Written Answers. - Medical Cards.
Seymour Crawford
Question:
109
Mr. Crawford
asked the
Minister for Health and Children
when he will increase the means test for medical cards in order that at least low income families with children can have access to doctors and medical treatment; his views on whether, with proper primary care, many patients especially children could avoid having to occupy hospital space and in turn be much more cost effective; and if he will make a statement on the matter.
[17356/03]
As the Deputy is aware, the health strategy includes a commitment that significant improvements will be made in the medical card income guidelines in order to increase the number of persons on low income who are eligible for a medical card and to give priority to families with children and particularly children with a disability. This 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. Due to the prevailing budgetary situation I regret that it is not possible to meet this commitment this year but the Government remains committed to the introduction of the necessary changes within the lifetime of this Government.
It should be remembered that health board chief executive officers have discretion in relation to the issuing of medical cards and also that a range of income sources are excluded by the health boards when assessing medical card eligibility. Many allowances, such as 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 the chief executive officers, having an income that exceeds the guidelines does not mean that a person will not be eligible for a medical card, and a medical card may still be awarded if the chief executive officer considers that a person's medical needs or other circumstances would justify this.
Non-medical card holders, and people with conditions not covered under the long-term illness scheme, can avail of the drugs payment scheme. Under this scheme no individual or family unit pays more than €70 per calendar month towards the cost of approved prescribed medicines.
The health strategy includes a series of initiatives to clarify and expand the existing arrangements for eligibility for health services, including recommendations arising from the review of the medical card scheme carried out by the health board chief executive officers under the PPF which include 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.
Access to primary care services is of crucial concern to the Government as is evidenced by the publication of a separate strategy document, Primary Care: A New Direction. Primary care is the first port of call for the majority of people who use health services. It can meet 90% to 95% of all health and personal social service needs. It is a vital public service. People want community-based, well-integrated, round-the-clock services that are easy to reach. They want themselves, their family members and their communities put right at the centre of care delivery.
The primary care strategy sets out a vision of the service we want to put in place building on our existing strengths, to develop a high quality, user-friendly primary care service to meet people's needs into the future.
Change will not be effected overnight. The strategy sets out an implementation plan, which recognises the breadth of the change, which will be required in order to support the rolling-out of the new primary care model over the next decade.
As the new model is developed, a wider primary care network of other primary care professionals will also provide services for the population served by each primary care team. The provision of a wide range of services in this way will allow a higher percentage of patients to be cared for in the community, thus reducing hospital admissions. Furthermore, as the strategy is implemented on a national basis many services will be provided on an extended-hours basis and out-of-hours cover for defined services will be greatly enhanced.
Last year I approved the establishment of a number of initial implementation projects which will involve putting in place an integrated primary care team in ten locations around the country. This will enable us to see in a real and practical way how the new model will operate in practice, the benefits which we hope will flow from this new way of working and to explore some of the implementation issues in a practical way.
This is, of course, only one of the first steps along the way. The implementation period recognises that there are major structural changes, which must occur in order for the new primary care model to be implemented. It is also necessary to ensure that the required numbers of health professionals are trained and retained in the system over the coming decade and beyond to meet anticipated needs.
One of the principal objectives of the plans for the modernisation of our health service structures which I have recently announced is that the system should be structured to enable the health strategy, including the primary care strategy, to be delivered. As part of the reform plans, there fore, the system for the planning and delivery of primary care services, at national, regional and local level, will be reorganised in line with the vision contained in the primary care strategy.
Primary care, planned and organised on this basis, will lessen the current reliance on specialist services and the hospital system particularly accident and emergency and out-patient services. Based on available evidence, it will have the potential to reduce the requirement for specialist services, reduce hospitalisation rates, reduce lengths of stay for those who are hospitalised, promote more rational prescribing, and improve efficiency.
Question No. 110 answered with Question No. 89.
