Alex White (Dublin South, Labour) | Oireachtas source

I thank the Deputy for raising this issue.

I am somewhat unclear as to the specific procedure the Deputy refers to and I certainly was not aware of the proposal that he was going to make before I approached my response to his contribution to which I have listened very carefully. For the benefit of the House I will outline the procedure that is in place. The HSE, has a very structured protocol in place for the review process and every effort is made for ongoing engagement with persons during this process.

Under the Health Act 1970, eligibility for a medical card is founded primarily on the undue financial hardship test and every application must be assessed on that basis. Under the legislation, determination of an individual's eligibility for a medical card is the responsibility of the HSE. The Health Act 1970 obliges the HSE to assess whether a person is unable, without undue hardship, to arrange GP services for themselves and their family, having regard to their overall financial situation and reasonable expenditure. Under the legislation, having a particular illness or medical condition in itself does not establish eligibility for a medical card. That is the law.

All medical card and GP visit card holders are subject to a periodic review of eligibility to determine continuing eligibility. The HSE makes every effort to provide a person with sufficient time to renew their eligibility. Each month, the HSE analyses the Medical Card Register to identify those medical or GP visit cards that are scheduled for review within three months. A review notification will indicate the card holder should complete a self-assessment or request the card holder to return evidence of household income, assessable outgoings and medical circumstances to enable a full review assessment to be conducted by the HSE. The Deputy has referred to that.

The HSE has increased this notification time to four months in respect of those persons who were granted eligibility on the basis of discretion. This is to allow an additional month to ensure that all pertinent medical and other data is provided for inclusion in the assessment process. A reminder letter is issued a month later if the requested review form details have not been returned at that point. If a person does not return the review form within the time specified, continuing eligibility cannot be confirmed and the medical card cannot be reissued. In these circumstances, or where the review process establishes that a person no longer holds eligibility, the eligibility ceases.

Persons are requested to return their completed review forms at least one month in advance of the due expiry date of their existing eligibility. This is to allow the HSE sufficient time to carry out the review and-or to get back to the individuals, if the application is incomplete or requires any further details to be furnished. Where a review form is returned, but not fully completed by the expiry date, it is HSE policy to extend the eligibility of the client for a reasonable period of time until the review is carried out and a final decision made on the person's continuing eligibility, once there is appropriate communication from the person concerned. Medical card holders who genuinely engage with the review of their medical card eligibility will not have their eligibility withdrawn before that review is complete.

In addition - this comes closer to the specific issue raised by Deputy Ciarán Lynch - a person's GP is kept informed of any review notifications of their patients. GPs are advised three months in advance of the review dates of their patients' GP visit cards or medical cards and, subsequently, the following month and the month after that, if the patient has not returned the review form by that time. GPs have full electronic visibility of the medical card panel of patients available to them and have the facility electronically to allow temporary extension of eligibility for expiring cards where a sensitive renewal is appropriate. The temporary extension may also be allowed where they are aware that a person is still availing of services but there may be something that prevents them from carrying out a standard review, for example, a blind person with little family support.

Given that over 40% of the population, or approximately 2 million people, qualify for a medical card or GP visit card, the scale of the administration of the general medical services, GMS, scheme is significant. Over 700,000 individuals were assessed by the HSE in 2013. Well in excess of 95% of applications were processed within the target of 15 working days. In view of the processes I have outlined, and the experience over 2013 that I mentioned I am satisfied that every effort is made to assist, support and facilitate persons undergoing review. I will consider carefully what the Deputy said with respect to pharmacists, and the involvement of GPs, who can extend the eligibility in certain circumstances. There is a different relationship between the GPs and their patient groups because in the GMS a GP has a list of his or her group which has its own integrity as a list associated with that GP. The same would not be the case in respect of pharmacists for the reason the Deputy has outlined. I will consider what he has raised. I did not have an opportunity to do so before he stood up but I will certainly consider it and come back to the Deputy.

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