Dáil Éireann Debate, Tuesday - 22 June 2004
6 Caoimhghín Ó Caoláin asked the Minister for Health and Children if he proposes to extend medical card cover to all persons under 18 years of age during the lifetime of this Dáil; and if he will make a statement on the matter. [18520/04]
View answerEntitlement to health services in Ireland is primarily based on means. Under the Health Act 1970 determination of eligibility for medical cards is the responsibility of the chief executive officer of the appropriate health board other than for persons aged 70 years and over, who are automatically eligible for 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. As a matter of course, the medical card income guidelines are revised annually in line with the consumer price index. The last such increase was notified in January 2004.
For those who do not qualify for a medical card there are a number of schemes which provide assistance towards the cost of medication, including the long-term illness scheme and the drug payments scheme. 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 chief executive officers, having an income that exceeds the guidelines does not mean a child or other person will not be eligible for a medical card. It may still be awarded if the chief executive officer considers that a person's medical needs or other circumstances would justify this.
Persons aged 16 to 25, including students, who are financially dependent on their parents are entitled to a medical card if their parents are medical card holders. Those who are dependants of non-medical card holders are not normally entitled to a medical card except where they have an entitlement under European Union regulations or where they are in receipt of a disability allowance. Students who are financially independent of their parents are entitled to apply for a medical card in their own right and are assessed on the same criteria as all other applicants. The decision on whether a person is regarded as a dependant or as being financially independent is made by the chief executive officer of the health board on the basis of the circumstances of each individual case.
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. In line with the health strategy, Quality and Fairness — A Health System for You, the possibility of extending the medical card by statute to various groups, including children, is under ongoing review in my Department in the context of the strategy's second goal.
Additional Information not given on the floor of the House.
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 incomes who are eligible for a medical card and to give priority to families with children, especially those 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.
I am disappointed by the nature of the Minister's reply which outlines the prevailing position. Does he recall that on the previous occasion I raised the question, he stated it was due to the prevailing budgetary situation that he was unable to fulfil the Government's pre-general election commitment? Does he accept that, since making the statement last December, the budgetary situation has improved greatly and the economic trends are showing an upward turn? If there was any real excuse last December for the answer he gave, I do not believe it would apply currently.
Is the Minister aware that a married couple with two children, with a miserly income of €260 per week, will not qualify for free general practitioner care for their children? Does he agree this is scandalous in the Ireland of 2004? Has he any idea of the real hardship families are suffering, especially where the choice is between GP referral and prescriptions and the needs of everyday life? The Government's health strategy repeatedly stresses the vital importance of primary care, and the Minister rightly repeats it. Is he aware that many children are denied proper access to primary care because of the financial circumstances of their families? Will he explain why it is that the principle of universal qualification can apply to people over the age of 70 but cannot apply to children under the age of 18?
Does the Minister agree that the fact that so many families suffer in this situation reflects the inadequate threshold for qualification where the bar is much too low? It needs to be heightened in terms of the qualification levels. Does he propose in the course of this Dáil to extend medical card cover to all children under 18 years of age?
The Government programme is for five years. I indicated in reply to a parliamentary question in December and recently that the financial envelope allocated to me this year with which I must work does not facilitate increasing the medical card income threshold. I accept the thresholds are too low and that a certain category of people would benefit from an increase in them. Given that we are in Government for five years, I hope we will be in a position to fulfil a commitment we gave to extend medical card eligibility to approximately 200,000 extra people and to target it at those in greatest need.
It is fair to say that, over the past two years, the cost of the general medical services, GMS, scheme has increased dramatically. If one examines the graph over the past three years, there has been a dramatic increase in the cost of drugs and the number of prescriptions, including the arrival on the scene of new drugs which are more expensive. We had to provide an additional €200 million this year for the overall GMS budget just to maintain provision for current medical card holders in the population. It is also fair to point out that the increase in employment in recent years has taken many people above the income thresholds so the number of medical card holders as a percentage of the population has declined by a number of percentage points.
The Deputy voted for the extension of medical card provision to the over 70 year olds. The Deputy's policy platform would extend medical card provision even wider so it baffles me how he can criticise the extension of medical card provision to the over 70 year olds while, on the other hand, have a completely different view——
I did not. I asked why universal qualification only applies to one sector.
I call Question No. 7. The Minister without interruption.
Rhetorical questions can be condemnatory in intent.
The Minister's incompetence is the problem. It is a bad deal.
I have called Question No. 7.
7 Mr. Hogan asked the Minister for Health and Children if he or his Department has ever carried out an estimation of the cost of the provision of a free universal general practitioner service here, either a partial medical card service or to include all services currently covered for medical card patients; and if he will make a statement on the matter. [18408/04]
View answerHealth boards established pursuant to the Health Act 1970 are obliged by section 58 to provide general practitioner services free of charge to persons having full eligibility for health services. Responsibility for the determination of the eligibility of an applicant to a medical card is, by legislation, a matter for the chief executive officer of the relevant health board to decide, having regard to the individual circumstances of each case. Medical cards are normally issued to persons for whom, in the opinion of the chief executive officer of the local health board, the provision of general practitioner and surgical services for them and their dependants would cause undue financial hardship.
