Dáil Éireann debate -
Thursday, 11 Dec 2003

Vol. 577 No. 1

Medical Cards.

Mr. Neville

I welcome the opportunity to raise this issue. I appeal to the Government to keep its promise made in the health strategy and An Agreed Programme for Government to extend the medical card to an additional 200,000 people living in poverty, with an emphasis on families with children.

Recent statements by the Minister for Health and Children suggest that the Government intends to break this promise for the third year in a row. This disregard for the health care rights for children living below the poverty line is unacceptable.

We need to extend medical card coverage to more children because it will improve their health. Too often the decision to see the doctor or to obtain prescribed treatment is made on the basis of financial considerations. Removing the issue of affordability will eliminate a major obstacle to equal access to health care for children.

More than two years ago, in a major report on the health of Ireland's children, the chief medical officer called for the introduction of universal medical card coverage for children, stressing the importance of socio-economic conditions in determining the health status of children. His report stated:

The weight of evidence supports the view that children's health can be traced to social, economic and environmental conditions. Poverty is the most powerful aspect of the social context associated with ill health in children.

Despite the chief medical officer's recommendations and the commitments made in the health strategy and An Agreed Programme for Government, nothing has been done to extend the medical card to additional children. As a result, families on very low incomes find themselves having to allocate up to a third or more of their weekly income to cover the cost of a visit to the general practitioner if a child becomes sick.

The UN Convention on the Rights of the Child, to which Ireland has been a party since 1992, says that all children have a right "to the highest attainable standard of health." The convention also says that children have the right of access to health services and Governments have the duty to ensure that no child is deprived of this right. The budget did not support measures such as the extension of the medical card that reflect an understanding of our obligations under the convention.

In its pre-budget submission this year, the Children's Rights Alliance called on the Minister to begin to extend the medical card to all children by rolling it out, on a phased basis, starting with children under the age of five.

The Government must also fund the commitments for children contained in the Framework Document accompanying the national anti-poverty strategy and commitments contained in the health strategy, including an integrated national programme for child health care, protocols and standards for the care of children in hospitals, and expanded mental health services for children and adolescents, including the implementation of the recommendations of the first report of the review group on child and adolescent psychiatric services.

The Minister should respond to this submission I received from the Children's Rights Alliance, which has done tremendous work in developing proposals to ensure children are taken care of.

Mr. B. Lenihan

I thank the Deputy for raising this matter on the Adjournment. While I have considerable sympathy with the point of view he expressed, the decision of the previous Government to provide universal cover for those aged over 70 is one that is made and that nobody in the House ever denounced. However, there is considerable merit in the point of view articulated by the Deputy that to invest in the health of children at the youngest age would be a good investment for the community generally. As the Deputy is aware, the decision to allocate funds in the area of health depends on priorities, which need to be determined.

I give this reply on behalf of the Minister for Health and Children, Deputy Martin. Under the Health Act 1970 determination of eligibility for medical cards is a matter for 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. The medical card scheme therefore primarily covers those in the lower income groups, and that obviously includes children falling within these groups.

I do not accept the contention of the Deputy that children in poverty in Ireland do not receive medical cards as our legislation provides for the determination in such cases, thus allowing them to obtain a medical card. However, as I have said, I have considerable sympathy with the wider issue raised by the Deputy.

Income guidelines are drawn up 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 determined by statute 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 or her medical needs or other circumstances would justify this. Medical cards may also be awarded to individual family members on this basis. 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.

As the Deputy is aware, the health strategy includes a commitment that significant improvements will be made in the medical card income guidelines to increase the number of persons on low income who are eligible for a medical card and to give priority to families with children, especially 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 position, the Minister regrets 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 the Government.

When assessing medical card eligibility the health boards exclude a range of income sources. 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.

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, 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 health services eligibility. The initiatives adopt recommendations suggested by the review of the medical card scheme which was carried out by health board chief executive officers under the Programme for Prosperity and Fairness. The review recommended streamlining applications and improving the standardisation of the medical card applications process to ensure a greater degree of fairness and transparency. It also recommended the provision of clearer information to people about how and where to apply for medical cards. Boards should proactively seek out persons who should have medical cards to ensure they have access to services.

The health strategy emphasises fairness. Its objective is to reduce health inequalities in our society. Shorter waiting times for public patients are prioritised along with the expansion of bed numbers and the introduction of a treatment purchase fund. Since the commencement of the national treatment purchase fund in July 2002, 8,922 people have been treated. Of these, 1,436 were children. In addition, there are clear commitments in the strategy to targeting vulnerable and disadvantaged groups. There will be continued investment in services for older people and people with disabilities, and initiatives to improve the health of Travellers, homeless people, drug misusers, asylum seekers, refugees and prisoners. The national anti-poverty strategy health targets will be implemented.

The targets to reduce health inequalities discussed in the Government's review of the national anti-poverty strategy were developed in the course of an extensive consultation process. They have been integrated into the national health strategy. Key health targets of the strategy are to reduce the gap in premature mortality and low birth weight between the highest and lowest socio-economic groups by 10% by 2007. It is also aimed to reduce differences in life expectancy between Travellers and the rest of the population.

Policy measures to implement these targets as outlined in the Framework Document for the national anti-poverty strategy review and the report of the working group on the anti-poverty strategy and health have been taken on board in the national health strategy. Due to the wide range of factors which affect health status and health inequalities, the national health strategy envisages targets being met through a range of actions. These actions will involve a greater focus on multisectoral work and health impact assessments.