Dáil Éireann Debate, Tuesday - 16 November 2021
557. Deputy Paul Murphy asked the Minister for Health if his attention has been drawn to an organisation (details supplied); if he will meet with those working with same; and if he will make a statement on the matter. [55733/21]
View answerThere are a range of services in place to protect individuals and families from excessive costs for their medical and surgical needs.
The Health Service Executive (HSE) provides a wide range of medical and surgical aids and appliances free of charge to eligible persons following assessment by a relevant health professional. These aids and appliances are provided by the HSE through community services known as Community Funded Schemes. Each application within a Community Health Organisation for eligible persons is assessed by the local Resource Allocation Group and a determination is made regarding approval based on priority and the funding available. At times, due to the demand for resources exceeding the available capacity, waiting lists may apply for some categories of items provided through the medical and surgical aids and appliances budget in a particular Community Health Organisation. A HSE Primary Care led National Service Improvement Programme has the aim of improving the equity of access, value for money, and functional processes of the Community Funded Schemes through the establishment of national guidelines for the provision of medical and surgical aids and appliances. As the situation involving the Covid-19 pandemic improves, this Programme will gather pace.
The Long Term Illness Scheme, established under Section 59(3) of the Health Act 1970 (as amended), allows patients to receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge. The conditions covered by the scheme are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide.
Under the Drugs Payment Scheme, no individual or family pays more than €114 a month towards the cost of approved prescribed medicines. The scheme significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.
People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card. In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. In certain circumstances the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances, such as extra costs arising from illness. The HSE afford applicants the opportunity to furnish supporting documentation to determine whether undue hardship exists and to fully take account of all relevant circumstances that may benefit them in assessment, including medical evidence of costs and certain expenses. In circumstances where an applicant is still over the income limit for a medical card, they are then assessed for a GP visit card, which entitles the applicant to GP visits without charge. Further information regarding these schemes is available at www2.hse.ie/costs-schemes-allowances/
Individuals may also be entitled to claim tax relief on the cost of medical expenses. This includes medicines prescribed by a doctor, dentist, or consultant. Relief is at the standard tax rate of 20%. Details on how to claim are at www.revenue.ie.
The HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. Reimbursement for medicines under the community drugs schemes is for licenced indications which have been granted market authorisation by the European Medicines Agency or the Health Products Regulatory Authority (HPRA) in Ireland. In making a relevant reimbursement decision, the HSE is required under the Act to have regard to a number of criteria including efficacy, the health needs of the public, cost effectiveness and potential or actual budget impact.
In May 2019 the drug Ataluren (Translarna®) indicated for the treatment of Duchenne muscular dystrophy resulting from a nonsense mutation in the dystrophin gene, in ambulatory patients aged 5 and older was approved by the HPRA under the high tech arrangement and is therefore included in the listing of reimbursable items. It is important to note that the medical decision to prescribe or not prescribe any treatment, for an individual patient is strictly a decision for the treating clinician, in consultation with their patient. I, as the Minister for Health, have no role in this clinical decision-making process and Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
Finally, while I make every effort to meet with as many stakeholders as possible, it is not always possible to commit to every meeting request. However, it is a normal and productive practice for my officials to meet with interest groups on my behalf and I would suggest that the organisation in question submit a formal meeting request to my office.
