of Question Time.
I always learn eagerly from the Deputy.
I hope so.
This policy issue has confronted successive Ministers for Health and arguments have been put forward. We are all aware of cases where we consider that, although a person may be over the income guidelines, he or she should have a medical card, even for a short time such as three or six months. It behoves public representatives to challenge the public administration system, which in some instances hides behind guidelines as if they were axiomatic rules. Chief executive officers have discretion to take into account personal circumstances. However, it appears that some chief executive officers use that discretion with a greater sense of good judgment than others.
This discretion was put in place for a good reason. While the criterion of means is maintained on equity grounds as a prerequisite for eligibility, discretion is available to cover individual family circumstances. Taking all matters into account, it should be possible for discretion to be used positively. Health board members and public representatives should discuss this issue with administrators to a much greater extent. From an administrative point of view, it is much easier to use the guidelines as the rule in all circumstances. However, it is not a conscientious exercise of the guidelines as set out.
The Deputy also referred to the elderly. I was glad to be in a position to ensure that the eligibility limits will be doubled over this and the next two budgets. This move was justified and it was a good proposal. However, it did not negate the basic principles of the scheme. The decision was to double the eligibility limits rather than move towards automatic entitlement because questions of inequity could arise. Elderly people with means should not be automatically entitled to a medical card when there are many people who are under 65 and slightly over the limits who are not automatically entitled to a card.
One can make cases for specific groups and one would have sympathy with many of the arguments. However, more has been done in this area by this Administration than any other Government. This matter is ongoing and the arguments will be raised when I am in Opposition and there is a different Minister.
The Minister is in a position to change matters. How can it be decided that Alzheimer's disease is not a long-term illness and should not attract the benefits of the long-term illness scheme?
That matter is not relevant. The Deputy is widening the scope of the question.
It is a chronic condition and the scheme is a form of medical cover under the GMS. It was the subject of Deputy McManus's supplementary question but it was not addressed by the Minister. I have been in politics for almost 20 years and I cannot understand that position. It has been said that memory is an affliction in politics. However, I remember a health commission report published by the Department in 1984 which recommended that such changes should be made. It recognised that some treatments prevented the need for some people to be institutionalised and that they should be made available on the basis of the condition. I do not understand why, in common with his predecessors, the Minister and the Department are unwilling to take that on board. Alzheimer's disease is only one of many examples where drug treatment avoids the need for other forms of care and should be made available.
The Deputy's point of view has been argued unsuccessfully since 1984 with successive Governments. The Deputy said I have the opportunity to change the position. I have moved on one matter where I considered that a group of people was not being recognised or dealt with in the same way as everybody else. Once an improvement is made, it is somebody's job to suggest other possible improvements. These policy matters can be reviewed from time to time and I am prepared to consider whether it is possible, in the context of constantly changing priorities, to make adjustments.
