Mr. Patrick Burke:

In any given month, we could also have 10,000 new applications as well as having to conduct 60,000 reviews of medical card eligibility. As part of the review process, a person with a medical card may now become eligible only for a GP visit card. People may appeal decisions and be granted a medical card on appeal. There is an absolute melting pot of activity in any particular month.

When we write to individuals, the person may have decided that he or she is no longer eligible and does not respond to the communication. We had a separate exercise in which we wrote to individuals who were not using their card and if they did not respond and did not confirm residency, we took them off the register. On our database we have 2 million people between medical card and GP visit card holders. Another 1.5 million people are registered under the long-term illness scheme, drugs payment scheme, Health (Amendment) Act. In total the central register would have 3.5 million plus unique clients. Even though access and touch off the service happens quite a lot, the address could be wrong. Incorrect addresses could be an element of the reason for non response. To safeguard the individual, we agreed with the Irish Medical Organisation and GPs, that if we had written to a client twice and if our address was wrong, when the client approached the GP, the GP could then move their eligibility for three moths to give them the opportunity to talk to the HSE. We put that measure in as a safety blanket. In the melting pot of transactional activity, there is churn, when people are fit and well they do not realise their card has expired and when they turn up at the GP, the GP realising he is not getting capitation urges them to get in touch with the HSE system and we assess their eligibility.