Dr. Bridget Johnston:

Following on from Professor Thomas's comments on efficiency, quite often people will say that we have to charge because if we do not - as the Senator said - then people may not use medication the way they should or they may visit the doctor when they do not need to. People do not necessarily know when they need care so it is better for them to access it and be sure of what is going on. It is about weighing the choice between unnecessary utilisation, making sure people do not go to the GP, do not take a drug they do not need or fill a prescription they do not use and crowding out those people who actually need to access care. We might look to improve efficiency on the one hand but we could end up with a very inefficient outcome in terms of people not accessing care until their problems are quite complex, or accessing the care in a scenario that could have been dealt with much earlier. We need to be careful. There is no evidence of a sweet spot for charges that somehow eliminates all the unnecessary utilisation but does not keep people from accessing care they way they need to and in its most appropriate setting. There is evidence in Ireland that charges prevent people adhering to their medication and keep the poorest and sickest from visiting their GP. The charges are a direct deterrent. It is not necessarily true that introducing charges or maintaining charges at all costs will keep utilisation to only the necessary components. With free GP access there has been an increase in demand because of the access for children under six, and due to the expansion of care, but there is also a call in the Sláintecare report for increased primary care capacity and increased GP capacity to meet these needs, along with increased palliative care, home care services and other services to complement those needs. It is not just up to the GP. The GP can work with other healthcare professionals in tandem to provide this.

On the drugs issue, it is important to note that these medications will not be free under Sláintecare, but they are going to be affordable. People who are on medical cards or GP visit cards, or with other types of safety nets, should not pay a charge that we have already deemed they are unable to afford. They received a medical card because they are low income, or they have a chronic illness and cannot afford these. For households that have a certain amount of affordability for these drugs it is proposed that they are not charged more than that. We have pushed the thresholds up over the last number of years to a level that is not sustainable for many households.