Vol. 510 No. 6
215 Mr. Kirk asked the Minister for Health and Children the plans, if any, he has to a variation on the medical card scheme to take account of the needs of those who are just marginally above the income threshold for eligibility with an end of year review of their income or medical outgoings; and if he will make a statement on the matter. [23166/99]
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 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 the 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 his-her medical needs or other circumstances would justify this.
The number of eligibility categories for entitlement to health services was reduced from three to two as a result of the Health (Amendment) Act, 1991. This followed the detailed analysis of the eligibility system by the 1989 Commission on Health Funding and its recommendation of measures to simplify the system and make it more equitable. In particular, the commission found that there were major problems and inequities inherent in allocating non-medical card holders to more than one eligibility category on income grounds. These problems were removed when the new eligibility system came into effect. A tiered means system of entitlement for non-medical card holders would presumably have to be based on income and would thus reintroduce these problems.
