Dáil Éireann debate -
Wednesday, 24 Apr 2002

Vol. 552 No. 4

Written Answers. - Medical Cards.

Jim O'Keeffe

Question:

63 Mr. J. O'Keeffe asked the Minister for Health and Children his views on the fact that the income limits for medical cards are far too restrictive and that as a consequence many in need of medical treatment are unable to afford or obtain same. [12524/02]

Minister for Health and Children (Mr. Martin)

Entitlement to health services 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 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 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 carer's 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. This 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 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. These 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 proactively 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 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.