asked the Minister for Health the estimated extra cost of providing a general medical service based on guidelines which take into account net income after deduction of PRSI and income tax, rather than the present system, which is based on gross income.
Written Answers. - Medical Service Guidelines.
391.
Under the provisions of the Health Act, the persons who are eligible for the general medical service are adult persons who are unable without undue hardship to arrange general practitioner medical and surgical services for themselves and their dependants, together with the dependants of such persons.
The determination of eligibility in individual cases is a matter for the chief executive officer of the appropriate health board. In order to assist in determining eligibility and to ensure uniformity of decisions in all areas, income guidelines have been adopted. These guidelines are based on gross income. If the guidelines were based on net income without any expansion of eligibility, this would require a lowering of the guidelines. This would tend to favour persons with larger incomes.
If the current guidelines, instead of being measured against gross income, were to be measured against income net of PRSI contributions and income tax an expansion of eligibility would result. It is not possible to estimate with any precision what the extra cost might be but it could be of the order of £15 million in a year. Moreover, the increase in the numbers covered by medical cards might make it necessary to renegotiate the fees payable under the scheme and this could add considerably to the extra cost involved.