Gay Mitchell
Question:19 Mr. G. Mitchell asked the Minister for Health and Children if he will raise the income limits for medical card qualification. [12618/02]
Priority Questions. - Medical Cards.
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 these are revised annually in line with the consumer price index. However, the guidelines are not statutorily binding and even if a person's income exceeds the guidelines a medical card may be awarded if the chief executive officer considers that his or her medical needs or other circumstances 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 the carers' allowance, child benefit, domiciliary care allowance, family income supplement and foster care allowance are all disregarded when determining a person's eligibility. Given these factors and the discretionary powers of chief executive officers, having an income that exceeds the guidelines does not mean that a person will not be eligible for a medical card.
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 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 who are eligible for a medical card and to give priority to families with children and particularly children with a disability. The 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 series of initiatives has been introduced to clarify and expand the existing arrangements for eligibility for health services, including recommendations contained in the review of the medical card scheme carried out by the health board chief executive officers under the Programme for Prosperity and Fairness.
Additional informationThese initiatives include 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 pro-actively seeking out those who should have medical cards to ensure they have access to the services that are available. In addition, there are clear commitments to targeting vulnerable and disadvantaged groups. During 2002, the Government's priorities for improving the health system and providing greater equity include the provision of 709 additional acute public hospital beds and 200 beds contracted from the private sector, addressing waiting times through a new treatment purchase fund and maintaining investment levels in the general programme to reduce waiting lists, commencing implementation of the new model of primary care, services for people with a disability and services for older people.
Is the Minister aware that his reply is what the late Winston Churchill would have termed a "terminological inexactitude" but what most people would call a much shorter three-letter word? Will the Minister confirm that the reality is this: that for males aged 55 and over, the death rate among poor people is something like 32 per thousand whereas for middle-income people it is 22 per thousand and for the richest group it is about 11 per thousand? In other words, poorer people die younger. Will the Minister confirm that a poor person living alone on €138 per week does not qualify for a medical card? Will he also confirm that the number of people qualifying for medical cards has dropped from 37% during the term of the rainbow coalition to 29% now, even though the existing agreement with the Irish Medical Organisation allows for 40% of the population to be covered? Does the Minister agree that this apartheid, which he has deliberately extended into primary care, is one of the most outrageous pieces of misgovernment that we have seen for a very long time and that it is based on injustice and indifference to the plight of the poor?
I disagree with the latter part of the Deputy's questions. We know from research – indeed, the health strategy identifies this issue as an important one – that there is a greater degree of poor health among lower income groups. However, there are wider issues to be considered such as preventative health strategies, patterns of behaviour, diet, smoking, access to education and other facilities and so on. It is a much more complex story which has given rise to these research findings. These statistics are also world-wide phenomena. That is why my Department was one of the first to agree to the new national anti-poverty targets for health and health improvement for people in low income groups. That is included as a solid commitment within the health strategy and within broader Government policy. This is a more broadly effective way to deal with this fundamental issue.
Furthermore, at the moment about 1,218,250 people are in receipt of a medical card, which is about 31.47% of the population. The obvious reason why the percentage has dropped from 37% is that over 370,000 extra jobs have been created and unemployment has come down from 11% in 1997 to 4% this year. Clearly, that has had an impact on medical card entitlement because the system is based on income thresholds. However, as I have pointed out, where people are suffering from particular conditions, income is not the determining factor. There are thousands of discretionary medical cards within the system, issued by chief executive officers to people who are above the income cut-off point but suffer from certain medical conditions. We did make a commitment in 1997 to give specific, special treatment to older people within our community—
And children.
Yes, children are also included. We are doing this so that the quality of life of older people across all the services is improved. Part of this programme is the issuing of free medical cards to those over 70.
The Minister would not go into a restaurant with €138 in his pocket, yet he denies people medical cards.
People over 70 deserve medical cards.
This is the most shameful act the Government has perpetrated in its term of office. It is an outrage. The Minister should be before the courts.
On a point of order—
Sorry, there will be no points of order.
The Minister would not go into a restaurant with €138 in his pocket. It is most outrageous misgovernment.
We must move on to Question No. 20 in the name of Deputy McManus.
It is most outrageous misgovernment.
The Deputy's remark that I should be before the courts should be withdrawn.
It is an outrageous example of misgovernment.
The remark should be withdrawn.
A Leas-Cheann Comhairle—
A policy decision was taken to give medical cards to those over 70.
The Minister has abused his position time and again.
The remark should be withdrawn.
Will the Deputy withdraw the remark?
I will not stand for poor people being left in such a state.
I ask Deputy Mitchell to resume his seat. Will the Deputy withdraw the offensive remark?
No, as it was a reasonable parliamentary remark. The Minister has denied a medical card to poor people on €138.
That is not the question. I have asked the Deputy to withdraw the offensive remarks.
To what remark does the Chair refer?
The Deputy said I should be before the courts—
The Minister should be before the courts.
—because I gave free medical cards to over 70s.
No.
That is what the Deputy said.
No, I did not—
The phrase "before the courts" has all sorts of connotations.
The Minister is now telling lies. He is telling lies.
I am sorry, but the Deputy will have to withdraw—
That is not what the Minister said.
Deputies cannot use the word "lies".
It is what he normally says outside the House.
That is what the Deputy said.
The Minister is telling lies.
Deputy Mitchell—
That is what he said.
I said that the Minister should be before the courts for denying poor people a medical card.
Deputy Mitchell—
That is not what the Deputy said.
The record will show that the Minister was telling untruths in this House.
Deputy Mitchell—
The record will show the untruth.
It will not.
Deputy Mitchell will have to withdraw the word "lies".
I substitute the word "untruths" for the word "lies".
I cannot accept that. The Deputy will have to withdraw the remark.
The word "untruth" is an accepted parliamentary term.
The Deputy will have to withdraw the remark.
The Minister was not telling the truth. The Chair can adjourn the House to check the record, which will show that the Minister has not been telling the truth.
I ask the Deputy to resume his seat. The Chair will deal with the matter.