I move:
That Seanad Éireann approves the following Regulations in draft:—
Health Services (Limited Eligibility Regulations, 1976,
a copy of which Regulations in draft form was laid before Seanad Éireann on the 22nd day of April, 1976.
Health Services (Limited Eligibility) Regulations, 1976: Motion.
These regulations deal with the income limits which apply for purposes of limited eligibility for health services. The health services concerned are: free hospital in-patient and out-patient services; free maternity services; free infant welfare services; assistance towards the cost of drugs and medicines.
The categories of persons who, together with their dependents, have limited eligibility are: persons insured under the Social Welfare Acts. For non-manual workers there is a remuneration limit of £2,250 per annum. This limit has been in operation since April 1974; non-insured persons with annual income less than £1,600. This income limit has been in operation since September 1971; farmers with a valuation of £60 or less.
The purpose of these regulations is to increase the income limit for non-insured persons from the existing figure of £1,600 to a new figure of £3,000. I intend to make separate regulations which will increase the existing limit of £2,250 for insured persons to a new figure of £3,000. Farmers are not involved in these changes and the existing limit of £60 valuation remains unaltered.
The reason for this change is to bring these limits into line with changes in money values and in incomes since they were fixed in 1971 and 1974. If allowance is made for movements in wages under the basic terms of the national wage agreements, an income of £1,600 in September 1971 would have a current equivalent of about £3,000. The change in limits does not therefore involve any extension of eligibility. It is aimed at retaining eligibility for persons who traditionally have had it and it does not involve any increase in the number of such persons. A further effect of the change will be to do away with the present anomaly whereby there are different limits for insured, non-manual employees and for non-insured persons. In future, the limit of £3,000 per annum will apply to both groups.
If, however, the existing limits are not changed, a large number of people will lose their eligibility, even though there has been no relative improvement in their financial situation. It has been estimated that about 85,000 such people would lose their eligibility by the end of 1976. The great majority of these are insured workers. The first group to lose eligibility—about 5,000 female workers—will become ineligible by 5th July if the limit is not increased to £3,000. An estimated 30,000 male, non-manual employees, together with some 40,000 dependants, will become ineligible by January next while 5,000 non-insured persons, with some 5,000 dependants, will become ineligible during the course of 1976, unless the new limits are introduced.
The proposed change in the limits has been discussed in detail at a number of meetings between officials of my Department and representatives of both medical organisations. The basis for the change has been explained fully and, as a result of these discussions, the medical organisations are not objecting to the new limits. Both organisations have requested that a new system for identifying eligible patients at the point of health-care delivery be introduced in order to ensure that eligible patients only are treated free of charge. The chief executive officer of the health boards and myself have agreed to this request and a more efficient system of identification is being worked out at present.
These regulations do no more than the minimum necessary to raise the present limits in accordance with the fall in the value of money since the limits were fixed, that was, in April, 1974, in the case of persons insured under the Social Welfare Acts and in 1971 in the case of non-insured persons.
The fact that it has taken such a length of time to deal with the inflationary erosion in regard to non-insured people is a cause for very serious complaint. These are the people who are hardest hit. We have a situation where, despite the admitted erosion in the value of money since September, 1971, it has taken practically five years to make up the deficit in regard to limits that have been steadily eroded, month in, month out. They have eroded to the extent that the Minister is now bringing in here at this late stage a proposal in these regulations to raise—and rightly raise—the limit of eligibility to £3,000, practically doubling the limits of eligibility in the case of non-insured people.
The House is entitled to raise this very serious social matter— that during that period since September, 1971, the non-insured category have had their rights in regard to eligibility for health services steadily eroded. Surely this category is not the category which should have to wait five years to have limits rectified in order to maintain their rights—not to enhance their rights, but, as the Minister stated, merely bring them up to the correct level having regard to the erosion in the value of money.
If there was ever a case for an automatic indexation in regard to the basic rights surely the case exists in respect of the non-insured. The least well-off category in the community has to wait for a period of practically five years to have their basic rights established in regard to the health services that the rest of the community owe this category above any other category in the State. If there is an aspect of administration that shouts loud and clear for indexation surely it is this area. The Minister could with his officials, devise some system of automatic readjustment in regard to limits for health services generally.
This also applies in the case of the insured category, although the complaint in that case is not as serious in that their limits are in operation since April, 1974, which is two years ago and not five years as in the case of the unfortunate non-insured people. The Minister recognises their position by lifting the limit from £2,250 to £3,000—again, doing just the bare minimum to adjust the limits in the case of insured employees with the erosion in the value of money.
I welcome the removal of the anomaly between insured manual and non-manual workers. This was quite clearly an anomalous position and it is to be welcomed that they are now on the same level of £3,000 and I hope that that will continue to be the case. I am sure it will.
