Dáil Éireann debate -
Thursday, 18 Nov 1999

Vol. 511 No. 2

Adjournment Debate (Resumed). - Drugs Refund Scheme.

Ms Shortall

I raise this issue in the hope that the Minister for Health and Children will seriously reconsider a decision he has made on the drugs refund scheme. I refer to the new arrangement whereby adult children between the ages of 23 and 25 years, who reside in the family home and who are still in full-time education are caught in a bind. On the one hand, the new drugs refund scheme, introduced by the Minster, only allows those who are 23 years of age or younger to be included on a family card so that 23 to 25 year olds are not classified as dependants for the purposes of the scheme. This is in keeping with the definition of a dependant set out in the Family Law Act, 1995, and the Family Law (Divorce) Act, 1996. On the other hand, as I am sure the Minister is aware, most persons in this age group are precluded from qualifying for a medical card except in very exceptional circumstances because up to the age of 25 years they are regarded as dependants and are, therefore, assessed on parental income.

For the few people who are affected by this change the discrepancy is ridiculous. The Department of Health and Children has adopted a system whereby people in this age group are classified as not being dependent while the health boards have adopted a procedure whereby they are classified as being dependent. This means they are disallowed from inclusion on the family card while not being entitled to a medical card either.

I ask the Minister to address this discrepancy in the drugs refund scheme by making exceptions for persons in full-time education up to the age of 25 years for the following reasons: Presumably the Minister was seeking consistency when he made the decision to base the scheme on the Family Law Act. However, he has introduced the inconsistency to which I have already referred. Clients of the health boards are entitled to some consistency between the old drugs payments scheme and the new one. That the State provides such a scheme is a recognition of the cost to families and individuals and to simply strike off a category of people without due consideration of its effect is unfair.

This problem affects very few people – only a few thousand, if that – who are mostly pursuing postgraduate courses. The expenditure implications are minute, considering the age profile of the group. However, such a change would make a considerable difference to a family with, say, a history of asthma or other long-term illness.

For any new scheme discrepancies will inevitably arise between existing and old schemes. However, as legislators it is our responsibility to address them as they become apparent and that is what I am attempting to do this evening. I hope the Minister will address this discrepancy as a matter of urgency and give a commitment to do so this evening.

Mr. Treacy

I take this Adjournment matter on behalf of my Government colleague, the Minister for Health and Children, Deputy Cowen. Everyone who is ordinarily resident in Ireland has either category one or category two eligibility for health services, depending on personal income. People with category one eligibility receive a medical card and can avail of services under the general medical services scheme. Entitlement to a medical card is means tested and depends on personal income and circumstances. A medical card normally covers the card holder, his or her spouse and any children under 16. It also covers people over 16, such as students, who are dependent on the medical card holder.

The decision on whether a person is regarded as a dependant is made by the relevant health board on the basis of personal circumstances. Similarly, in the case of an individual who lives in a family home and applies for a medical card in his or her own right, health boards take the individual's income and circumstances into account when deciding on the application. Ultimately, under the Health Act, 1977, granting of a medical card is entirely at the discretion of the chief executive officer of the health board or his or her dedicated staff.

People who are ordinarily resident in Ireland, but who do not qualify for a medical card automatically have category two eligibility and are entitled to services available to people in this category, including the new drug payment scheme. Under this scheme, individuals or families need only pay the first £42 in any month on approved drugs, medicines and medical and surgical appliances which were prescribed by a registered medical practitioner and were for the treatment of the person or his or her dependants. The balance of the cost is met by the State.

For the purposes of the scheme, dependants include spouse and children under 18 years. A dependant with a physical disability or a mental handicap or illness who cannot maintain himself or herself fully, who is ordinarily resident in the family home and who does not hold a current medical card, may be included in the family expenditure under this scheme regardless of age. Dependants over 18 years and under the age of 23 years who are in full-time education are also included. The upper age limit is in keeping with recent family law legislation – the Family Law Act, 1995, and the Family Law (Divorce) Act, 1996. A person over the age of 18 years, and who is not in full-time education, or a person who is over the age of 23 years and is in full-time education, can avail of the drug payment scheme in his or her own right or may be eligible for a medical card.

The general medical services scheme and the drug payment scheme are two separate schemes, one of which is means tested while the other is not. As I mentioned earlier, there is automatic entitlement to the drug payment scheme, while health boards take account of personal circumstances in making decisions on the provision of medical cards. I do not see any discrepancies between the operation of the two schemes, which as I say, are different in nature.

It is important to outline the advantages the new drug payment scheme has over previous community drugs schemes. The drug payment scheme is designed to significantly improve the cash flow situation for most families and individuals incurring ongoing expenditure on medicines. For example, under the old drug refund scheme, families and individuals paid the full cost of their prescription medicines and, at the end of the quarter, claimed reimbursement from their health board of expenditure over £90 in that calendar quarter. This caused considerable cash flow problems for a significant number of families and individuals with heavy ongoing expenditure on medication.

However, families and individuals will now be able to budget for the cost of medicines. In addition, there were families where, although one member qualified for a drug cost subsidisation scheme card, combined expenditure on medicines by other members, which could be considerable, could not be recouped until the end of the quarter. The new scheme will be of significant benefit to such families.

That the drug payment scheme operates on a monthly basis has distinct advantages over the drug refund scheme. Under the drug refund scheme, a family or an individual could, for example in one month have expenditure of, say, £80 but no expenditure in the other two months. They would not have been entitled to a refund. Under the new scheme, they will only have to pay £42 in that month. That is a major change.

The new drug payment scheme is for everyone. Unlike the drug cost subsidisation scheme, there are no qualifying criteria. All in all, the new drug payment scheme provides a better deal for most families. I hope this is to the satisfaction of both the Deputy and the House.