Mr. Tony O'Brien:

I, too, welcome the invitation to attend this meeting, in advance of which a report on medical cards was submitted to the committee. I am also aware that members of the committee have received the briefing material which has been the subject of briefings in the Oireachtas this week. I will, therefore, be brief in my opening statement.

Eligibility for a medical card or a GP visit card is determined on the basis of an assessment of financial means. If an applicant's means are above the financial thresholds set out in the national guidelines, the HSE examines for any indication of circumstances, medical or social, which might result in undue financial hardship. Eligibility may be granted on a discretionary basis if these circumstances are such that a person cannot access general practitioner or other medical services without undue financial hardship. There can be a significant crossover between social and medical circumstances and applications do not fall discretely into these specific categories. The process whereby the application of discretion may be considered includes a review by HSE medical officers led by a principal medical officer.

Almost 2 million people are covered by either a medical card or a GP visit card. This means that 43% of the population have medical cards or GP visit cards, with the number of people with eligibility having increased by 74% since January 2005. The HSE continues to make significant progress in the reconfiguration of this key component of national health infrastructure. The medical card centralisation project which commenced in 2011 has been successfully delivered. Medical card processing is now carried out, with single national governance, at a central office location, compared with 100 locations in the past. Customer service processes, assessment of applications and reviews, correspondence and the application of discretion are now operated in a consistent and equitable manner across the country.

Turnaround performance in processing medical card applications is reported online each week. This reporting confirms that the HSE continues to surpass the turnaround rate of 90% processed at 15 days. For example, as of 14 October, more than 96% of complete applications had been processed in 15 days. It is important to stress that eligibility for a medical card is founded on the undue financial hardship test. The HSE must operate within the legal parameters as set out in the Act, while also responding to the financial, medical and social circumstances and complexities faced by individuals who apply for a medical card. In parallel with a focus on service provision and improvements in customer service and efficiency, the HSE is also focused on its public accountability role in the overall management of the medical card scheme. New legislation passed in March created the legal basis for the sharing of records with Revenue and the Department of Social Protection. This will allow for further improvements in the management of the medical card system and offers an additional assurance that medical card eligibility continues to be provided for people appropriately in line with the national assessment guidelines for eligibility.

The availability to the HSE of data indicating changes in a medical card holder's circumstances such as change in employment status, income levels and a change in eligibility for Department of Social Protection schemes will inform the HSE in focusing reviews on subsets of the register to identify clients who may no longer be eligible. The introduction of these additional controls will strengthen the risk management framework for the scheme. I assure members that the assessment arrangements are designed to ensure people who are eligible for either a medical card or a GP visit card receive it quickly and efficiently and equally to ensure those who are not eligible to receive or retain a medical card do not.

Each month the HSE analyses the medical card register to identify those medical card-GP visit cards which are scheduled for review within three months. We have increased this timeline to four months in respect of those clients who were granted eligibility on the basis of discretion in order to allow an additional month to ensure all pertinent medical and other data are provided for inclusion in the assessment process. All customers scheduled for review are notified and a process of either full reviews or self-assessments is conducted.

The HSE will continue the focus on medical card probity into 2014. In the nine months between January and September this year, we initiated 428,682 medical card reviews, and we plan to more than double this level of review activity in 2014. Since the guidelines have been substantially reduced for those 70 years and older, we are required to review the means of over 350,000 individuals in this cohort completely, with the exception of those reviewed in 2013 and where income levels are already held on file by the HSE. We estimate that approximately 10% of the individuals concerned will be provided with GP visit eligibility in place of full eligibility.

Since centralisation, 106,828 individuals whose medical cards have been inactive have been contacted requesting residence confirmation. As of 1 October, 68,333 individuals, or 64%, had confirmed residence and eligibility was removed for 38,495 people, or 36% of the cohort. The Comptroller and Auditor General commenced an examination of the medical card system in June 2013 and completed it in September 2013. The audit report produced six recommendations and these have been fully agreed by the HSE for implementation.

This concludes my opening statement on medical cards but I should mention, with the Vice Chairman's permission, that with regard to the section 38 audit that has been discussed, we have been in a position to provide the report to the committee and in due course we look forward to discussing it.