Dáil Éireann díospóireacht -
Tuesday, 15 Feb 2000

Vol. 514 No. 3

Written Answers. - Medical Cards.

Bernard Allen

Ceist:

237 Mr. Allen asked the Minister for Health and Children the steps, if any, he will take to ensure that persons requiring general practitioner care will not be prevented from receiving it as a result of their exclusion from the medical card scheme; and if he will examine the present income limits for medical cards in view of recent disclosures that Irish people have one of the highest rates of mortality in Europe. [4409/00]

Minister for Health and Children (Mr. Martin):

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 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. Medical cards may also be awarded to individual family members on this basis.

While Ireland does have a mortality rate higher than the EU average, it is important to recognise that health status and mortality rates are influenced by several factors. These include people's natural endowment; the physical and emotional nurturing they receive; the lifestyle they adopt; the degree to which the health services and the wider environment support and complement their attempts to prevent disease and to improve their health as well as the access they have to quality health and personal social services in times of need. International research has found that there are large differentials in mortality and morbidity between the higher and lower socio-economic groups and the conclusions from this research are that health inequalities are primarily a consequence of material differences in living standards.

The health strategy recognised that the pursuit of equity – one of the main principles underlying the strategy – must extend beyond the question of access to services and must also be concerned with variations in health status between groups. The strategy sets a framework for reorienting the health services to achieve health and social gain with a particular emphasis on improving the situation of people in the lower socio-economic groups.

A range of measures are in place to reduce health inequalities and improve health status and mortality rates. These include the national cancer strategy, the national cardiovascular health strategy and the waiting list initiative. My Department's new health promotion strategy for the years 2000 to 2005 is informed by the findings of the national health and lifestyles surveys, SLAN. All these measures include specific strategic aims and objectives for the reduction of health inequalities.

Many of the causal factors of health inequalities, such as poverty and unemployment, are outside the direct control of the health services. This has been recognised in the establishment of structures such as the Cabinet committee on social inclusion, the associated senior officials social inclusion group and the NAPS interdepartmental group, which provides the principal strategic focus for the national anti-poverty strategy. In the context of the new partnership agreement, Programme for Prosperity and Fairness, my Department will take part in a group to consider the setting of health targets to be included in the next phase of the national anti-poverty strategy.