Dáil Éireann díospóireacht -
Tuesday, 23 Feb 1993

Vol. 426 No. 5

Adjournment Debate. - Medical Card Eligibility

Mr. M. Kitt

I thank the Minister for coming to the House to reply to this matter. I tabled a motion at the Western Health Board's October meeting last year to ask the health board to allow medical cards to handicapped persons. I did this after being approached by the parents of handicapped children who were concerned that medical cards in many cases were being withdrawn from their children. I discussed this matter at meetings in November and December. I was glad the Western Health Board agreed on 9 December 1992 to a proposal to meet the Minister for Health to discuss four issues. One of these issues was the inclusion of legal provision in the Health Acts for the cost of general medical card services for all handicapped children. I hope the Minister will be able to accede to my request.

I noticed in the Programme for a Partnership Government that there was a very fine section dealing with the health services, particularly mental health service but there was no reference to the question of medical cards for the handicapped. The situation developed on from there in that parents of handicapped children came together as a group. They have had many meetings and have received support from the parents of Down's Syndrome children. They have made the point to me that they wish to get a definite answer either from the health board or from the Minister as to whether medical cards can be granted as a right. They have been concerned particularly that medical cards have been withdrawn from handicapped children who suffer from Down's Syndrome, cerebral palsy or other types of handicap.

They made the point also with the gross income taken at £118 for a married couple and £14 for each child that sometimes they may lose out if the guidelines are strictly interpreted. A letter from a secretary of this parents' committee pointed out that there was no allowance for bus travel for the children to their special schools or if they had to go for private tuition and there was no allowances for childminding. It was also pointed out that in many cases handicapped children have an inferior immune system and, consequently, suffer much more regularly from throat infections and respiratory infections. There is a long term illness programme but these parents have been trying to impress on the Western Health Board that regular visits to GPs and other doctors and consultants are an enormous drain on their financial resources. I hope from that point of view that the Minister can include legal provision in the Health Acts to have medical cards granted as a right. Ironically these families receive a domiciliary care allowance which is a recognition that these special children need special care.

Unfortunately from the replies I and parents have received from previous Ministers the question has been transferred back to the health board when the chief executive officer can use his discretion to grant medical cards if people cannot provide medical care. In this situation the parents consider the matter so seriously that they have come together to form an ad hoc committee and an ad hoc group to press for medical cards as a right. I hope the Minister will be in a position tonight or as soon as possible to announce a change in the legal provision of the health Acts to allow medical cards as a right to handicapped people.

Minister for Health (Mr. Howlin)

I thank the Deputy for raising this issue and welcome the opportunity to explain to the House the background to the medical card scheme and the conditions under which medical cards are issued. One of the basic principles underlying the provision of the health services in Ireland is that no one is denied essential services because of inability to pay. The medical card scheme is designed to ensure that persons who are unable without undue hardship to provide general practitioner services for themselves and their dependants are provided with a full range of health services free of charge.

Determination of eligibility for medical cards is the responsibility, as the Deputy has correctly said, of the chief executive officer of the appropriate health board. Entitlement to a medical card is based on means and income guidelines are available to assist the chief executive officer in the determination of a person's entitlement. These guidelines are revised annually in line with changes in the consumer price index.

However, these guidelines are not statutorily binding and the health boards have the discretion to issue a medical card to a person whose income exceeds the guidelines if medical or other circumstances warrant it. At present almost 36 per cent of the population hold medical cards and in 1992 payments under the medical card scheme came to £227 million, or 13 per cent of the total health expenditure. By anyone's standards that is a huge amount of money. Every 1 per cent increase in the numbers entitled to a medical card represents an increase of expenditure of £2 million to £3 million.

Even in by brief period as Minister of Health I have received a number of requests to extend the automatic entitlement to a medical card to particular groups such as, for example, the elderly or children, asthma sufferers and students. There is a case to be made for each of these requests but I cannot look at requests for improved services in isolation from the overall context of providing health services in an extremely difficult and tight financial situation.

Deputies will appreciate that there are very many demands on the health services and that I am already faced with difficult decisions as to what services are given priority. Once such decision relates to the medical card scheme. Having given the matter raised by the Deputy very careful consideration, I consider it is not justifiable to grant an automatic entitlement to a medical card to any group without any reference to their means or, in the case of children, without any reference to their parents' means.

If there are persons with a handicap who do not hold a medical card and who are experiencing difficulty in paying for general practitioners' services, it is open to them to apply to the chief executive officer of the appropriate health board on hardship ground. I am satisified that health boards take a sympathetic view of applications where circumstances warrant.

I take the opportunity to point out that non-medical card holders are entitled to an extensive range of health services free of charge. For example, everybody, regardless of income, is entitled to public hospital and public consultant services subject to modest statutory hospital charges.

Mr. Deenihan

It is going up tomorrow.

Mr. Howlin

On 1 March, Deputy. With regard to persons with a handicap, I would like to point out the drugs and medicines prescribed for the treatment of a wide range of conditions are available free of charge. I would also like to add that hospital inpatient and outpatient services are available free of charge to all children suffering from the following conditions: mental handicap, mental illness, PKU, cystic fibrosis, spina bifida, hydrocephalus, haemophilia and cerebral palsy.

In conclusion, I am anxious that every person who is in genuine need of a medical card should receive one. It is in the best interests of the public at large to rely on the careful consideration of individual cases by the health board rather than to grant automatic entitlement without reference to means.