Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

The Government rejects the notion that persons who were issued with medical cards on a discretionary basis are being deliberately targeted where their incomes exceed the HSE's income thresholds. Despite what Opposition Deputies have stated, there is no target to reduce the number of discretionary medical cards in the HSE's national service plan for 2013. It did not form part of budget 2013 and it is not Government policy. During the course of the debate last night and again tonight, there have been numerous references to automatic medical cards and medical cards awarded on the basis of medical need. As my colleagues stated last night, this is not the case. There is not, and there never has been, an entitlement to a medical card for a person with a specific disease or on the basis of medical need. Under the Health Act 1970, persons who are unable to arrange GP services for themselves or their families without undue hardship qualify for medical cards. Deputy Kelleher is familiar with that Act.

Applications for medical cards are considered by the HSE on the basis of an assessment of the applicant's means by reference to the HSE's national assessment guidelines, which set out the income thresholds. Where a person's income is within the guidelines, a medical card or a GP visit card will be granted by the HSE for three years in most cases. However, the HSE has discretion to grant a medical card where a person's income exceeds the income guidelines. The discretion must be exercised by the HSE but the fundamental provision in the 1970 Act is that a person is assessed on the basis of undue hardship in arranging a GP service, having regard to his or her means. I accept that the interpretation of that provision has changed over the years. Social and medical issues are considered when determining whether the individual faces undue hardship in accessing GP services.

The Deputies point out in their motion that the number of discretionary medical cards has decreased. The documentary evidence shows this is correct but, rather than its being a deliberate targeting as suggested by the Deputies, there is a valid and, indeed, logical and rational explanation. The HSE has indicated that there has been a decrease of approximately 24,000 in the number of discretionary medical cards between the start of 2011 and July 2013. Of these 24,000 people, nearly 23,000 have qualified for medical cards on the basis of their means assessment alone, with no need for discretion to be considered.

I can further clarify the figures. At the start of January 2011, there were more than 80,000 discretionary medical cards. In July 2013, there were more than 56,000 discretionary medical cards out of a total of almost 1.9 million medical cards. This shows a reduction on paper in the region of 24,000. However, of that 24,000, almost 23,000 have been awarded medical cards on the basis of their means assessments. As such, they have not lost their medical cards. The number of people who hold medical cards on discretionary grounds has fallen in recent years, largely because more people who previously were marginally over the normal qualifying income limit became eligible for medical cards under the normal qualifying scales. It is important to note that medical cards provided on the basis of means or where discretion is involved are identical and provide access to the same set of health services.

There is no target for reductions in discretionary medical cards in the 2013 HSE national service plan. Last night, it was stated that the service plan set a target to reduce discretionary medical cards by 40,000. This is incorrect. The plan reads: "Policy changes will reduce eligibility for approximately 40,000 people currently in receipt of medical cards, giving an anticipated net growth in 2013 of 60,000 medical cards." Note that I stated "medical cards" and not "discretionary medical cards". Due to the current financial climate, it was necessary to identity measures to mitigate the escalating costs of the medical card scheme. However, I assure the House that discretionary medical cards were not targeted in this regard. There has been no change to the qualifying criteria for discretionary medical cards in the past year and the scheme continues to operate in such a way that those who suffer undue financial hardship as a result of a medical condition receive the benefit of a medical card.

Contrary to the suggestion that we are targeting people who need our support, the Government has provided funding to ensure that an additional 220,000 people are covered by the general medical services scheme, GMS, since entering office. This means that more than 43% of the population has access to general practitioner, GP, services without any charge under the scheme, comprising 40.6% with medical cards and 2.7% with GP visit cards.

The HSE continues to issue medical and GP visit cards, with nearly 2 million people currently having access to free GP care. In fact, the number of people with medical cards has increased by approximately 45% since the start of 2008 when the current economic crisis began. This commitment to meet the additional financial costs of a greatly expanded medical card scheme makes light of any contention that this Government is targeting certain people.

See this speech in context