Entitlement to health services in Ireland is primarily based on residency and 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. Other than persons aged 70 years and over who are automatically entitled to a medical card, 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/or their dependants without undue hardship. The chief executive officers of the boards/authority are currently reviewing numerous issues, including assessment of income, in the administration of the medical card scheme, and I understand that their findings and recommendations will be available in the near future.
Income guidelines are drawn up each year by the health board/authority chief executive officers to assist in the determination of a person's eligibility for a medical card and these are revised annually in line with the consumer price index, CPI. The last such increase was notified in January 2004, and the next increase is due by the end of this year.
In regard to the retention of medical cards on re-entering employment, as part of budget 1996, the then Government announced that persons who have been unemployed for at least one year shall retain their medical cards after entering employment. Persons on the live register for at least one year who take up paid insurable employment were deemed to meet the criteria for retaining their medical cards for three years. The provision also covers participants on approved schemes applicable to the long-term unemployed, including back to work allowance, BTWA, community employment, jobstart, job initiative, partnership and community group initiative and development courses such as workplace and vocational training opportunities scheme, VTOS. The purpose of the budget provision was to remove disincentives to labour force participation by long-term unemployed persons.
The retention of medical card eligibility is approved for a period of three years when a person or the spouse of a person who has been unemployed for a minimum of one year takes up employment. In this context, time spent on the live register, approved schemes or courses for the long-term unemployed is treated as an unemployed period.
Furthermore, it is the case that increases in social welfare rates in recent years have given rise to a situation where such rates may exceed the income guidelines for a medical card. Accordingly, my Department has written to the chairman of the Chief Executive Officers' Group on a number of occasions asking that he advise the CEOs of the concern that medical card holders should not be disadvantaged by virtue of increases in social welfare payments announced in the budget. They were asked to ensure that increases in social welfare payments do not lead to medical card holders losing their medical cards by reference to the income guidelines and to make every effort to ensure that both medical card holders and applicants are made fully aware that increases in social welfare payments will not disadvantage them when applying to hold or retain a medical card.
For those who do not qualify for a medical card a number of schemes provide assistance towards the cost of medication. Under the long-term illness scheme, persons suffering from a number of conditions can obtain the drugs and medicines required for the treatment of that condition free of charge. Under the drug payments scheme, a person and his or her dependants will not have to pay more than €78 in any calendar month for approved prescribed drugs and medicines.
Health board chief executive officers have discretion in regard to the issuing of medical cards and a range of income sources are excluded by the health boards when assessing medical card eligibility. Despite someone having an income that exceeds the guidelines, a medical card may still be awarded if the chief executive officer considers, on an individual case by case basis, that a person's financial needs arising from medical or social circumstances would justify this. 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.
The Government is fully committed to the extension of medical card coverage as set out in the health strategy. This will focus on people on low incomes. The timing of the introduction of the extension will be decided having regard to the prevailing budgetary position.
The health strategy includes a series of initiatives to clarify and expand the existing arrangements for eligibility for health services, including recommendations arising from the review of the medical card scheme carried out by the health board CEOs under the PPF which include: streamlining applications and improving the standardisation of the medical card applications process to ensure better fairness and transparency; providing clearer information to people about how and where to apply for medical cards; and proactively seeking out those who should have medical cards to ensure they have access to the services that are available.
In addition, my Department is committed to the preparation of new legislation to update and codify the legal framework for eligibility and entitlements in regard to health services.
