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Dáil Éireann debate -
Wednesday, 23 Feb 2000

Vol. 515 No. 1

Written Answers. - Medical Cards.

Alan Shatter

Question:

156 Mr. Shatter asked the Minister for Health and Children the consideration, if any, given to the provision of a graduated eligibility test for medical cards. [5373/00]

Entitlement to health services in Ireland has been primarily based on means rather than payment of income tax or PRSI. Since 1991 any person, regardless of nationality, who is accepted by the health boards as being ordinarily resident in Ireland is entitled to either full eligibility – category 1, that is medical card holders or limited eligibility – category 2 – for health services. Health boards normally regard a person as ordinarily resident in Ireland if he-she satisfies the health board that it is his-her intention to remain here for a minimum period of one year.

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 their 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 graduated system of entitlement for medical cards would presumably have to be based on income and would thus reintroduce these problems.

Under current eligibility criteria persons in category 1 are medical card holders and are entitled to a full range of services including general practitioner services, prescribed drugs and medicines, all in-patient public hospital services in public wards including consultants services, all out-patient public hospital services including consultants services, dental, ophthalmic and aural services and appliances and a maternity and infant care service.

Persons in category 2, non-medical card holders, are entitled, subject to certain charges, to all in-patient public hospital services in public wards including consultants services and out-patient public hospital services. The current public hospital statutory in-patient charge is £26 per night, up to a maximum of £260 in any 12 consecutive months. Attendance at accident and emergency departments is subject to a charge of £25 where the patient does not have a referral note from his-her doctor. This charge applies only to the first visit in any episode of care. A maternity and infant care service is provided during pregnancy and up to six weeks after birth. Hospital in-patient and out-patient services are provided free of charge to certain people including medical card holders and their dependants, woman receiving services in respect of motherhood, children up to the age of six weeks, all children aged under 16 who are suffering from a number of specified illnesses including mental handicap, phenylketonuria, and cystic fibrosis. Children referred for treatment from child health clinics and school health examinations, as well as people receiving services in respect of prescribed infectious diseases are also exempt from these charges.
Income guidelines are drawn up 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. Medical cards may also be issued to individual family members on this basis.
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