In the case of the insured workers I would ask the Minister to comment on an indexation system also, an automatic readjustment in the case of insured workers who find themselves moving out of the category of entitlement due to increased wages and the erosion of money and inflation but who, although their real wages remain the same, find themselves deprived of rights. I would like to hear what the Minister has to say on these two aspects because I believe there is an aspect of fundamental natural justice here. The Minister has failed lamentably to achieve the ideal of complete socialisation of all health services, but that is a separate matter. I realise that due to the basic fact of financial exigencies complete socialisation of medicines cannot be achieved. But short of achieving that ideal the basic matter to which we should attend—no matter who is in Government, be it a socialist or conservative Government; Fianna Fáil or Fine Gael-cum-socialist Government—is to ensure that our existing services give value and that they do what they set out to do, that is, to ensure that the lower-income group get the full range of medical services that are available, that the middle-income group get their entitlements and that overall the scheme of medicine and health services which is operating in Ireland today works. That is the very least that a socialist Minister for Health should bend his energies towards achieving. The Minister, as I have said, subscribes to the ideal of complete socialisation but that has failed under his aegis during the past three-and-a-half years. The minimum that should be achieved is that the existing services give value and give the highest degree of social justice within the ambit of the existing legislation and administration. This means having hospitals properly staffed, having the existing services functioning properly and not cut in any way as they have been in many areas during the past few months. It means above all else that what is enshrined here in these regulations, that the limits under which the present health services operate, are real limits. In other words, that the people who are entitled are not pushed out of entitlement, month in, month out, by the erosion in the value of money.
The Minister brings in these regulations at a late stage. This is just not good enough. It means that far from improving health services, over the past five years they have steadily diminished in that a category of people have steadily worked out of the area of health and medicine to which they are entitled. On the Minister's own admission, that is the purpose of these regulations. At this late stage, that, at least, is to be welcomed; that we see here recognition of the facts of life in regard to the erosion in the value of money. We see now a restoration of rights to people that existed five years ago. We are merely restoring the position in the case of non-insured people that they had five years ago and in regard to insured persons that they had two years ago.
I would ask the Minister in his reply to comment on my suggestion of having some form of automatic regulator or indicator or adjustment system that would keep people within eligibility even though wage rises and the fall in the value of money may push them out of it.
I suppose there is no useful purpose in saying that under the previous regime the intervals after which reviews took place were in many cases much more than five years. That is no consolation and I do not want to go into the past.
I agree.
The Minister is right but the inflation rate then was nothing like what it is now.
I agree. No doubt that point will be made often during the debate next week on the Appropriation Bill. However, I do not think Senator Lenihan really appreciates what the position has been. It is not a question of people's rights being eroded either since April, 1974 or since September, 1971, because I should explain that those who were earning less than £2,250 in April, 1974, were eligible for limited services in hospitals' outpatients' infant-care service and so on. But although that amount was exceeded they did not suffer any loss whatever because the provision was that they had a period of approximately two-and-a-half years during which they would stay eligible even though the £2,250 was exceeded. They were entitled to the services for the balance of their insurance year when they had the last stamp and for two years after that.
Therefore, since the period April, 1974, none of these people has had any of the services withdrawn from him. That may not be spelled out. I do not think it is spelled out but I want to assure Senator Lenihan that the 85,000 persons we are talking about were the number who were included in that particular period and that there was nobody at all who suffered. The intention now would be that the same system would carry on and, if the £3,000 is exceeded during a particular period, that those people who exceeded that amount would not suffer either. The categories are different.
It is legitimate criticism for the Senator to say there was no change in their income limit from £1,600 since September, 1971 but I think the Senator, as one who travels his constituency or his prospective constituency, would know that in all these cases the CEO's examine the means of the applicant and although the income exceeds £1,600 the hardship clause is applied. The CEO has the right to do this and I have yet to get many complaints to the effect that people were barred from these services by reason of the fact that their income exceeded £1,600. It has been said that, in order to regularise the position, this might have been done in 1974. But these people are somewhat different from the insured groups. I would agree with the Senator that there is a case for consideration of this category and possibly to have their income reviewed on, say, a yearly basis.
The speech is self-explanatory. As I said, it is not a question of the erosion of entitlement of people since April, 1974, or indeed September, 1971. The only purpose of the regulations is to ensure that those people who are now covered will be covered for the future for approximately three years in the case of men and two-and-a-half years in the case of women. I take the point made by Deputy Lenihan that those who are in the non-insured group would need to have their case specially looked at to ensure that there is no hardship, even though, as I said, the hardship clause can be applied by the various CEO's.
Question put and agreed to.