Negotiations with general practitioners who provide services for medical card holders in the GMS scheme have been conducted on this basis. Any plans to change the spirit or the extent of the operation of the GMS scheme in the area of eligibility would necessarily mean further negotiations with representatives of the medical and pharmacy professions. It is, therefore, extremely difficult to assess accurately the likely cost of the introduction of universal eligibility to a medical card. However, based on preliminary figures from the GMS Payments Board for the average national cost for the provision of GP services to medical card patients for 2003, it could cost in the region of €685 million per annum to provide general practitioner services to the balance of the population. To give free pharmacy services for the range of approved prescribed medications, again for the balance of the population and based on the 2003 preliminary figures from the GMS Payments Board, could cost in the region of an extra €1.64 billion. Neither of these figures takes into account any changes which may result in the fee structures for either GPs or pharmacists following negotiation with these contractors.
The Minister is correct that the current income threshold for medical cards is too low. It is half the minimum wage, which is, effectively, destitution. One must be destitute to qualify for a medical card. The reason I asked this question is to explore the possibility of something less than a full medical card service for people. Each taxpayer pays an average of €6,000 to the health service and, undoubtedly, the cost of the GMS is high and increasing.
Deputy, there is just one minute for supplementary questions.
I know and you are using some of it.
The Deputy should confine herself to asking questions.
Would the Minister accept that pouring money into a bloated hospital system is not giving value for money? Is he willing to explore the possibility, albeit that it might require new negotiations with pharmacists and general practitioners, of changing the focus of the health system towards one of prevention and primary care and of targeting specific illnesses rather than insisting that we should stay with the old medical card system?
I agree with the Deputy that we should continue to invest more in primary care and prevention. However, we must be careful in allocating available resources. We need to target and prioritise the resources. I favour targeting resources towards children and people with disabilities in the context of access to general practitioner services as the first priority. A blanket allocation of up to €600 million, and the amount could be even more given that this figure is estimated before any negotiations take place, would not be the best allocation of scarce resources.
That is not what I suggested. I was asking about a targeted approach as a halfway house. People with chronic illnesses, for example, have no medical card.
Many have and some do not because of the long-term illness card.
Does the Minister accept that the price of his failure to extend the medical card scheme is being paid by families on low incomes, including those with children? The Minister has reduced the total number of patients with medical cards by 100,000. People are losing out, although the Minister promised in the programme for Government that they would gain.
The Minister struck a deal with GPs under which they are paid almost four times more for treating a wealthy patient over 70 under the medical card scheme than a poorer patient over 70. Surely this is bad value for money and prevents the natural expansion of the scheme to provide for those most in need.
I do not accept that 100,000 people lost out because of a failure to increase the threshold for eligibility. The vast majority of those people are over the income limit because of the thousands of extra jobs that have been created in recent years. Whether or not we like to admit it, income levels for those with jobs have gone up substantially over the past five years and this rendered some people ineligible for the medical card scheme.
Income levels have not gone up substantially. Let us get real.
That is the reality. I have answered the Deputy's question.
I am talking about people on low wages.
Allow the Minister to continue without interruption.
Yes, but many who found jobs over the past four or five years went over the income limit for eligibility for the scheme and as a result did not receive medical cards.
The Minister should get real. They are still on low wages.
The Deputy has tried to have it every way on the issue of the over 70s for a long time. Prior to any agreement she was asking every day when we would strike a deal with the hard-pressed GPs. That was her position. Then she endorsed the extension of the medical card scheme to all those over 70 by voting for it. Irrespective of all her rhetoric, she trooped through the lobbies and voted for it.
I did not vote for incompetence.
Order, please.
I did not vote for the Minister's incompetence. He did not do the business.
This has had an interesting outcome in terms of value for money. There has been some evaluation of the extension of the scheme and it is showing good results in terms of the frequency of visits to GPs by elderly people and the resulting improvement in vaccination levels and general health. That is good value for money by anyone's standards.
As a general practitioner I am very aware of the difficulty people experience in accessing primary care services. If the Minister can increase access he will save money. When will he issue the 200,000 extra medical cards that are promised?
I have answered that question already. The Deputy knows the extensive contribution the State makes towards all the schemes and that GPs, pharmacists and so on do quite well out of the allocation.
I am talking about patients.
May I ask one more question?
Sorry, Deputy, we have gone over time on this question. We must be fair to other Deputies who wish to submit questions. Standing Orders must apply to everybody.
How can the Minister defend the lousy deal he made? The GPs had him over a barrel.
