I propose to take Questions Nos. 87 and 93 to 95, inclusive, together.
The health strategy commits to making improvements in the income guidelines to increase the number of persons on low incomes who are eligible for the medical card and to give priority to families with children. True to the commitment expressed in the health strategy, both the income guidelines and income allowances for children taken into account for the purposes of assessment of eligibility for the medical card will be increased from 1 January 2005. These increases were among the set of priorities for new health initiatives in 2005 which I announced on 18 November last. The higher rate of increase in respect of the allowances for children is specifically aimed at assisting low income families with children in accessing primary care services. The Government's policy remains as stated in the programme for Government to extend eligibility for medical cards, rather than to achieve coverage of a certain percentage of the population or to issue a specific number of medical cards. The sum of €60 million has been provided in the 2005 health Estimates to improve access to primary care by providing for additional persons to become eligible for a medical card and free access to general practitioners for those on low incomes. The medical card income guidelines will be increased with effect from 1 January 2005 by 7.5% generally. Specifically, the income allowance for each of the first two children in a family will be increased by 20% and for the third and subsequent children by 30%. It is estimated that this will increase the numbers eligible for medical cards by approximately 30,000. The estimated cost of an additional 30,000 standard medical cards would be in the order of €30 million in a full year.
Free access to general practitioner visits will be provided to individuals and families based on incomes of 25% over the new medical card income guidelines. However, it should be noted that discretion to allow eligibility for the doctor-visit medical card for those above the guidelines suffering hardship exists as for the existing medical card. It is estimated that approximately 200,000 persons will become eligible for free general practitioner services. Subject to clarifying legislative and administrative issues, the new doctor-visit card will be introduced as soon as possible in 2005. The estimated cost of 200,000 new doctor-visit cards is in the region of €50 million in a full year.
These initiatives will assist in overcoming barriers to accessing GP services in the case of those on low incomes. They will also help in removing poverty traps and disincentives to people taking up work or progressing to better paying work. Parents of children whose illnesses persist from year to year will no longer be required to re-apply each year for a medical card. Taking into account both of these initiatives, in the region of 230,000 additional people, including children, will be able to access their general practitioner free-of-charge.
Currently, the setting of individual income limits is a matter for health board chief executive officers and will be the responsibility of the Health Service Executive in 2005. However, based on the percentage increases outlined, the relevant income guidelines are likely to be as follows:
|
2005 Weekly
|
|
Medical Cards
|
Doctor Visit Cards
|
|
€
|
€
|
|
Single person living alone (under 66)
|
153.20
|
191.50
|
|
Single person living alone 66-69 years
|
167.70
|
209.60
|
|
Single person living with family (under 66)
|
136.50
|
170.60
|
|
Single person living with family 66-69 years
|
144.05
|
180.05
|
|
Married couple (under 66)
|
222.00
|
277.50
|
|
Married couple 66-69 years
|
248.30
|
310.40
|
|
Married couple 70-79 years
|
496.65
|
620.80
|
|
Married couple (80 and over)
|
522.45
|
653.05
|
|
Allowance for each of 1st two children under 16
|
31.20
|
39.00
|
|
Allowance for each of 3rd and subsequent child under 16
|
33.80
|
42.25
|
|
Allowance for dependant over 16 with no income maintained by applicant
|
29.00
|
36.25
|
|
Allowance for house expenses (rent etc.): in excess of
|
26.00
|
26.00
|
|
Allowance for cost of travelling to work: in excess of
|
23.00
|
23.00
|
My Department will work closely with the health boards and authority and the HSE to oversee the operation of the scheme. Arrangements have already been agreed to put the processes required in train. The practice of ensuring that no one is disadvantaged by virtue of social welfare increases in retaining or applying for a medical card will also continue. The Irish Medical Organisation has been made aware of these initiatives and indicated that the developments are in line with its views.
Entitlement to health services in Ireland is primarily based on means and residency. 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. 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. 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 decision on whether or not 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.
