Alex White (Dublin South, Labour) | Oireachtas source

I thank the Deputy for raising this issue. The long-term illness, LTI, scheme is a non-means-tested scheme which was introduced in 1971. It provides free medicines and medical and surgical appliances for people with specified conditions. The conditions covered by the scheme are: mental handicap, mental illness - under 16 years only, phenylketonuria, cystic fibrosis, spina bifida, hydrocephalus, diabetes mellitus, diabetes insipidus, haemophilia, cerebral palsy, epilepsy, conditions attributable to the use of thalidomide, multiple sclerosis, muscular dystrophies, Parkinsonism and acute leukaemia. Down's syndrome is classed as a qualifying condition under the mental handicap heading of the scheme. Persons diagnosed with Down's syndrome are supplied with an LTI scheme book and receive prescribed medication associated with the condition free of charge. However, autism is not a qualifying condition under the scheme.

Mental illness, under 16 years, is one of the illnesses covered under the long-term illness scheme. Previously some HSE areas regarded attention deficit hyperactivity disorder or ADHD as a form of mental illness for the purposes of the scheme, while others did not. The Ombudsman examined the operation of the scheme with reference to ADHD on foot of a complaint and issued a report to the HSE in July 2013 with recommendations for implementation by the end of October that year. In particular, the Ombudsman recommended that a uniform policy be put in place on ADHD across the country. The HSE advised the Ombudsman on 15 August 2013 that it accepted the findings made in the report and the recommendations in principle. Subsequently, it issued appropriate national guidelines for the uniform administration of the scheme. Implementation of the guidelines will ensure all children with ADHD are treated equally when they apply for a long-term illness scheme book.

There are no plans to extend the list of conditions covered by the long-term illness scheme. People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. In the assessment process the Health Service Executive can take into account medical costs incurred by an individual or a family. Those who are not eligible for a medical card may still be able to avail of a GP visit card which covers the cost of a general practice consultation. Non-medical card holders and people whose illness is not covered by the scheme,can use the drug payment scheme which protects against excessive medicine costs. Under this scheme, no individual or family pays more than €144 per calendar month towards the cost of approved prescribed medicines. The scheme significantly reduces the cost burden for families and individuals incurring ongoing expenditure on medicines. In addition, non-reimbursed medical expenses can be offset against tax.

The Government is embarking on a major reform programme for the health system, the aim of which is to deliver a single tier health service, supported by universal health insurance, where there is fair access to services based on need, not ability to pay. The programme for Government commits that everyone will have a choice of insurer. Under the universal health insurance scheme, everyone will be insured and have equal access to a standard package of primary and acute hospital services, including acute mental health services. A new national insurance fund will subsidise or pay insurance premiums for those who qualify for a subsidy. Intensive work is under way on the preparation of a White Paper on universal health insurance which will provide more detail on the UHI model for Ireland, including its overall design, the standard package or basket of services, funding mechanisms and the key stages of the journey to universal health insurance.

The Government is also 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 and the future health strategy framework. Work is under way on legislation in that regard to offer a contract to general practitioners for the provision of this service.

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