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Dáil Éireann díospóireacht -
Tuesday, 1 Jun 1999

Vol. 505 No. 6

Written Answers. - Medical Cards.

Bernard Allen

Ceist:

148 Mr. Allen asked the Minister for Health and Children the consideration, if any, he has given to allocating medical cards to everybody over 66 years of age; and the estimated cost implications. [14248/99]

The Government identified in its programme An Action Programme for the Millennium the need to review medical card eligibility for the elderly and large families. The Government has decided that the income guidelines for entitlement to medical cards for persons aged 70 years or over should be doubled. This improvement which is being introduced over a three year period, began on 1 March. The income guidelines for those aged 70 to 79 and 80 years and over, which are already higher than the normal guidelines, have increased by one-third and there will be similar increases in 2000 and 2001.

Entitlement to health services in Ireland is primarily based on means. Under the Health Act, 1970, determination of eligibility for medical cards is the responsibility of the chief executive officer of the appropriate health board. Medical cards are issued to persons who, in the opinion of the chief executive officer, are unable to provide general practitioner medical and surgical services for themselves and their dependants without undue hardship.

Income guidelines are drawn up by the chief executive officers, to assist in the determination of a person's eligibility and these are revised annually in line with the consumer price index. However, the guidelines are not statutorily binding and even though a person's income exceeds the guidelines, a medical card may still be awarded if the chief executive officer considers that his or her medical needs or other circumstances would justify this.

In view of this special provision I do not feel it justifiable, nor did previous governments, on health policy grounds, to extend an automatic entitlement to a medical card to any specific group without any reference to their means, as a general rule. It is open to all persons to apply to the chief executive officer of the appropriate health board for health services if they are unable to provide these services for themselves or their dependants without hardship.

Non-medical card holders are entitled to a broad range of health services including an entitlement to public hospital and public consultant treatment subject only to modest statutory charges and out-patient services free of charge. There are a number of schemes which provide assistance towards the cost of medication.

It is not possible to state precisely the cost of extending the medical card to all persons aged 65 years and over. However, it is now estimated that it would cost about £17 million to extend medical card eligibility to such persons. This figure does not take account of the costs involved in the drug refund scheme attributed to persons in this age category who do not currently hold a medical card. Such costs, which are based on expenditure by individuals or families and do not relate to the age of a person, would have to be offset against the above figure. Similarly costs of other health and social services which may be made available without charge to medical card holders are not included in the estimate above. Loss of income from public hospital statutory charges, from which medical holders are exempt, would also have to be taken into account.

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