asked the Minister for Health the average cost of providing comprehensive medical care under the general medical services scheme to persons between 16 and 25, old age pensioners and others.
Ceisteanna—Questions. Oral Answers. - GMS Comprehensive Medical Care.
10.
The average cost in 1983 of health services provided for a person aged between 16 and 25 years by virtue of his being eligible for a medical card is estimated to be roughly of the order of £27. The corresponding estimate for an old age pensioner is £110. For a person who is not in either of those categories, the average cost is estimated at £60. These estimates are tentative. They are based partly on information relating to years prior to 1983.
In view of this, does the Minister not consider that the savings which he is alleged to be making are very tiny compared with the overall cost of the medical services? In effect, he is simply transferring the cost of treating students to the hospital services.
The first part of the Deputy's argument about the size of savings is advanced in relation to all efforts to resolve any question of savings in relation to any services — Departments of Health, Education or Social Service. That argument does not hold up. On the second part of the Deputy's argument, since students avail of GP services only a couple of times a year, they are not likely to require, by and large, hospitalisation. There is no evidence that those who do not require GP services automatically arrive at the door of a hospital, demanding praticular services. The co-relation is not there and that argument will not stand up on examination in the months ahead.
We cannot have argument.
Could I draw the Minister's attention to a statement which he made, if I remember correctly, that there was a direct co-relation between hospitalisation of people holding medical cards and visits to GPs?
The co-relation is between people having medical cards and attending in the surgeries of general practitioners. The number of those who are subsequently referred to hospitals is rather interesting. The vast bulk of students who attend doctors, from the information available to us, attend about twice a year. The degree of hospitalisation is minimal, as one would expect for 16 to 25 year olds.
Does that not mean——
Might I remind the Deputies that the practice some years ago used to be that Deputies got information at Question Time and later made speeches on the information which they got. However, they appear to make the speeches now immediately they get the information.
From the Minister's argument regarding the non-taking up of these services and the very small number of times that a student goes to a doctor, is that not a good argument for retaining the medical card for the student population?
It is not an argument. It relates to the prospect of hardship involved. Forty per cent have total exemption from any cost in relation to their children at second and third level institutions and for the remaining 60 per cent the average cost would be about £15 or £16 per annum for attending a GP and perhaps another £10 for drugs — about £25 a year. There is also income tax relief on this.
The Minister stated that there was no evidence that persons who did not have medical cards would use the casualty services. Would he not accept that students are a special case, particularly students living away from home? He gave the example of his own family who are living at home, so he may not be aware of the problems created for students living in flats, say in this city who find themselves ill and without the money to go to a family doctor. Surely, the Minister will accept that they will go to hospital outpatient departments as an alternative and that this will prove very costly? A number of times this afternoon the Minister has stated that we are talking about two visits to the GP per year. Surely he will accept that an average of two visits per year does not mean that parents will be faced with only the cost of two visits. It means that many parents will be charged for ten or 12 visits and others will have no charges. Indeed, on the question of hardship, will the Minister not accept that in many cases — and particularly in regard to those living away from home — the hardship arises only when they become ill and the CEO is not in a position to anticipate the students who will suffer hardship?
I have yet to know of members of the medical profession who, in the case of students suffering from sudden illness, demand that they be given an advance payment there and then. Perhaps some do, but as a generality I do not know that this happens.
What about the cost of drugs?
I would stress that the hardship provision in the regulations are designed to take care of the situation outlined by the Deputy. It is no different from the case of an unemployed worker from the country who is living in Dublin. He too, in my opinion——
He should have a medical card.
His particular requirement is that he should apply for a medical card. I do not see why a differentiation should be made between him and somebody who is attending a third level educational centre and living in Dublin. That is a matter of normal equity within the delivery of the system.
(Interruptions.)
I am passing on to the next question. I am sorry, Deputies.
Could I ask a question?
I am not going to allow a further question. I am sorry, Deputy.
Just one final question. In view of the figures of £27, £110 and £60 with respect to general medical services for those from 16 to 25 years of age and old age pensioners and those in between, could the Minister explain the reasons for the difference in the costs? Does he think that an old age pensioner costs more, or someone in the in-between category?
There is a different means of assessing students and unemployed people. I understand that students are assessed on their parents' means and the unemployed on their own means.
It depends on the extent to which the unemployed person is in receipt of income. He may not be drawing any unemployment assistance and in that instance an assessment would be made of his income within the house. I stress that an unemployed young person who applies for unemployment assistance has an assessment of his board and lodgings taken into account and a value put on these by the social welfare officer who is investigating the case. This is done prior to the person being given a qualification certificate for unemployment assistance. I do not see why there should be total non-assessment for the issue of medical cards.
Even if the Minister——
Would the Minister please answer Question No. 11?
(Interruptions.)
11.
asked the Minister for Health the extra cost of providing full comprehensive hospital services to those between the ages of 16 and 25 years from whom general medical services have been withdrawn.
