Tim O'Malley (Limerick East, Progressive Democrats)

I thank the Deputy for raising this matter. Eligibility for health services is primarily based on residency and means. Under the Health Act 1970, determination of eligibility for medical cards is the responsibility of the chief executive officer of the appropriate health board other than for persons aged 70 years and over, who are automatically eligible for a medical card.

Medical cards are issued to persons who, in the opinion of the chief executive officer, are unable to provide general practitioner medical and surgical services for themselves and their dependants without undue hardship. It is open to all persons to apply to the chief executive officer of the appropriate health board for health services if they are unable to provide these services for themselves or their dependants without hardship.

However, the principle that it is fair and reasonable that those who can afford to contribute to the cost of their long stay care should do so is central to our system of publicly funded long-term care. The health strategy reinforces this point and states:

It is recognised that quality care is expensive and that the bulk of the cost of providing a high standard of quality care should be borne by the exchequer. Nonetheless, it is fair that all those in receipt of publicly provided residential long-term care should make some payment towards accommodation and daily living costs, if they can afford to do so, just as they would if they were living in the community. This principle supports the aim to provide as high quality a service as possible and to make the most equitable use of resources and thus to help maximise the availability of these services.

The current position reflects this approach.

Charges for long-stay care in health board institutions may be raised under the Health (Charges for Inpatient Services) Regulations 1976, as amended in 1987. These regulations enable charges to be made towards the cost of providing hospital inpatient services for persons with income who have been in receipt of such services for more than 30 days or periods totalling more than 30 days within the previous 12 months. Inpatient service charges are payable only by persons with limited eligibility. Medical card holders are exempt from the charges, as are persons with dependants.

Charges may also be made under the Institutional Assistance Regulations 1965 where the patient receives "shelter and maintenance" rather than treatment. These charges apply from the date of admission and are payable by all patients in receipt of incomes, including medical card holders and persons with dependants.

Health boards have regard to the person's individual circumstances in deciding the amount to be contributed. Allowance is made for the financial commitments the person may have and a reasonable amount is left to meet the person's needs. Charges may be waived if, in the opinion of the chief executive officer of the appropriate health board, payment would cause undue hardship. Different arrangements apply to financial contributions from people availing of public long-stay care, as opposed to those accommodated in private nursing homes, for example, under the Health (Nursing Homes) Act 1990.

The health strategy, Quality and Fairness — A Health System for You, acknowledges the need to clarify and simplify eligibility arrangements and sets down a commitment to introduce new legislation to provide for the introduction of clear statutory provisions on entitlement and eligibility. A review of all existing legislation in this area has been carried out in my Department and this will inform the approach to the drafting of new legislation in this area. As part of this exercise, my Department will attempt to resolve the current differences in approach in the consideration of individuals' ability to pay under the various regulations in this area. My Department is consulting the Attorney General on these issues and will address this situation in light of the advice received. I trust this assists in clarifying the position for the Deputy.

See this speech in context