Dáil Éireann díospóireacht -
Tuesday, 9 Feb 1999

Vol. 500 No. 1

Adjournment Debate. - Medical Card Guidelines.

Mr. S. Ryan

I welcome the opportunity to raise this important matter with the Minister of State. Since becoming the Labour Party spokesperson on older peoples' issues, I have articulated the Labour Party policy that all persons over 65 years should be entitled to free medical care. We must ensure that the fruits of the economic success currently filling the coffers of the Department of Finance are wisely used to improve our social conditions. Ensuring that the elderly are provided with high quality, comprehensive medical care is one of these priorities and I and the Labour Party are determined to see this policy put into practice. The changes the Minister announced in the budget were a positive step in this direction and I welcome his initiative. Health care is high on the agenda of older people. Access to health care and the affordability of that care are their key concerns. Every Member is aware of elderly people who postpone important medical appointments because of the substantial costs involved. This is a scandal.

Last December the Minister for Finance announced that major changes to the medical card income guidelines for people over 70 years of age would be introduced. The three year reform package would steadily increase the income limits for persons over 70 years of age starting from 1 March this year. The changes would see an additional 10,000 elderly people entitled to the medical card and receiving free, comprehensive health care. This was a progressive move on the Minister's part.

However, major opposition to the Government's proposals has emerged, chiefly among the medical professionals. Legitimate concerns have been raised by general practitioners. GPs who face the prospect of losing patients to the GMS scheme have sound reasons for objecting to the manner in which the extension of the medical card scheme has been carried out, the effect it will have on their patients and the implications for their own practices. GPs who would be expected to take on the additional 10,000 people who will receive medical cards under the new arrangements are concerned about how they are expected to cope.

It is a disgrace that the Government has allowed this situation to escalate to the point where a number of doctors are now considering taking legal action under the Competition Act. It appears that the Government is in danger of presiding over a fiasco and that the proposed extension of the medical card to people over 70 is now in jeopardy. Having raised the hopes of thousands of people in December, the Government, through its own incompetence, is about to fail them. This is unacceptable.

It appears that neither the Minister for Health and Children nor his colleague, the Minister for Finance, engaged in detailed consultation with the medical profession in advance of the Budget Statement last December. Will the Minister outline the steps his Department will take in the next three weeks to ensure that the issues at the heart of this dispute are resolved? In seeking a resolution of this dispute, patient care and the inclusion of the additional 10,000 people entitled to medical cards from 1 March must be at the top of everybody's agenda. Nothing less will be acceptable.

In this respect, is it wise for the Minister to require people who are over 70 years of age to change their general practitioner? Many elderly people have formed a unique bond of trust with their general practitioners over a long number of years and the disruption of this relationship will cause them extreme concern. With this in mind, there is an opportunity for the Minister to negotiate a settlement that will satisfy the concerns of general practitioners and, most importantly, the concerns of older people who expect to receive the medical card on 1 March.

I hope the Minister will take this issue seriously and ensure that by 1 March these people will receive their medical cards and that the other issues are resolved in the meantime.

Minister of State at the Department of Health and Children (Dr. Moffatt)

I wish to respond to this debate by making some observations, both general and specific, about the development of general practice in Ireland in recent years and the particular issue of extending the income limits for medical card eligibility for the over 70s which is effective from 1 March.

Recent years have seen significant investment by the State in general practice through the general practice development fund and the GP capi tal fund. Substantial investment funds have also been made available under the indicative drugs target savings scheme and I wish to acknowledge the role the IMO played in promoting the merits of that scheme among its members.

General practitioners have also benefited in terms of increased fees and allowances, in particular under last year's PCW agreement. Apart from fees and allowances, that agreement also dealt with a number of other matters of considerable benefit to general practitioners, including out of hours payments for periods outside 9 a.m. to 5 p.m., Monday to Friday; a revised banding structure for allowances payable in respect of practice nurses and secretaries; funding to alleviate one-in-one rotas; a new scheme and allowance for GP trainers and a reduction in panel size arrangements for the recruitment of partners and/or assistants-with-a-view. This year, 1999, also saw a substantial increase in the pensions entitlements of retired former permanent district medical officers.

All this is in keeping with the priority and profile the Government, Minister and Department attach to developing and sustaining a successful general practice infrastructure. It is the Minister's intention to continue to build on what has been achieved to date in further developing this pivotal area of primary care. Plans are already under way, for example, to pilot a major national computer training project for general practitioners.

I will turn now to the specific matter of extending the eligibility limits for the over 70s. There are a number of points I wish to make. First, the extension is wholly in line with the commitment given in the Programme for Government. Second, the decision to increase the limits was made by Government in the context of the budget last December. Third, there have been claims in the press that the Department has not responded to requests for a meeting on this issue with the Irish Medical Organisation and that this refusal has meant that undue pressure has now arisen to resolve points of contention raised by the IMO before 1 March.

That is not the case. The IMO request for a meeting on this issue was immediately acceded to. At that meeting, which took place last week, the IMO put forward several matters for consideration which they regard as relevant to addressing the interests of their members. Officials in the Department undertook to examine the points raised and a second meeting is scheduled for this Thursday. Deputies will appreciate that it would not be appropriate for me, at this time, to go into detail on the specifics of the points raised at these meetings. Conducting industrial relations negotiations by media speculation and innuendo may be thought to have some merits but it is not the best way to resolve matters of concern.

I wish, however, to make the following general points. The increase in the eligibility limits is being phased in over a three year period. In that regard, it is worth noting that just under 80 per cent of persons over the age of 70 – about 229,000 – already have medical cards. Moreover, it is difficult to estimate precisely the actual effect that the increase in the income limits will have on bringing more persons within the scheme over the next three years.

The past few years have seen a substantial increase in the total number of private patients coming into the general practice system as a result of the economic boom we continue to experience. On balance, it is reasonable to presume that our continuing strong economic performance will mean that general practitioners will see more private patients come into the system than medical card holders created as a result of the over 70s income increase. Consequently, the actual economic effect, if any, of the income limit changes for GPs may well be minimal.

In addition, the issue of the so-called excluded doctors, that is, non-GMS doctors, has also featured prominently in the context of the scheduled income limit increase for the over 70s. It is argued that such doctors will be particularly affected by the loss of some elderly private patients who stand to benefit from the increased income limits. That matter, and a number of others, is already being examined in a more general sense under the auspices of a working group set up last year to examine the matter of GP entry to the GMS generally.

The group, comprising representatives from the Department, the health boards, the GMS (Payments) Board and the IMO, has met on a number of occasions to date and I expect that it will conclude its deliberations on this important matter in the near future. It is more appropriate that the group should be allowed to deal with the entry matter in a comprehensive way rather than attempting the more piecemeal approach of dealing with it in the context of the over 70s issue.

It is regretted that the extension of the income limits for the over 70s appears to have generated the adverse attention it has, particularly since as a matter of principle it has so much to recommend it. Further discussions are scheduled on this subject between the Department and IMO for Thursday and I do not propose to comment further now on what the outcome of those discussions might be.