9 Mr. R. Bruton asked the Minister for Health whether he has satisfied himself that persons with long term illnesses, which are not included in the restricted list recognised by his Department, are receiving equitable support; and if he will make a statement on the matter.
The illnesses covered by the long term illness scheme are: mental handicap, mental illness, for persons under 16 only, phenylketonuria, cystic fibrosis, spina bifida, hydrocephalous, diabetes mellitus, diabetes insipidus, haemophilia, cerebral palsy, epilepsy, multiple sclerosis, muscular dystrophies, parkinsonism and acute leukaemia. Persons suffering from any of these illnesses can obtain, without charge, drugs and medicines for the treatment of their condition. There are over 45,000 people availing of this scheme at an annual cost in excess of £8 million.
Many other persons with a chronic illness are eligible for the full range of health services under the general medical services scheme without charge and the chief executive officer of a health board may take into account expenditure incurred by a person on drugs, medicines and general practitioner care when determining eligibility for this scheme.
Other persons who do not qualify for the above two schemes and who are certified as having a long-term medical condition with a continuing requirement for prescribed medication are eligible for the drug cost subsidisation scheme, which I introduced last year, and are not required to pay the pharmacist more than £32 per month for their prescribed medicines.
Would the Minister not agree that non-medical card holders who have chronic illnesses should be given more favourable treatment than the rest of the population who might have only very occasional cause to use drugs? Would he not agree therefore that there is need to provide some long term support to people such as asthma sufferers who have long term commitments to very substantial sums, £32 every month of their lives?
It was to alleviate the difficulty for these people that I introduced the drug cost subsidisation scheme last year. As Deputies are aware, previous to that scheme being introduced many of these people were obliged to pay perhaps £100 or to wait three, four or five months for the refund to which they were entitled. That scheme has ensured that those people are obliged to pay only £32 per month and that they do not have the anxiety of waiting for perhaps over £100, depending on the cost of their medication.
Would the Minister not agree that by changing the exemption limit people with chronic illnesses have to pay £50 more every year for their drugs? Would the Minister answer the specific question — does he not agree that people with chronic illnesses must get more favourable treatment than those who only have very occasional use of the medical service?
I was very conscious of the point made by the Deputy when it was decided to increase the threshold from £28 to £32. The most recent previous increase was made in December 1983. The increase at that time, when the Fine Gael Party and the Labour Party were in Government, was 75 per cent, an increase of £16 in one year. After eight years we have increased it by £4, which I believe to be a modest increase.
I also point out to the Deputy that no addition to the long term illnesses has been included in that scheme since 1975.
Does the Minister plan to include asthma sufferers in a proposed extension to the list? I think all of us would agree that they should be included.
I do not intend to extend the range of that scheme at the moment. While I agree with Deputy Ferris that persons suffering from asthma do need constant and ongoing treatment, it would be true to say that several other illnesses such as chronic bronchitis, blood pressure, heart problems and skin diseases — which we hear very little about but which are probably some of the most expensive conditions to treat — also cause patients much trouble. The reintroduction of the drug cross-subsidisation scheme is an attempt to alleviate their burden.
(Carlow-Kilkenny): Does the Minister not agree that, despite all of the difficulties with regard to the definition of asthma, it should be accepted that someone who is gasping for breath, as distinct from someone who might have to take it easy because of heart problems or some other condition, deserves to be recognised as being under terrible pressure? The Minister, as a doctor, does not need to be told that as a result of asthma such a person's heart is under pressure as well. The position is absurd. I have asked at health board meetings for a definition of asthma. Could the medical profession decide that asthma can be recognised as a long term illness? Red herrings about bronchitis, hay fever and a whole rigmarole of illnesses are not really relevant; asthma sufferers do suffer.
The Deputy has raised a very interesting point: what is the definition of asthma as distinct from chronic bronchitis? There is a very fine dividing line that is not always apparent. Even if asthma were to be included on the list doctors would be faced with a problem of definition, as the Deputy pointed out himself. In certain circumstances it would be difficult to identify which patient had asthma and which patient had chronic bronchitis. That example highlights the difficulty of taking one specific group whose medicine is expensive and leaving out other groups such as the groups I have referred to, for example, people with blood pressure problems and people with heart problems. That is what we had in mind in introducing the drug cross-subsidisation scheme.
I also point out that 35 per cent of the population are covered by medical cards.
No, they are not.
Many of those who suffer from these illnesses do have medical cards. Again, the chief executive officers do have discretion in allocating medical cards to people undergoing particular hardship.
I should like the Minister to check the percentage of people who have full eligibility to medical cards, because I think the figure given out recently does not correspond. I wish to ask the Minister two supplementary questions. First, does the Minister know that the incidence of asthma seems to be on the increase among children and that it imposes great hardship on families marginally over the limit for full eligibility? Secondly, is the Minister aware that because of mark-ups and so on it costs more to dispense drugs on drug cards than are issued to pharmacists? Instead of the use of drug cards I should like the Minister to examine the possibility of extending eligibility for medical cards.
There are 1.2 million people covered by medical cards. As has been discussed in the House before, there was a reduction in the number of medical cards issued following a change in the method of payment to general practitioners from fee for service to capitation. Under the new capitation arrangement doctors are paid on the basis of each patient on the GMS list. It was necessary for the boards to ensure that there would be no payment for patients who no longer existed. People who had either moved away or died were removed from the lists, which did reduce the total percentage.
I have read various reports concerning the incidence of asthma in children. I do not have up-to-date information here today, but again I make the point that chief executive officers have discretion to ensure that nobody is denied treatment, either medical treatment or the issue of drugs, because of inability to pay. I know that that discretion is used, and so does every Deputy in the House. There are people who would be over the limit on the guidelines issued but who do have medical cards because of their particular circumstances, very often because of a particular disability.
A Cheann Comhairle, could I ask a very brief question?
The progress on questions today has been exceptionally slow, and I was going to appeal to Members to try to expedite matters. Let us make progress on other questions.
May I ask one final, brief supplementary question?
The Deputy may certainly ask the question, but the more supplementary questions are asked the less progress is made.
Would the Minister consider, for the future if not now, a lower threshold for those who are admitted by his own Department as being on long term medication? The Minister has established that category of people, so would he consider such a measure for the future?
At this time I do not intend to change the present system. However, the drug bill represents about 10 per cent of the cost of the public health service and the method of the supply of drugs is always under review. The Government want to ensure that patients who need medication will have easy access to that medication.
Before the next election.
No, I am satisfied that that is happening at the moment. Chief executive officers do use their discretion.
