Vol. 549 No. 1
29 Mr. G. Mitchell asked the Minister for Health and Children the reason the rise in medical card eligibility limits for 2002 was so low that several categories of people on social welfare who qualified in 2001 no longer qualified. [5976/02]
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 entitled to 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 by the chief executive officers to assist in the determination of a person's eligibility and revised annually in line with the consumer price index. However, they 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. It is open to all persons to apply to the chief executive officer of the appropriate health board for health services if they are unable to provide these services for themselves or their dependants without hardship. The Deputy is no doubt aware that a range of income sources are excluded by the health boards when assessing medical card eligibility. Many allowances, such as carer's allowance, child benefit, domiciliary care allowance, family income supplement and foster care allowance are all disregarded when determining a person's eligibility.
The issue of eligibility was considered in the context of the new national health strategy launched by the Government late last year. The strategy outlines a number of measures designed to improve eligibility for health services, to 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 last year's 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 eligible for a medical card and give priority to families with children, particularly children with a disability.
My Department advised the health board chief executive officers in writing last year and again this year that medical card holders should not lose their cards because of increases in social welfare rates announced in the budget. In addition, the health boards have been asked that every effort be made to ensure both medical card holders and applicants are made fully aware that increases in social welfare payments will not disadvantage them when applying to hold or retain a medical card.
In addition, there are clear commitments to targeting vulnerable and disadvantaged groups. During 2002 the Government's priorities for improving the health system will include: 709 additional acute public hospital beds and 200 beds contracted from the private sector; addressing waiting times 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.
Additional InformationThe Government's commitment to extending medical card coverage should be viewed in the broader context of the strategy's emphasis on fairness and its stated objective of reducing health inequalities in our society. A whole series of initiatives are outlined to clarify and expand the existing arrangements for eligibility for health services, including many of the recommendations drawn directly from the review of the medical card scheme carried out by the health board chief executive officers under the Programme for Prosperity and Fairness, such as: streamlining applications and improving the standardisation of the medical card applications process to ensure better fairness and transparency; providing clearer information about how and where to apply for medical cards; and proactively seeking out those who should have medical cards to ensure they have access to the services available.
Will the Minister confirm to the House that, far from the chief executive officers of health boards being in any way responsible for this mess, the limits for medical card eligibility are set by him? Does he agree that the payments to certain categories of recipients exceed the medical card income limit? For example, the income for a pensioner now is €137.30, but the medical card income limit is €144. In the case of widows and widowers in receipt of a contributory pension, the payment now is €144.80, which is over the medical card income limit. This applies in a whole category of cases. Will the Minister tell the House how and why the percentage of the population covered by medical cards under agreement between the Department and the Irish Medical Organisation has dropped from about 38% to 29% since the rainbow Government was in office? How does he justify extending apartheid deliberately and wilfully to the primary care area by giving a medical card to retired bank managers, who have more money than many Members of this House, while excluding those on incomes of less than €130, some of whom live alone? The reason is that the people concerned do not vote while wealthy retired bank managers do. It is a disgraceful abuse of power. I accuse the Minister of activities which really should be inquired into by a criminal tribunal. It is outrageous.
This is Question Time, not an opportunity to make accusations.
In the first instance, the Deputy is mistaken. In introducing the budget, when the Government decided to give very generous increases to old age pensioners, which it has done over the past five years and again in the budget, we made a premeditated decision at the Cabinet table that welfare recipients were not to lose their medical cards as a result of any increase in social welfare payments. I communicated this to the health board chief executives in January and again in February. As the guidelines apply, therefore, any increases in social welfare payments, particularly pensions and so on, will not result in the loss of medical cards. That is the factual position as far as the Government is concerned. It is something of which we were cognisant at the time of the granting of increases at budget time.
Tell the truth and leave the statistics alone.
There are 31% of people now with medical cards, of whom about 27% are over and about 72% are under the age of 70 years. I am somewhat bemused by the Deputy's proposition because his own party proposes to extend the medical card to everybody over the age of 65 years.
And to everybody up to the age of 18 years—
The Deputy wants a criminal investigation into my decision to give everyone over 70 years a medical card, but he himself is pursuing a policy of giving one to everyone over 65 years. It is absolute hypocrisy.
Is the Minister aware that, in a comprehensive proposal to reform the medical card system, I have proposed that medical cards be given to the lowest paid 40% of the population, that a free GP service be given to the lowest paid 60% of the population, that a free GP service be given to children up to the age of 18 years and beyond if in full-time education, and to everybody from the age of 65 years and over? That is the truth. He is misleading the House in suggesting anything else, as he usually does, speaking out of both sides of his mouth at once. Will the Minister tell the House why he gave wealthy retired people, who are on better money than Members or this House, a medical card when people earning less than €130 a week and living alone were left without it? Is the Minister aware that ESRI research shows that among males aged 55 and older, the death rate for those on lowest incomes is 32 per thousand and among wealthy people it is 11 per thousand? The Minister's activities should be inquired into by a tribunal.
The time allocated for this question has now expired and we must continue to Question No. 30.
The Government is absolutely satisfied with the decision to give older people, particularly those over 70, access to a medical card because older people need access to their GP more than any other age category of the population.
It would not have happened in apartheid ridden South Africa.
I stand over the Government's commitment to older people in respect of medical cards. The vast majority of older people are on very average incomes. For most of them, their incomes are halved when they retire.
It would not have happened in South Africa under apartheid.
The Deputy knows that people's incomes are halved when they retire.
What about those living alone on €130 a week?
Older people also have to go to their GP more often.
What about those living alone on €130 a week?
I find it difficult to comprehend how Deputy Mitchell can attack the over 70s getting a medical card yet turn around and say over 65s should get one.
The Minister must be allowed to speak without interruption.
To be fair to the Deputy I know the priorities in the Fine Gael policy document but I also note that the Fine Gael spokesman on finance said that public expenditure must be slashed. How is the Deputy going to meet all the objectives if the finance spokesman—
Does the Minister know what his own party leader said in the manifesto for the last general election about medical card provision for those on low incomes? This is shameful.
