Dáil Éireann debate -
Tuesday, 11 Dec 2001

Vol. 546 No. 3

Written Answers. - Medical Cards.

Dick Spring

Question:

200 Mr. Spring asked the Minister for Health and Children the reasons he has decided not to extend medical card eligibility to 200,000 persons; and if his attention has been drawn to the hardship that this will cause to many families. [31517/01]

Bernard J. Durkan

Question:

236 Mr. Durkan asked the Minister for Health and Children his plans to review the extension to the medical card scheme; and if he will make a statement on the matter. [31788/01]

Minister for Health and Children (Mr. Martin)

I propose to take Questions Nos. 200 and 236 together.

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 other than for persons aged 70 years and over, who are automatically eligible for a medical card. 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 sta tutorily 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. It is open to all persons to apply to the chief executive officer of the appropriate health board if they are unable to provide health services for themselves or their dependants without hardship.

The issue of eligibility was considered in the context of the new national health strategy, Quality and Fairness, A Health System For You. The strategy outlines a number of measures designed to improve eligibility for health services which the Government has committed itself to introducing over a number of years. Among the measures proposed is an increase in access to medical cards. In addition to the recent extension of eligibility to all persons aged 70 years and over, the strategy includes a commitment that significant improvements will be made in the income guidelines in order to increase the number of persons on low incomes who are eligible for a medical card and to give priority to families with children and particularly children with a disability.

The strategy sets out a blueprint for ambitious and wide ranging change across the whole health system over the next seven to ten years and is underlined by a set of comprehensive targets. In setting out such a comprehensive and large-scale plan, it is inevitable that prioritising of actions must take place. The strategy represents a clear plan for moving forward which is based on a step-by-step approach to reducing inequalities in the system and building the necessary capacity to meet the growing needs of the population. This Government has now set out a comprehensive programme for delivering high-class and accessible health care for all.

Equity in health care is about a full range of services and supports and goes well beyond the issue of income guidelines for medical cards. It is a core principle on which the strategy is based and one which this Government is committed to addressing in the implementation of the strategy and through service developments across the board. The overriding necessity in relation to equity is the need for access to services.

Services have to be built up, waiting lists reduced, activity increased and specific groups such as children and those with disabilities require targeted service developments if equity is to be served in a meaningful way. A broad strategic focus is essential to deal with these sort of problems and no single narrow approach will address the real need for better more equitable health care services for all. I have already stated that in 2002, the Government's priorities for improving the health system will be: 650 additional acute hospital beds; addressing waiting lists through a new treatment purchase fund; commencing implementation of the new model of primary care; services for people with a disability; and services for older people.