Tuesday, 27 January 2004

Questions (15)

Caoimhghín Ó Caoláin


137 Caoimhghín Ó Caoláin asked the Minister for Health and Children the details of the new income guidelines for medical card qualification; and if it is intended to extend qualification as promised before the general election in 2002. [1789/04]

View answer

Oral answers (20 contributions) (Question to Minister for Health and Children)

The medical card income guidelines issued by the chief executive officers of the health boards for 2004 are effective from 1 January 2004. They are as follows: a single person aged up to 65 years and living alone —€142.50; a single person aged between 66 and 69 years and living alone —€156; a single person aged up to 65 years and living with a family —€127; a single person aged between 66 and 69 years of age and living with a family —€134; a married couple aged up to 65 years —€206.50; and a married couple aged between 66 and 69 years —€231. The allowance for children under 16 years is €26 and is €27 for a dependant aged more than 16 years with no income maintained by the applicant. The allowance for outgoings on house, rent, etc. is €26, and for reasonable expenses necessarily incurred in travelling to work the allowance is €23.

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 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 situation, I regret 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.

Before the next election.

It should be remembered that health board chief executive officers have discretion in terms of issuing medical cards and also that a range of income sources are excluded by 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 disregarded when determining a person's eligibility. Given these factors and the discretionary powers of CEOs, 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 it. 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 €78 per calendar month towards the cost of approved prescribed medicines.

The health strategy emphasises fairness and the objective of reducing health inequalities in our society. Shorter waiting times for public patients are 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 the implementation of the national anti-poverty strategy targets relating to health.

I am almost speechless as a result of the Minister's response. I will do him one little courtesy by not referring to the Government's pre-2002 general election promise to extend the medical card to more than 200,000 additional people because he is already sufficiently discredited on that point.

The Government's health strategy, under what it calls, "National Goal No. 2 — Fair Access", promises to increase income guidelines for medical cards. Last year a married couple aged up to 65 years were entitled to a medical card if their income was under €200. However, the Minister has indicated in his reply that that figure has been increased by €6.50 for the current year, which is a 3.25% increase. Was that the best the Minister could do? If a married couple with two children under 16 years of age have an income of €260 per week, they will not qualify for a medical card.

Under the Minister's guidelines families with young children regularly face a terrible choice. To visit a GP costs between €30 and €50 depending on where in the country one is domiciled. Families must choose which of their daily needs to do without to visit a GP with a sick child. Up to one fifth and in some cases one quarter of a weekly income is spent on the GP visit alone, before the cost of medication. The figures the Minister has announced for 2004 continue a pattern that is removed from the reality of the daily living conditions of ordinary people and contributes to the basis of ill-health. Real needs, particularly those of children, which the Minister emphasised, are not being addressed because of the terrible and stark choices facing families.

How does the Minister morally justify the extension of the medical card to all over the age of 70, regardless of income or means, while children up to the age of 18 years, some living in real or relative poverty, do not have the benefit of a medical card? I do not believe that the Minister can morally justify that. This is a very serious matter affecting an increasing number of people because the curtailments and restrictions introduced on the medical card leave people in real poverty on a daily basis.

It is medically established that people over 70 have far greater need to visit their GPs than those under 70, perhaps with the exception of young children. The Deputy voted in this House for the measure that he now finds morally reprehensible.

I am asking the Minister to justify it morally.

The Deputy voted for it and the record speaks for itself.

I asked the Minister to justify it morally. There is a major difference.

The Government gave this commitment and I regret it is not in a position to deal with it this year, but there has been fiscal confinement or restraint for the past two years. I have concentrated on other areas of our commitments, particularly to have public patients treated faster. Soon we will reach the point where 12,000 who had been waiting longer than 12 months will have been treated by the national treatment purchase fund, to which we allocated €30 million. The cost of the GMS has risen dramatically in the past two years, from €890 million in 2002 to €1.2 billion. These are all factors at which we have been looking and we have been drilling deeply into the GMS scheme to see if we can effect savings that can be returned to the people whom the Deputy mentioned. The significant escalation of the GMS, however, cannot go unnoticed or uncommented on, or be tossed aside as if it has no application to the decisions we take.

There are fewer people in the GMS scheme today.

That is a fairly significant factor which requires reflection.

The Minister is causing that problem.

The consumption levels of medicine are increasing each year——

So is the number of people over 70.

——as is the rate of prescribing.

Why penalise patients?

They are the key factors. One only has to look at drugs such as statins, peptic ulcer drugs and so on for an illustration of that.

The Minister is encouraging that. It is a good thing.

Yes, it is a good thing, but it is a factor.

Others are affected as a result of that.