Entitlement to health services is primarily based on residency and 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. 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.
Income guidelines are drawn up each year by the health board or authority chief executive officers to assist in the determination of a person's eligibility for a medical card and these are revised annually in line with the consumer price index, CPI. The last such increase was notified in January 2004.
It should also be noted that health board chief executive officers have discretion with regard to the issuing of medical cards and a range of income sources are excluded by the health boards when assessing medical card eligibility. Despite someone having an income that exceeds the guidelines, a medical card may still be awarded if the chief executive officer considers that a person's medical needs or other circumstances justify this.
With regard to the assessment of means and circumstances for a medical card, and in particular the discretionary element operated by the CEOs of the health boards, I have been advised that health board staff have been using an interim set of guidelines for the administration of the medical card scheme, drafted by HeBE in 2003, which addressed this issue along with other guidance aimed at a more standardised approach to the consideration of medical card applications generally. A revised final set of such guidelines is under consideration by the chief executive officers of the boards, which, I understand, will be circulated to the health boards and the Eastern Regional Health Authority shortly.
For those who do not qualify for a medical card, there is a number of schemes that provide assistance towards the cost of medication. Under the Health Act 1970 a health board may arrange for the supply, without charge, of drugs, medicines and medical and surgical appliances to people with a specified condition, for the treatment of that condition under the long-term illness scheme. The conditions are mental handicap, mental illness — for people under 16 only, phenylketonuria, cystic fibrosis, spina bifida, hydrocephalus, diabetes mellitus, diabetes insipidus, haemophilia, cerebral palsy, epilepsy, multiple sclerosis, muscular dystrophies, parkinsonism and conditions arising from thalidomide and acute leukaemia. There are currently no plans to amend the list of eligible conditions. Under the drug payments scheme, a person and his or her dependants does not have to pay more than €78 in any calendar month for approved prescribed drugs and medicines.
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 EU 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 health strategy includes an entire 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 CEOs under the PPF. These 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.
The Government is fully committed to the extension of medical card coverage as set out in the health strategy, with a particular focus on people of low incomes. 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. The timing of the introduction of the extension will be decided having regard to the prevailing budgetary position. In addition, my Department is committed to the preparation of new legislation to update and clarify the entire legal framework for eligibility and entitlements in regard to health services.
