asked the Minister for Health if he will state the estimated percentage of the population now registered on the General Medical Services Register and entitled as such to free medical services under the Health Act.
Ceisteanna—Questions. Oral Answers. - Health Act Services.
The latest date for which the information is available is the 30th June, 1958. On that date the estimated percentage of the population registered on the General Medical Services Register was 28.5.
asked the Minister for Health if he will state (a) the number of insured persons and dependents entitled to institutional and specialist services under the Health Act, (b) the number of persons and their dependents within £600 yearly means similarly entitled, (c) the number of farmers and their dependents similarly entitled, (d) the number of women who have availed of the maternity service under Section 16, Health Act, 1953, and the estimated yearly number upon which the cost is now based, and (e) the number of doctors who have agreed to provide medical care for mothers under Section 16 of the Health Act, 1953.
The approximate number of persons in the category "insured persons and their dependents" is 1,580,000. The approximate number eligible as farmers and their dependents is 770,000. A reliable figure could not be given of the number of persons outside these two classes who are entitled to the services because their family income is less than £600 a year. This number is, however, thought to be considerably less than 10 per cent. of the total number of entitled persons.
The number of agreements entered into by doctors with local authorities as at 31st March, 1958, totalled 1,588. This figure represents more than the total number of doctors engaged in the service, as some doctors enter into agreements with more than one local authority. The number of doctors, as distinct from the number of agreements, is not available in my Department.
In regard to (d) in the question, the Deputy will appreciate that Section 16 provides for a variety of services in respect of maternity. By far the most widely used was the general practitioner service which, according to returns furnished by health authorities but not yet checked in my Department, provided care for 29,200 women whose confinements occurred in 1957 (including 13,600 domiciliary confinements). In addition to this number, there were over 3,100 domiciliary confinements and nearly 14,000 hospital confinements in which services (ante-natal, intra-natal or post-natal, or a combination of those) were provided under the Act, but in which cases the women concerned had not registered with any particular medical practitioner. (Cases in point are those provided with care by the major voluntary maternity hospitals under their agreements with health authorities.) The returns show also that nearly 11,000 women availed in the year of services under Section 25 of the Act in respect of maternity. There is an overlap, the precise extent of which cannot be stated, between the last mentioned figure and the figure quoted for Section 16.
The cost of services under Section 16 of the Health Act, 1953, is estimated by each health authority for its own area. Each year's estimate is based on the health authority's most recent experience in relation to such expenditure. While the number of women availing themselves of the service would be a major factor affecting expenditure, other significant considerations would be the extent to which the services available are utilised and changes in the balance between hospital and home confinements.
asked the Minister for Health if he will state the total number of persons entitled to free medical services under Section 14 of the Health Act, 1953, and the total number of persons estimated to have been entitled under the pre-existing provisions of the Public Assistance Act, 1939.
According to the returns furnished to me by the local authorities the number of persons covered by general medical services cards at the 30th June, 1958, was 824,756; this is the latest date for which the information is available.
Under the Public Assistance Act, 1939, persons requiring medical assistance were obliged to obtain a medical assistance ticket from (a) a warden appointed by a public assistance authority or (b) a member of the public assistance authority or (c) an assistance officer of the public assistance authority.
No statistics were kept of the numbers availing of such services and it would not be possible to give a firm estimate of the number who were entitled to medical assistance under the 1939 Act.
The same class of persons who were entitled to medical assistance under the Public Assistance Act, 1939, are entitled to general medical services under Section 14 of the Health Act, 1953, and I have no reason to believe that there is any substantial difference as between the number now covered by general medical cards and the number who were entitled to the services of the dispensary doctor under the Public Assistance Act.
Is it a fact that the estimated number believed to be entitled to free medical services under the Public Assistance Act was one-third of the population? Is that correct or not?
I am not in a position to answer that question precisely.
Surely the Minister is aware that there is a general complaint now that there are people who were entitled to free medical services under the old Act but who, by the introduction of the new Health Act, are not so entitled?
I do not know whether that complaint is well founded because, under the 1939 Act, free medical assistance was to be provided only for persons who could not, by their own industry, or other lawful means, provide medical attention for themselves and their families. It is quite possible that a number of people who were getting assistance under the 1939 Act were not entitled to do so.
Is the description of the persons entitled not the same under the Health Act of 1953 as under the Public Assistance Act, 1939?
Precisely.
I am asking the Minister if it is correct that the estimate of those entitled under the previous code was one-third of the population? Does the figure now appear to be somewhat less?
It is somewhat less than one-third, but not significantly.
Is the Minister not aware that many people around the country, agricultural workers, casually employed persons, and persons in posts which do not carry substantial remuneration, are being refused medical cards although many of them could get free medical treatment under the Public Assistance Act? It is well known in many counties, to my own knowledge. At a time when the is worth about 8/7 and when £6 a week represents little more than 50/- would the Minister call the attention of local health authorities to the necessity of appraising accurately the inability of these persons to provide medical assistance on to-day's scale of charges, when illness happens to afflict any member of the family?
By and large, I have no reason to believe that the local authorities who act as health authorities in this matter deny any person who is entitled to it a medical card, but it is very possible, having regard to the manner in which medical assistance tickets were issued prior to the Health Act of 1953, that many people were given medical assistance tickets who were not entitled to have them.
On £2 a week and not entitled to have a medical card?
asked the Minister for Health if he will state the details of the cost of general medical services under Section 14 of the Health Act, 1953, under the headings dispensary doctors' salaries, cost of medicines, investigation of claims and administration, etc.
Returns received from local authorities, and which have not yet been audited, indicate that the expenditure on the general medical services for the year ended 31st March, 1958, was £879,000, made up of £570,000 for salaries of dispensary doctors, £184,000 for medical supplies and £125,000 for remuneration of other staffs, upkeep of dispensary premises and miscellaneous expenses.
In view of that large expenditure, would the Minister not consider that the time has come to examine the dispensary system in order to provide a free choice of doctors to those entitled to free medical assistance?
I should like to allow every person a free choice of doctor, but there could not be an absolutely free choice of doctor in every case. At the most, it could only be a choice between one doctor and another. We could not allow a person to select a doctor from any part of the country or even county in which he resides. In any case, the 1953 Act has been in full operation only for the past three years, and I think it would be premature to interfere with the existing system until we see how it will work out in the end.
Surely it appears from what the Minister has said that the dispensary system has been in existence for a number of years and many of the provisions in the Health Act were taken from the previous code unaltered and unvarnished?
But what I have said is that the 1953 Act has been in operation only since 1956 and I think it would be entirely premature to interfere with it until we see how it works out in the end, particularly bearing in mind in this connection that the cost of the Act is very much greater than was originally anticipated.