James Reilly (Dublin North, Fine Gael) | Oireachtas source

I move: "That the Bill be now read a Second Time."

The Health (Alteration of Criteria for Eligibility) (No.2) Bill 2013, on which I look forward to hearing Deputies' views, amends the Health Act 1970, as amended - principally sections 45A and 48A - to take account of the changes to the eligibility criteria for medical cards for persons aged 70 years and over as announced in budget 2014.

The 2014 financial provision for the health services is €13.66 billion, including €397 million in capital expenditure. This provision also includes savings measures amounting to €666 million. This year's provision is some €360 million less than was provided in 2013 and represents a 3% reduction in funding. As a result, 2014 will be the most challenging year yet for the health services. However, I can assure Deputies that despite the need for significant and difficult financial savings, maintenance of safe, quality health services will be as much a priority for the Government in 2014 as it is in 2013.

It has been, and most assuredly continues to be, the Government's intention that front-line health services be protected to the greatest extent possible. I have made clear that the provision of safe, quality services in a timely fashion is my top priority. We are continuing to build on the ongoing measures to achieve savings through efficiencies and reorganisation under the public service agreement, curtailing the growing cost of pharmaceuticals and increasing income generation. None the less, the level of savings required means that Government has had to make some very difficult decisions. The Government continues to ensure a reduction in the cost of services while maintaining safe services to ensure that the most vulnerable are protected.

The General Medical Service scheme, GMS, is one of the areas identified in budget 2014 in respect of which savings are required. As Deputies will be aware, the GMS scheme comprises GP services and prescription drugs as well as some other services provided to holders of medical cards or GP visit cards. Over recent years, there has been a significant expansion in the GMS scheme. It now costs in the region of €2 billion per annum and a number of steps are being taken to reduce this cost.

At the end of September 2013, approximately 1,990,000 people qualified under the GMS. Medical cards at 1.86 million or 93% of the total make up the majority of this number. At the end of 2005, there were 1.16 million medical card holders, which is an increase of over 60% or 700,000 individuals. At end 2005, only 27% of the national population held medical cards. Currently 40% of the population now holds a medical card, which is reflective of the nature of our economic meltdown under the previous Government. Medical cards for persons aged 70 years and over account for about 350,000 or 19% of all medical cards. The total cost of GMS services provided to over 70 medical card holders is approximately €750 million per annum, which represents over one third of the total cost of the GMS scheme.

Under the Health Act 2008, special eligibility rules applying to persons aged over 70 years were put in place and are more generous than those applying to the standard means test medical cards. It is estimated that there are approximately 379,000 people aged over 70 in the State. Given that there are currently approximately 350,000 medical cards issued to people aged over 70, medical card coverage of the over 70s population is approximately 93%. In comparison, medical card coverage of the under 70s population is approximately 36%.

In the recent budget, changes to the over 70s eligibility criteria were announced to deliver €25 million in savings during 2014 from the expenditure on over 70s medical cards, which as I stated is in the region of €750 million annually. Under this proposed legislation, the income limit for an over 70s medical card is to be set at €500 per week, equivalent to an annual income of about €26,000 for a single person. For a couple, the income limit for the over 70s medical card is to be set at €900 per week, equivalent to gross annual income of almost €47,000. Those affected by these revised thresholds will qualify for an over 70s GP visit card. A single person over 70 years of age with a gross income of up to €700 per week or €36,000 per annum will continue to automatically qualify for free access to a GP. A couple over 70 years of age with a gross income of up to €1,400 per week or €72,000 per annum will also qualify for a GP service without fees.

In addition, under the drugs payment scheme, the HSE will meet the prescription drug costs of older people without a medical card who face drugs costs higher than the DPS threshold of €144 per month. This means that a single person aged over 70 years with a gross income of over €500 per week or a couple with an income of over €900 per week will have to pay no more than about €33 per week on prescription drugs.

