Tom Fleming (Kerry South, Independent) | Oireachtas source

This country's senior citizens took a significant hit in the Health (Alteration of Criteria for Eligibility) Bill 2013, which we considered in March of this year. It is estimated that as a result of the enactment of that legislation, up to €12 million will be saved at the expense of vulnerable sections of our society. Statistics show that older people make more use of their medical cards than the general population. Figures indicate that 94% of people over the age of 70 visit their GPs on a regular basis. They have a high intake of drugs and medicine to help them cope with their above-average rate of illness and disability. The plight of these people and thousands of others will be exacerbated by the budget cuts and the measures in the Bill.

It is proposed to downgrade the medical cards of 35,000 people over the age of 70 to GP-only cards, to remove or restrict the cover offered to tens of thousands of people under the age of 70 and to clamp down on excessive prescribing and dispensing by doctors, dentists and pharmacists. This harsh initiative is designed to save a total of €138 million, some €25 million of which relates to over 70s and the other €113 million of which was categorised in the budget as relating to "medical card probity", which is a very vague term. Under the new thresholds for full medical card eligibility that will apply to the over 70s, a single person with a weekly income of over €500 or a couple with a weekly income of over €900 will lose their medical cards. Instead, they will get a GP card which merely entitles them to visit the doctor.

There is a glaring anomaly in the new eligibility criteria with regard to married couples over the age of 70. The new system for assessing applicants sets a limit of €500 for a single person. In the case of a married couple, the limit has been reduced to €900. I believe this discriminates on the grounds of marriage. It is probably illegal under the Equal Status Acts. Perhaps the Minister for Health should ask the Attorney General to review this. The question of whether this measure is illegal should be examined. Clarification should certainly be sought. I propose that the threshold for couples should be increased to the right amount of €1,000, rather than being set at €900.

The increase in the prescription charge to €2.50 per item will impose a significant additional burden on medical card holders, especially those who are on many forms of medication. Some people are on four or five medications for complex problems. Some of these people are in financial hardship, naturally. This increase will deter those who are finding it hard to make ends meet from going to get their prescriptions looked after and seeking the proper medicine. This certainly needs to be reviewed.

I would like to speak about eligibility for discretionary medical cards. The number of cards provided on the basis of discretion has decreased dramatically since 2010.

In 2010 some 80,500 qualified for these cards. Over the past three years this number has plummeted down to just 50,000. Discretionary cards based on financial hardship and exceptional medical needs have always been a feature of the medical card system. However, there is anecdotal evidence in abundance to suggest that discretionary medical cards are more difficult if not almost impossible to obtain and this has been the case in the past six months in particular.

The move to deprive non-terminal cancer sufferers of these cards is imposing further anguish and stress on these people. It is having a psychological impact if they are in danger of losing their medical cards when they also have to try to cope with their ongoing illnesses and in many cases deteriorating conditions.

In the past people with lifelong illnesses such as cystic fibrosis, multiple sclerosis, motor neuron disease, cerebral palsy and cancer were always granted discretionary medical cards on compassionate grounds. Now those who suffer with such conditions are asked repeatedly for information about their meagre income and their general means or assets. As a result the application process is very long and drawn out. Reviews are carried out and applicants may eventually be obliged to lodge appeals on the basis that they have a rapidly progressing illness. In the meantime their medical condition may have deteriorated further and may eventually prove terminal during that waiting time. Many things are not taken into account. The assessment for cards is very questionable particularly on the part of the medical people who are examining some really deserving cases.

Taking away the discretionary cards is not cost effective because it means that fewer patients can be cared for in their homes. In many cases they are becoming institutionalised prematurely. It is certainly leading them into hospital and institutional care much earlier than would be normal. To have a good quality of life these people desire to live in their own communities with the backup of their family and community care. While in their local environment they are much happier.

If the Bill is enacted I urge the Minister to ensure that future reviews of people who are under reassessment will be carried out in a sympathetic manner. Since the previous Health (Alteration of Criteria for Eligibility) Bill in March, the HSE has been extremely harsh and, I believe, irrational in its evaluations. In many cases it seems to be ignoring very valid further information regarding patients' medical conditions and financial hardships.

We should also be cognisant that these people are now burdened with overheads that are not taken into account in the normal assessment of need. For instance, we now have the local property tax, the abolition of the telephone allowance and cuts to the household benefits, and we will have the introduction of water charges. All these issues cause further deterioration in their living standards. We will need to change the assessment criteria to take account of all these matters which were not previously considered.

The cost of private health insurance is dramatically increasing for all age groups and this will also need to be noted in carrying out assessments.

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