Mr. Joe Ryan:

I thank the Chairman and members for the invitation to discuss the operation of the medical card scheme. I am joined by my colleagues, Mr. Shaun Flanagan, assistant national director of the primary care reimbursement service, PCRS, Dr. Joseph Green, assistant national director and national oral health lead in HSE operations, and Ms Kate Halliwell, head of our national medical card unit in PCRS.

The PCRS is responsible for ensuring that eligibility is in place for qualifying persons for primary care schemes such as the general medical services scheme, the drugs payment scheme, the long-term illness scheme, the dental treatment services scheme, DTSS, and other schemes and arrangements. These schemes and reimbursement arrangements are essential to the operation of the health service.

PCRS is also responsible for making payments to primary care contractors, suppliers of essential high-tech medicines and acute hospitals and others across a range of schemes and arrangements. The proportion of the HSE’s budget for 2021 that PCRS is responsible for amounts to €3.269 billion. We constantly focus on patient and service user experience in using the services of PCRS. It works hard to make the best use of its resources, and as a result, its administration costs represent less than 1.5% of all costs over the past decade.

The past 12 months have been unprecedented and Covid-19 has had major impacts across all sectors of society. It is important to reference the challenges that Covid-19 has presented to the primary care reimbursement service and the efforts made to address those challenges.

Throughout the pandemic, PCRS has ensured that all necessary eligibility and reimbursement systems to underpin the arrangements for existing health services are in place and has sustained its performance in meeting key performance indicators. Important new Covid-19 services, negotiated with and provided by our primary care contractors, have been put in place in a timely manner to enable key elements of the overall HSE Covid-19 response.

The staff of HSE PCRS have responded admirably throughout the pandemic to new needs and new work streams. PCRS staff were called upon and responded to multiple other Covid-19 initiatives in support of colleagues. This included the national ambulance service testing of patients and staff in nursing homes, co-ordinating the booking of Covid-19 vaccinations for GPs and their staff and providing pharmacy support to mass vaccination clinics.

Over the past 12 months, applications for new medical cards or new GP visit cards have remained reasonably consistent with historical patterns, with on average between 3,000 and 4,000 new applications being handled weekly. In the early phases of the pandemic, while new applications continued to be processed, the HSE suspended reviews of existing cards. This was because, first, PCRS staff were required to support multiple Covid-19 responses; second, PCRS wanted to reduce requests for GPs to complete the relevant sections of application forms; third, PCRS needed to be in a position to process the then expected large numbers of applications, which did not develop due to the significant economic supports put in place by Government, for new medical cards; and, fourth, PCRS staff needed to support new reimbursement systems such as the GP Covid-19 supports.

Reviews of medical and GP visit cards recommenced for cards that were due to expire from 31 August 2020 onwards. Of those cards, up to 80% of expiring cards have been automatically extended without requiring individuals to engage with the application process. Cards which are reviewed are those which are risk-assessed as more likely to not meet eligibility criteria.

As at 28 February 2021, 1,579,589 individuals held medical cards. This has increased from 1,544,374 medical cards on 1 January 2020. Some 531,121 individuals hold GP visit cards now compared to 524,494 individuals on 1 January 2020.

The PCRS is responsible for making payments to healthcare professionals such as general practitioners, dentists and pharmacists, for free or reduced cost services provided to the public. In 2020, PCRS received in excess of 80 million reimbursement claims from more than 7,000 contractors.

With regard to terminal illness cards, on 9 February, the Government decided to extend provision of medical cards to individuals with a terminal illness who have a prognosis of 24 months or less and have been certified by their treating consultant. It asked that the HSE put this in place as soon as possible. The card will be awarded to the individual for his or her lifetime and will not require a means assessment, nor will the card be reviewed.

Adult medical card holders have access to dental services under the DTSS through care provided by private dentists that hold DTSS contracts with the HSE. Medical card holders can choose which dentist they wish to attend. In a typical year, just over 30% of the eligible population receive treatment through the DTSS. In 2020, this level dropped to 22.4%, mostly due to the impact of the Covid-19 pandemic. Some 1,084,321 claims were received under the scheme in 2019, resulting in expenditure of more than €56 million. In 2020, 789,940 claims were received at a cost of €40.57 million.

An electronic claims system was introduced in late 2017. Currently, 67% of contractors claim online, with 74% of treatment items under the DTSS now claimed electronically. The HSE is aware that some medical card holders have experienced difficulties in accessing treatment under the DTSS. Wherever this is made known to the HSE, each inquiry and representation is followed up by local community services which seek to assist medical card holders. As well as assisting medical card holders, the executive is working closely with the Department of Health on the operation of the scheme and difficulty faced by some patients. The executive liaises with the Department on a regular basis. This concludes my opening statement.