It is estimated that under the new income rules about 35,000 people will have their medical card replaced with a GP visit card. It is necessary to reassure people in their 70s and older that we are implementing this measure in a manner that is intended to avoid affecting the most vulnerable of our elderly population. Out of every five people aged over 70 years, the four poorest will not be affected. It is useful to note that 10% of the over 70s who previously qualified for a medical card will now qualify for a GP visit card. Following implementation of this budget measure, only 7% of people over 70, those with the highest incomes, will not qualify for either a medical card or a GP visit card. Every person aged over 70 living on the State pension alone will still qualify for an over 70s medical card. The new income limits for the over 70s medical card is more than twice the level of the basic State pension of €230 per week for a single person and €436 per week for a couple. In other words, 93% of over 70s will continue to be covered for free GP care, either through a medical card or a GP visit card.

As I stated earlier, there has been a significant expansion in the GMS scheme and while the rate of increase in the numbers of people eligible under the GMS scheme has declined the overall number of people eligible has increased. We must ensure that those most in need can qualify for the service.

We have an obligation under the legislation to ensure the State is not paying for a service for those who are no longer entitled to it because their situation has improved. To this end, a critical element of probity in the medical card scheme is the ongoing review of client eligibility by the HSE. As I have said previously, that is not the only area where probity applies. It applies to the doctors working in the scheme. It applies to the pharmacists working in the scheme. It applies to the dentists working in the scheme.

Medical card probity measures were announced in the 2014 budget, whereby significant savings are to be achieved by improving the accuracy of the medical card system. This is about ensuring that those who are entitled to medical cards continue to hold them and that those who are not entitled to medical cards do not. I am aware that there has been public concern that cards may be indiscriminately withdrawn or cancelled. It is similar to the misconception that cards awarded on a discretionary basis are being withdrawn or refused arbitrarily. This could not be further from the truth. Let me dispel any misconceptions that might still exist. In line with the legislation there has never been an automatic entitlement to a medical card on the basis of having a specific illness or condition; there has been no change to the policy on discretionary medical cards in the past year; the scheme continues to operate in such a way that those who suffer genuine financial hardship as a result of a medical condition receive the benefit of a medical card; and notwithstanding the need to secure savings under the medical card scheme, nobody who is entitled to a medical card will lose it or be refused one. I again want to stress that no person meeting the eligibility conditions laid down in the legislation for a medical card will be affected.

We want people to be clear on their entitlements and this should help ease the fears of those who have been worried unnecessarily. To this end and at my request, the HSE devised a wide-ranging plan to improve the provision of information to the public about medical cards. On 30 October 2013, the HSE announced a communications campaign designed to raise awareness of the rules governing eligibility for medical cards. This is just one example of how the Government is focused on improving the health service. While it may not be affordable to provide medical cards to the entire population, the Government is committed to introducing, on a phased basis, a universal GP service without fees within its term of office, as set out in the programme for Government as an integral part of the road towards universal health insurance, and as laid out in the "Future Health" strategy framework.

The introduction of a universal GP service free at the point of use constitutes a fundamental element in the Government's health reform programme and the introduction of universal health insurance. A universal GP service will underpin the delivery of health care close to people in their communities, at the lowest levels of complexity and at the lowest levels of cost. This is a critical step on the road to universal health insurance and towards eliminating the two-tier health system. Free GP care for all will not address that on its own. Only universal health insurance can do that. We can end the two-tier system that has resulted in so much hardship for so many people who have real medical need, but not the means to pay for it. There is no disagreement on this side of the House that patients and citizens should be able to access medical care on the basis of their medical card, not on what they can afford to pay.

As announced in the budget, it has been decided to commence the roll-out of a universal GP service free at the point of use, by ensuring that all children aged five and under will have access to a GP service without fees. Including the 93% coverage of the population aged over 70, this will mean that almost half of the population will have access to GP services without fees. As I restated recently, the Government is committed to achieving the goal of a universal GP service before spring 2016.

I commend this Bill to the House and look forward to hearing the views of Deputies.

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