Dáil Éireann debate -
Tuesday, 28 Mar 2000

Vol. 516 No. 6

Written Answers. - Health Insurance.

John McGuinness

Question:

272 Mr. McGuinness asked the Minister for Health and Children the health cover available to people who cannot obtain private medical insurance; if he will make a statement on the case of a person (details supplied) who cannot obtain private cover due to the cost and is willing to con tribute to a medical insurance scheme of some kind; the way in which the person concerned can proceed; and the plans, if any, he has to amend policy in this regard. [9120/00]

Minister for Health and Children (Mr. Martin)

Entitlement to health services in Ireland is primarily based on residency and means, and there are two categories of eligibility. Persons in category 1 are medical card holders and they are entitled to a full range of public health services free of charge. Persons in category 2, non-medical card holders, have limited eligibility for health services, including an entitlement to public hospital and public consultant treatment subject only to modest statutory charges.

Persons in category 1, medical card holders, 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.

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 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 or her medical needs or other circumstances would justify this.

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 including consultants' services. The current public hospital statutory in-patient charge is £26 per night, up to a maximum of £260 in any twelve 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 or 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.

For those who do not qualify for a medical card there are a number of schemes which provide assistance towards the cost of medication. Under the long-term illness scheme persons suffering from a number of conditions can obtain without charge the drugs and medicines for the treatment of that condition. Under the drug payment scheme, a person and his/her dependants will not have to pay more than £42 in any calendar month for approved prescribed drugs, medicines and appliances.

Entitlement to health services is such that persons choose to avail of private health insurance cover in Ireland on a voluntary basis. The Health Insurance Act, 1994, and the 1996 Health Insurance Regulations provide for open enrolment which obliges insurers to make cover available to persons under the age of 65 regardless of whether or not they were previously covered. Cover is subject to underwriting provisions, normally associated with private health insurance contracts. Such provisions involve waiting periods for benefit payments both in respect of the period immediately after taking out cover and in respect of pre-existing medical conditions. The law also provides for lifetime cover which means that once a person is covered by a registered insurer, he or she cannot be deprived of cover except in limited exceptional circumstances.

The citing of the age of 65 years, under which insurers are obliged to provide first time cover in the State to persons requesting it, reflects the practice prevailing in the market prior to the introduction of the 1994 Act. It is a matter for registered insurers to decide whether or not to provide cover for a person of or over the age of 65 years who is seeking access to the community rated health insurance system for the first time. However, if an insurer decides to make such cover available, it must do so on the basis of community rating and lifetime cover.

The White Paper on Private Health Insurance, published in September 1999, addresses the question of enabling those aged 65 and over to avail of private health insurance based on lifetime community rating. Legislation to give effect to this entitlement is being drafted at present.