All persons between the ages of 16 and 25 years who were eligible for medical cards prior to the coming into operation of the Health Services (No. 3) Regulations, 1983, had full eligibility for free hospital services. This eligibility has not been altered by the regulations. There is therefore no extra cost involved in providing hospital services for these persons.
Does the Minister accept that he has been making a virtue out of the fact that he was allowing students, irrespective of their parents' income, to retain full, comprehensive hospital services, including consultant services because, in fact, it will not cost the Exchequer anything? I should also like to ask the Minister how he proposes to implement this decision.
It is contained within the regulation, and all matters relating to this decision have been notified to the health boards and other hospital agencies. I do not want to be giving too many examples but 10 per cent of the population earn over £13,000 per annum. Even a student in a family who have an income of £20,000 per year who requires hospital treatment will have free consultant services, free maintenance in a public ward irrespective of his parents' income. As the Deputy knows, the general limit for the population as a whole is £11,000. People over that amount are obliged to pay for conultant services or to be covered by the VHI——
The Minister has gone very far outside the question.
Would the Minister say if this is in conflict with the policy he has been advocating here all afternoon, that those who can afford to pay for their services should pay for them and if parents happen to be millionaires——
That is argument.
I should also like to ask the Minister — I did ask him but he did not answer — how he proposes to implement this scheme? Does he propose to issue hospital service cards to all students and, if so, has he consulted the medical profession in this regard?
There are many things about which I should like to consult the medical profession but I do not want to raise any more hares as I have enough on hands at present. I did not remove consulant services from students because I had more than enough to handle already. I do not think I should be tempted in that direction despite the obvious merit the Deputy has put forward in his observation.
Would the Minister accept that he made a wrong decision, that he should have left the medical cards with students and perhaps have looked at the hospital services which he agrees are the most expensive——
That question has been put about 25 times already today and answered.
12.
asked the Minister for Health the average cost of means testing a person between the ages of 16 and 25 who has applied for the restoration of a medical card on income grounds.
The cost of means testing a person who has applied for restoration of a medical card would be made up mainly of the labour cost of the staff involved in processing the application together with cost of postage, paper and printing. A special study would be required in order to assemble information on the work involved in dealing with such applications from persons between the ages of 16 and 25 years who are affected by the terms of the Health Services (No. 3) Regulations, 1983. I do not think that the cost of such a study would be justified.
It is extraordinary that health boards who have been dealing with assessment of persons for means test and so on for many years have not been able to develop cost effectiveness. Could the Minister give an estimate of what the cost would be in view of the fact that it costs £50,000 to send out a single letter notifying students that their cards are being withdrawn?
The total cost involved is a very tentative estimate spread over all the health boards. In some health board areas, however, the register is fully computerised, it is merely a question of a print-out and postage. In that case the cost would be minimal and most of our health boards are highly efficient in that regard.
Has the Minister's Department issued any snoop rules to the people who are involved in this assessment?
What kind of rules?
Snoop rules.
The Coalition have been accused of many things but we did not inherit those rules.
The Minister has a snoop in the Department of Social Welfare.
I should like to meet him.
There is refined and advanced snooperism.
The Minister referred to guidelines issued to health boards concerning applications from students for restoration of medical cards. Could he indicate what these guidelines are and could they be made available to Deputies?
Regulations have been issued and consultations have taken place with the chief executive officers of the health boards. In cases of hardship they have been advised that very special consideration should be given. After all the controversy over the past month, in fact only a couple of hundred cards have been withdrawn and great care is being exercised by the health boards not to indulge in unilateral action. People will be given a chance to state their case.
If the handing out of medical cards is decided on means, how can the Minister justify this decision in the case of students who have no means?
If a health board are satisfied that a student has no means from his parents a medical card will be issued. The degree of hypothetical complication introduced by Deputies is extraordinary and intriguing. If a student says he has no income and the health board are satisfied that that is so he will get a medical card provided he furnishes proof as to his lack of income. It is reminiscent of the small-holders' allowance. We must have proof for assessment and there will no longer be automatic entitlement by virtue of some unknown criteria.
The Minister said that if a student claims he has no income from parents he will be treated as having no income. Will this apply regardless of whether the student is living at home or not?
I can only lay down regulations in flexible terms. Responsibility rests with the CEOs of the health boards — and rightly so — of interpreting the regulations. That is what they are now doing and I have not heard that they are draconian in that regard. After all, 40 per cent of the population have medical cards.
That is a U-turn.
Is the Minister saying that health boards should accept the word of students that they have no income from their parents whether they live at home or not?
Health boards do not accept anybody's word. They require evidence of income and eligibility and then they make their assessment. Because people fill in a form with "nil" under "income" it does not automatically give them entitlement to free services. There must be proof. There has to be information and the ultimate criterion is the medical card number of the family.