Alex White (Dublin South, Labour) | Oireachtas source

The medical card scheme cost in excess of €1.9 billion in 2012 and, by the end of 2012, 1.85 million people were covered by the scheme, an increase of half a million people since 2008. It is expected that the total will reach 1.9 million by the end of this year.

Under the provisions of the Health Act 1970, medical cards are not awarded on the basis of having a specific illness or a specific disease. Rather, they are provided for persons who, in the opinion of the Health Service Executive, are unable without undue hardship to arrange general practitioner, GP, services for themselves and their dependants. The assessment for a medical card is determined primarily by reference to the means, including income and reasonable expenditure, of the applicant and his or her partner and dependants. The assessment guidelines were published by the HSE in 2009 and are publicly available on the HSE's website. Under the current legal framework, there is no automatic legal entitlement to a medical card solely on the basis of a specific illness.

However, under the Health Act, there is provision for discretion by the HSE to grant a medical card where a person's income exceeds the income guidelines. The HSE takes a person's social and medical issues into account in determining whether "undue hardship" exists for a person in providing a health service for themselves or their dependants. The HSE recently set up a clinical panel to assist in the processing of applications for such discretionary medical cards, where there are difficult personal circumstances. This approach recognises the need to have in place a standard process for considering applications in respect of people who, while over the income guidelines, require a discretionary assessment on the basis of illness or undue financial hardship.

There are no proposals to revise the criteria under which medical cards are granted. However, the programme for Government commits to reforming the current public health system by introducing universal health insurance with equal access to care for all. As part of this, the Government is committed to introducing, on a phased basis, GP care without fees within its first term of office. Legislation is currently being drafted by the Office of the Attorney General and the Department to extend access to GP services without fees to persons with prescribed illnesses and it will be published shortly.

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