Dr. Ambrose McLoughlin:

I thank the committee for the invitation to assist in the examination of Chapter 22 - eligibility for medical cards. I welcome the opportunity to bring clarity to the legal position regarding such eligibility. As Secretary General of the Department of Health, I strongly endorse the recommendations pertaining to eligibility outlined in the Comptroller and Auditor General's report.

I will begin with some factual information regarding medical cards. It may be useful for Deputies to know that, as of 1 October, 1,864,509 medical cards were issued by the HSE. This represented an increase of more than 60% in the number of medical cards, or 700,000 individuals, since the end of 2005. More than 40% of the national population hold medical cards compared with 27% at the end of 2005. Between 2004 and 2012, when medical card coverage rose from 27.7% to 40.4% of the population, unemployment rates increased from 4.3% to 14.4%.

This indicates a high correlation between these two variables. Therefore, as the economic position improves, resulting in more people returning to employment, we should expect to see a marked decrease in the number of medical cards issued.

As Deputies may be aware, the legislation governing the medical card scheme, section 45 of the Health Act 1970, as amended, allows for persons who are unable, without undue hardship, to arrange a general practitioner's service for themselves or their family to qualify for a medical card. Under this legislation, the determination of eligibility for a medical card is the responsibility of the Health Service Executive. Section 45 requires the HSE to have regard to the overall financial circumstances of a person and his or her spouse or partner in view of their reasonable expenditure. The HSE gives effect to the legislation and the Government's policy through its medical card national assessment guidelines. Where a person's income is in excess of the thresholds set out in the national assessment guidelines, the HSE uses its discretion to grant a medical card to a person who is unable, without undue hardship, to arrange a GP service. In doing so, it is obliged to have regard to the financial position and expenditure of the individual and his or her dependants.

To dispel any misconception that there still might be, I want to clarify that, in line with the legislation I have just outlined, there has never been an automatic entitlement to a medical card on the basis of having a specific illness or condition such as cancer. While there may be criticism of that approach, the correct interpretation is very clear from a reading of the legislation which has been in place for a considerable period of time.

There is an additional arrangement available to persons aged 70 years and over to establish their eligibility for a medical card. Persons over 70 years of age can also qualify for a medical card on the basis of a gross income test. Under the legislation, individuals aged over 70 years with a gross income not exceeding €600 per week qualify for a medical card. Couples over 70 years of age with an income not exceeding €1,200 per week also qualify for a medical card.

Medical card processing was centralised at the HSE Primary Care Reimbursement Service, PCRS, in July 2011. This system facilitates standardised, homogeneous and equitable assessment of all applications, irrespective of the origin or nature of the application. In previous years there was a decentralised process which led to inequities throughout the country. Medical cards may have been awarded on a discretionary basis in some geographical areas and not in others because of the lack of a centralised and standardised approach. This resulted in having regional and local areas in which there were high numbers of medical cards above what one might have expected. The assessment procedures used to determine eligibility for medical cards and GP visit cards has not changed, rather, through the centralised processing of applications where discretion is exercised, it is now applied equitably and consistently based on standard operating procedures, with medical officers assessing medical evidence for cost and necessary expense. The HSE has in place a process whereby a team of medical doctors, unrelated to the patient, assess his or her situation and grant or decline a discretionary medical card on a medical basis. Previously, different approaches may have been used in different parts of the country, resulting in an inequitable distribution of discretionary medical cards. With this standardised process there is fair and equitable treatment for all. This ensures the scheme operates to enable those who suffer financial hardship as a result of a medical condition to receive the benefit of a medical card.

For the record, persons in receipt of a medical card may also be entitled to the following additional benefits: exemption from paying the health portion of social insurance, PRSI; free transport to school for children who live three miles or more from the nearest school; exemption from State examination fees in public second level schools and financial assistance with buying school books. Under section 49(1) of the Health Act 1970, as amended, there is an obligation on medical card holders to advise the HSE if there is a change in their circumstances that could affect entitlement to a medical card. This provision, allied with data sharing legislation which came into effect in March 2013, allows the sharing of personal data between the Revenue Commissioners, the Department of Social Protection and the HSE which will result in a higher level of compliance and an overall reduction in the amount of medical cards issued.

The scheme has been in existence since the 1970s and benefited millions of citizens. I would like members to note this point. I assure Deputies that there has been no change in the past year to the qualifying criteria for discretionary medical cards. Notwithstanding the need to secure savings under the medical card scheme, it is important to note that nobody who under the legislation is entitled to a medical card will lose it or be refused one. I thank members for their time. I am happy to answer questions they may have.