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Dáil Éireann debate -
Tuesday, 11 Feb 2003

Vol. 561 No. 1

Written Answers. - Health Board Services.

Bernard J. Durkan

Question:

102 Mr. Durkan asked the Minister for Health and Children if he is satisfied that the general public have adequate and unimpeded access to the health services; if he proposes to address the issue; and if he will make a statement on the matter. [3455/03]

Entitlement to health services in Ireland is primarily based on residency and means rather than income. Any person, regardless of nationality, who is accepted by the health boards as being ordinarily resident in Ireland is entitled to either full eligibility, category 1, or limited eligibility, category 2, for health services.

Persons in category 1 are medical card holders and they 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 consultant services, all out-patient public hospital services including consultant services, dental, ophthalmic, aural services, appliances and a maternity and infant care service.

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 consultant services and outpatient public hospital services including consultant services. The current public hospital statutory inpatient charge is €40 per night, up to a maximum of €400 in any 12 consecutive month period. Attendance at accident and emergency departments is subject to a charge of €40 where the patient does not have a referral note from his-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.

In July 2001 the medical card was extended to everybody over the age of 70. The extension of medical cards to the over 70s is wholly consistent with Government policy aimed at improving the position of the elderly. I should also mention that 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 do not have to pay more than €70 in any calendar month for approved prescribed drugs, medicines and appliances.
Under the Health Act 1970, the determination of eligibility for health services is the responsibility of the chief executive officer of the appropriate health board and neither I nor my Department have a function in the matter. I would like to add that health boards have discretion, in cases of exceptional need, to provide assistance to individuals where undue hardship would otherwise be caused. The Deputy may wish to note that the existing arrangements for eligibility for health services will be simplified, clarified and expanded.
Recommendations from the review of the medical card scheme carried out by the health board chief executive officers under the Programme for Prosperity and Fairness are being implemented including streamlining applications and improving the standardisation of the medical card applications process to ensure better fairness and transparency; providing clearer information to people 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 2001, I launched the national health strategy which is a comprehensive strategic plan for the health system for this decade. One of the key concerns of the health strategy is to promote fair access to services, based on objectively assessed need. In line with this objective my Department is drawing up legislative proposals to provide a clear statutory framework in relation to eligibility for health and personal social services.
The strategy recognises that both public and private patients have an entitlement to access needed care within a reasonable period of time. The challenge is to ensure that a fair balance is achieved and that those who depend on the public system are not disadvantaged. Significant measures are being taken to improve equity of access for those in need of health care. Funding of €43.8 million has been made available for the waiting list initiative over the last three years and again for 2003. The number of adults waiting more than 12 months for admission to hospital as in-patients fell by 15% between June 2002 and September 2002. The number of children waiting more than six months for admission to hospital as in-patients fell by 24% between June 2002 and September 2002. Clearly the prioritisation of those waiting longest is beginning to yield results.
The national treatment purchase fund was established in April 2002 with an allocation of €10 million for acute hospital treatment and €5 million for orthodontic treatment. The fund is used to purchase treatment for public patients from private hospitals in Ireland or from international providers where it is not possible to provide treatment within a reasonable period in Ireland. More than 1,900 patients were treated in 2002. In 2003, the throughput has been estimated at 7,200.
A total of 968,000 – provisional figures – patients were treated last year as either in-patients or day patients in acute hospitals. This is an increase of 5% over the 2001 figure. The Deputy may wish to note that since 1997 the number of patients treated in our acute hospitals has increased by approximately 23%. An additional €65 million was provided in 2002 to begin the first phase in the provision of 3,000 additional acute beds by 2011 and 520 beds were funded to the end of 2002, that is 70 in excess of the strategy target of 450.
We are all aware that poverty can make it more difficult to access or afford appropriate health care and tackling health inequalities is inextricably linked with tackling poverty issues. One of the objectives of the strategy is to reduce health inequalities and work is progressing in this regard. The homelessness preventative strategy was launched in 2002 and implementation of that strategy along with Homelessness – An Integrated Strategy 2000 and the Youth Homelessness Strategy 2001 is ongoing. Enhanced services for asylum seekers and prisoners were also provided in 2002. Funding of €1.9 million was allocated for the implementation of the Travellers health strategy and implementation of the national drugs strategy 2001-08 is ongoing. In devising the actions to tackle health inequalities for the health strategy, the Department worked closely with the group working to review the targets for health for the national anti-poverty strategy.
I remind the Deputy that an additional allocation of €694 million has been made available for the health service in 2003 bringing the total spend for this year to €8.9 billion. This represents 74% of the net total increase in public expenditure in the Estimates and demonstrates the Government's determination to continue to prioritise health.
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