The first part of our statement deals with entitlement and Mr. Purcell has covered that issue in his opening statement. In the North-Eastern Health Board we have a population of just under 345,000. Of these 108,000 approximately, 31% have medical card eligibility. The GMS population figures represent 66,996 cards and of this about 25,000 cards are reviewed every year. This review mechanism is based on such criteria as age, occupation, mobility, income source, dependency, education, family circumstances etc. There is significant activity involved in maintaining the register up to date where the average changeover of cards per year is 13,000.
Since all persons aged 70 became eligible this was the first time that a comparison could be made of a distinct measurable medical card population cohort with census data, even though it was five years. Mr. Purcell has dealt with some of the actions taken. In respect of the north eastern region we estimated that approximately 2,500 persons over 70 years of age would qualify under the new provisions. The database indicated that there were 6,057 new registrations on or before l July 2001 and on that basis 3,556 would have been seen as inappropriate registrations. We participated in the national investigation scheme mentioned by Mr. Purcell. The North-Eastern Health Board, in addition to the existing medical cards team which consists of 13 staff based in five offices across the region, has put in a project manager and additional administrative resources, between three and six persons as necessary. The main actions were assignment of a project team, led by a senior executive officer and reporting directly to the assistant chief executive officer, key control and risk points in the card cycle were identified and a control strategy was developed.
Reference has been made to the letter issued by the Department in 1995. Prior to that we reviewed those in the same way as all others. What we did in the alternative approach was to use field staff such as public health nurses and community welfare officers. In hindsight that process has proved ineffective and we are now dealing with that.
Most of the incorrect registrations related to people over 70 years of age who had either died or had moved out of the area. Another factor has been that there is no explicit requirement on GPs to notify changes in their panels. During the review we found that a significant number of persons who in previous investigations had been reported as alive were deceased and vice versa. The problem here is that there is no unique identifier in use. While the system is on computer, one depends on manual systems to follow through on this.
Another problem is that deaths registered do not automatically come through. That will change when the general registry office has the registration of deaths, births and marriages fully computerised. I understand that will happen next year. In the meantime certificates have to be accessed manually and because of proximity to Dublin, many of those in the Louth-Meath area will die in hospitals in the Dublin area. There is no automatic feedback on death registration.
The computer systems, neither in 1995 nor today, do not support the exchange of electronic data. That has been identified also by the comptroller as a defect. Our board is currently piloting the central client eligibility, CCEI, index with the GMS payments board and we hope that when that rolls out, it will improve the position. The key to it, however, will be the use of the PPSN number.
The decision to extend eligibility to all those over 70 has increased control as many of the new medical card holders were not within the previous systems of notification, such as the Department of Social and Family Affairs.
We would make the point that there has been a major increase in population in our area in the six year period of 12.7%. The full details of the census will not be available until about July of this year so we are still working on estimates, particularly for the County Meath area, which is included in part of the eastern region by the Central Statistics Office.
A review of the entire over 70 database was completed following which we cancelled 4,900 cards. They include normal deletions as well as the special process. We now have a comprehensive roll-call using project and local community care staff. There has been a review of the patient registers in long-stay institutions and a review of duplicate and listings of inactivity produced by the GMS payments board. We are now able to audit the Department of Social and Family Affairs database.
We are also working to get monthly checks with the local registrar of births, marriages and deaths. We have new reporting relationships in respect of persons recorded as deceased on the hospital information system in our own hospitals, although the problem of the Dublin hospitals remains. In relation to long-stay institutions, we get monthly listings from the social welfare officers locally and we have also established a linkage with the nursing home subvention office.
We have also arranged with general practitioners to notify changes in their panel as they become known to them. We have procedures in place to capture local knowledge. We do a cross-check of the PPSNs against the Department of Social and Family Affairs database but as I pointed out, not all people have PPSNs. Where we have the PPSN the check is very accurate but we do not have all of them on it. We are also doing an annual roll-call register.
These actions will allow us to achieve at all times as accurate a medial card register as possible but in the absence of the integration of all the various schemes nationally, that requires a major human resource input because so much of what I have described is manual work until it is put on the system.
The board will also implement the system and process changes as recommended by the health boards executive GMS project, which was set up by the chief executive officers to achieve the overall modernisation of the process. I have included a summary of that process in appendix 1 of my statement.
The current position is set out on page 10. The provisional figure from the census of April 2002 is a total of 24,896. We estimate that since April 2002, a further 301 people would have attained the age of 70, giving us a figure of 25,197. Of those, 682 are in long-stay institutions without a card. The estimated number who have not applied for a card is 124, giving a balance of 24,390. Our database shows 26,039, so there is a difference of 1,649 or 6.8%.
We carried out an extensive validation programme and we are currently completing our second roll-call since January 2001. At this stage we have a high degree of confidence in our own figures. It is possible that the final process will reveal some 500 cases but I believe the number of 1,649 is an over estimate based on the estimates of the census of population figures. Unfortunately, until these figures are released in July, we will not be able to accurately verify that. It is significant, however, that the CSO figure for the north east as a whole, prior to the publication of the provisional figures, was significantly under-estimated. I would have a fair degree of confidence in that regard, and I have outlined the reason for that.
In relation to overpayments and to validate the 4,900 deletions carried out, I have set out in the table at the top of page 12 the detailed breakdown of the various reasons. Of that 4,900, we estimate that approximately 40% were found as a result of our normal verification procedures. That is about 2,000, and the other 2,900 were found as a result of the special examination. The GMS payments board has estimated that total overpayments are in the area of €329,000. We intend to pursue recovery of these payments as part of the national project, details of which are currently being examined jointly by the chief executives as regards the action that will be taken.
I am also satisfied that for the people in the 65 to 69 category, the database has been kept up to date.
