Dáil Éireann Debate, Thursday - 2 December 2004
1 Dr. Twomey asked the Tánaiste and Minister for Health and Children if the new doctor only medical card is a permanent feature of the GMS; the limitations which apply to the card; the additional resources she intends putting into primary care to ensure all new medical card and doctor only card patients will be able to avail of treatment under the GMS; and if she will make a statement on the matter. [32003/04]
Amharc ar fhreagraThe commitment to increase income guidelines to increase the number of persons on low incomes who are eligible for the medical card is contained in the health strategy. Families with children are a priority. In keeping with this commitment and the priorities for new health initiatives in 2005 both the income guidelines and the income allowances for children, in assessing eligibility for the medical card, will be increased in January 2005. The higher rate of increase in respect of the allowances for children is specifically aimed at assisting low income families with children in accessing primary care services. It is expected that in the region of 30,000 will benefit from this initiative.
The introduction of the doctor visit card provides free general practitioner services for individuals and families whose income will be up to 25% over the new medical card income guidelines. It is estimated that approximately 200,000 will become eligible for free GP services. Patients holding doctor visit cards will be or may seek to be assigned to particular doctors who hold general medical services contracts with local health boards. The new card is an entitlement to free general practitioner visits for those with otherwise limited category 2 eligibility. These new card holders are also eligible for the drugs payments scheme which provides that no person or family unit pays in excess of a current threshold of €78 per month, increasing to €85 per month from January 2005, for a range of approved prescribed drugs and medicines.
A sum of €60 million has been provided in the 2005 Estimates for these initiatives in primary care which will assist in overcoming barriers to accessing GP services for those on low incomes. This will also help remove poverty traps and disincentives to people taking up work or progressing to better paying work. An additional amount of €142 million is also being made available to meet the increased costs of the GMS. This represents an increase of 12%.
The Tánaiste did not deal with the core question. Is there a timescale on the doctor only medical cards? I fear patients could be worse off in the long term unless there is a timescale on them. They should be converted to full medical cards within a certain period. Patients will not benefit from the other services available with a full medical card. They could still end up paying €550 if they need to stay ten days in hospital and €1,000 per year if their medication costs more than €85 per month.
One subject that has not been broached in this discussion is the holders of discretionary medical cards who constitute a significant number with medical cards. What approach is the Minister taking to these cards? Discretionary medical cards are given to patients with a serious illness——
A question, please, Deputy.
I wish to explain this in case the Tánaiste does not fully understand it. A discretionary medical card is provided where the patient has a certain illness but is above the income threshold for a medical card. Will the Tánaiste ensure everybody who receives a discretionary medical card is given a full medical card rather than a doctor only card? The doctor only medical card might be used as a means of saving money by the health authorities. I hope the Tánaiste agrees every person with a discretionary medical card should have a full medical card.
The Tánaiste has not said what she will do in the primary care area to increase services for patients, especially now that an extra 250,000 will be included in the GMS scheme. In certain parts of north County Dublin which will be hugely affected by this change there is one general practitioner for every 2,500 patients. If certain areas become overloaded with extra medical cards, it could have a huge effect on the service.
The discretionary cards will remain full medical cards. There are 70,000 such cards in existence. Clearly, under the new unified system, there will be uniformity. There are varying gaps between regions. In some regions, by virtue of the discretion of the chief executive officer, a person might qualify while in another they might not. With a centralised system there will at least be consistency and uniformity.
It is not intended to convert the doctor only card into a full medical card. I strongly believe in the provision of graduated levels of services. I do not believe there should be one line where one gets everything and another where one gets nothing. This is a form of trying to give free doctor visits to the largest possible number on low incomes in order that they will not have to worry about taking a child to the doctor. Approximately 30% of those who visit doctors do not require follow up treatment and there is no prescription involved.
With regard to the primary care services, I am conscious of the huge gaps, not just in Dublin. However, in north Dublin there are huge gaps which we hope to address as part of our package for next year. There are many innovative proposals for providing GP services in the greater Dublin area, some of which involve collaboration with some of the insurers in the market. We need to examine all the proposals to ensure, for example, that a town such as Mulhuddart with 10,000 people is not left without a doctor, a pharmacy and basic facilities in the primary care area.
Does the Tánaiste——
Deputy, the six minutes for this question are concluded.
An important point was missed.
That may well be but there are only six minutes allotted. The Chair does not have a choice in the matter.
