Billy Timmins
Question:10 Mr. Timmins asked the Minister for Health and Children the total number of persons and the percentage of the population covered by the medical card scheme for each year from January 2001 to end September 2003. [22467/03]
Other Questions. - Medical Cards.
Kathleen Lynch
Question:57 Ms Lynch asked the Minister for Health and Children the total number of persons holding medical cards at the latest date for which figures are available; the proportion of the population this represents; when it is intended to implement the commitment to extend eligibility for medical cards in order to bring in over 200,000 extra people; the steps he intends to take, pending this, to meet the primary care needs of those on lower incomes who do not qualify for medical cards at present; his plans to review the very low levels of income required for eligibility; and if he will make a statement on the matter. [22523/03]
I propose to take Questions Nos. 10 and 57 together.
Data from the GMS (Payments) Board indicate that 1,160,875 persons or 29.64% of the population were covered by the medical card scheme on 1 September 2003. The information for the previous years is included in tabular form which will be circulated in the Official Report.
|
Date |
Total medical card population |
% of population covered |
|
January 2001 |
1,148,055 |
30.32% |
|
January 2002 |
1,199,454 |
31.24% |
|
January 2003 |
1,168,745 |
29.84% |
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, 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 its lifetime.
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 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 the chief executive officers, having an income that exceeds the guidelines does not mean—
On a point of order, a Leas-Cheann Comhairle, would you consider it to be good order for the Minister to give part of the factual information that is sought in the question in the form of an oral answer and the rest of it in a tabular form, whereby it is not possible for Members to make any comparison between one and the other?
That is true.
I gave the total number. It indicates that 1,160,875 or 29.64%—
The Minister should give the percentages.
Will the Minister give the comparative percentages?
In January 2001, the total medical card population was 1,148,055, or 30.32% of the population. In January 2002 the figure was 1,199,454, which represents 31.24% and in January 2003 the figure was 1,168,745, which represents 29.84%.
I thank the Minister.
I have outlined the discretion given to the chief executive officer. Having an income, therefore, 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 whole 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 proactively seeking out those who should have medical cards to ensure they have access to the services that are available; providing clearer information to people about how and where to apply for medical cards; and streamlining applications and improving the standardisation of the medical card applications process to ensure better fairness and transparency.
The health strategy emphasises fairness and the 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. Shorter waiting times for public patients is prioritised, with the expansion of bed numbers and the introduction of the national treatment purchase fund.
In addition, there are clear commitments to targeting vulnerable and disadvantaged groups, including continued investment in services for people with disabilities and older people; initiatives to improve the health of Travellers, homeless people, drug misusers, asylum seekers-refugees and prisoners; and implementation of the NAPS targets relating to health.
Access to primary care services is of crucial concern in terms of the overall issue of access to services and equality. The health strategy sets out an implementation plan, which recognises the breadth of the change which will be required to support the rolling-out of the new primary care model over the next decade.
Additional information.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. Last year I approved the establishment of a number of initial implementation projects, which involves putting in place an integrated primary care team in ten locations around the country. A number of these have already become operational and are providing enhanced primary care services to their target populations. This is enabling us to see, in a real and practical way, how the new model operates 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 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 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, therefore, 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.
I thank the Minister for a very long answer but the bottom line is that there are many young families in dire straits because he has not increased the means test threshold for medical cards.
An Leas-Cheann Comhairle
The Deputy must be brief because we have to move on to the Adjournment Debate.
The situation is very simple. Technically, a person on social welfare is unable to get a medical card. It is shameful that the Minister has not increased the medical card threshold to a figure that is at least in line with inflation.
Will the Minister accept it is grossly unfair that people on low incomes cannot access medical cards and that the numbers of people proportionate to the population is decreasing percentage wise, even though the better off over-70s are now included? Will he not accept that extraordinary hardship is being caused to young families? Will the Minister deal with that issue?
I regret we are not in the position, because of the budgetary framework, to extend the medical card eligibility to cover another 200,000 people. I would like to be in a position to do that, but I have been given a certain envelope within which I have to operate in 2003, and there are other competing priorities where inequities have existed, historically.
It is the poor who are suffering.
An Leas-Cheann Comhairle
We must move on to the Adjournment Debate.
To give a classic illustration of what I am talking about, this morning I launched a radiotherapy report. It could be argued that in terms of equity and access to services, that is a key intervention in cancer care. Historically, we have not provided the requisite capacity to provide that service to a range of people, particularly those on low income. There are always competing priorities and I have to make decisions within the envelope I have received. I accept the point that this causes hardship for people, particularly those above the threshold, but I would point to the drugs payment scheme. Over 200,000 additional people have come on-stream in the DPS since we reformed it. We proactively brought people into that scheme. We have dramatically increased the investment.
An Leas-Cheann Comhairle
We must move on to the Adjournment Debate.
A Leas-Cheann Comhairle, will you allow the Minister reply to Question No. 11? He wants to reply to it and he has been waiting a long time.
An Leas-Cheann Comhairle
The Chair would like to accommodate the Deputy but, unfortunately, the Standing Order states that the House adjourns at 4.45 p.m., and we are now past that time.
We will have to refer to it again.
Written answers follow Adjournment Debate.