Alex White (Dublin South, Labour) | Oireachtas source

I thank Deputy McGrath for raising this issue. Recent reports have stated that approximately 1,000 children with Down's syndrome - the Deputy said 100 but that might have been a mistake on his part or perhaps he was referring to a different report - have lost their medical card. I assure the Deputy that there is no policy or practice, in the context of medical card renewals, to target children or adults who have Down's syndrome.

The primary care reimbursement service, PCRS, which now processes all medical card applications and renewals, does not have any indicator on its clients registers that would identify people with Down's syndrome. That is the reason it is simply not possible to answer one of the Deputy's questions, which was how many people with Down's syndrome had lost their medical card in the last period. It is impossible to ascertain that. The way the records are kept in the PCRS does not categorise applicants in accordance with their medical condition. Even if the PCRS or the HSE wished to target people with particular illnesses or conditions for the removal of the medical card, they would be unable to do so. I can arrange for a briefing for the Deputy in this regard because this is something I was very anxious to ensure I understood. In fact, I was at the PCRS in Finglas a few days ago for a general meeting and briefing.

The applicants and those who have whole medical cards are not categorised in the system in accordance with their illness or condition. Even if somebody wanted to target people with particular conditions, which would be perverse, they could not do so because the system is not set up in a way that categorises people in accordance with a particular illness or condition.

I might add that this situation obtains to other medical conditions, including diseases and disabilities. There is no system in place that would enable people with particular disabilities or diseases to be targeted for review or discontinuation of medical card eligibility. The reason for that is that medical cards are provided to persons who, in accordance with the provisions of the Health Act 1970, as amended, are in the opinion of the HSE unable without undue hardship to arrange GP services for themselves and their dependants. Therefore the 1970 Act established a financial means assessment. The legislation has been in place for over 40 years. No Minister can override that decision of the Oireachtas that medical cards are essentially issued on the basis of financial means. They are issued to people on the basis that if they did not have a medical card they would suffer undue hardship in arranging for GP services for themselves or their dependants. That is the law under the Health Act 1970. The only way the situation can be changed would be for the legislation to be changed.

The Deputy will be aware that under the legislation, since 1991, the assessment for a medical card is determined primarily by reference to the means, including the income and reasonable expenditure, of the applicant and his or her partner and dependants. In the case of a child, the parents' income and reasonable expenditure is assessed. Under the legislation, determination of eligibility for a medical card is the responsibility of the HSE.

The HSE has produced national assessment guidelines to provide a clear framework to assist in the making of reasonable, consistent and equitable decisions when assessing an applicant for the general medical services or GMS scheme. These guidelines are publicly available and can be downloaded from the HSE's medical card website. They include the net after-tax, after-expenses income guidelines for the awarding of medical cards.

While there is no automatic entitlement to a medical card for persons with specific illnesses or with a disability, the HSE has discretion to award a medical card to avoid undue hardship, having regard to a person's or family's overall financial situation, even where the person's income exceeds the income guidelines. It is important to correct any impression circulating that medical cards are issued automatically or irrespective of means, even if an applicant is suffering from a serious medical condition. The Deputy will be aware that the GMS scheme is a means-based scheme, rather than one based on having a specific illness, as a reading of the legislation makes clear.

The HSE has established a panel of community medical officers to assist in the processing of applications for medical cards on a discretionary basis, where the income guidelines are exceeded but where there are difficult personal circumstances, such as an illness or physical disability which would impact on the applicant's financial situation.

I see my time has run out but perhaps I can return to this later.

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