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

I thank the Deputy for raising this issue. To clarify, an additional €37 million in funding was made available in the budget for the specific purpose of providing free GP care for children aged six years and under. We are not taking money from anybody else to fund the initiative.

Under the Health Act 1970, persons who are unable, without undue hardship, to arrange GP services for themselves and their families can qualify for a medical card, having regard to their overall financial situation and reasonable expenditure. The Health Service Executive can only award medical cards in accordance with the Health Act and, therefore, must assess the overall financial situation of the applicant and his or her spouse or partner. The HSE gives effect to this legislation through its medical card national assessment guidelines. "Undue hardship" is ascertained through an assessment of financial means.

It is not legally possible to award a medical card by virtue of an illness or a disease. However, where an applicant or a member of his or her family has an illness or disease, medical costs and necessary expenses arising from that condition are taken into account in the assessment process for a medical card. Thus, people whose means are above the income limits but who face genuine hardship in providing GP care for themselves and their dependants may qualify for a medical card.

Recent media reports have referred to the reduction in the number of discretionary medical cards. I reiterate that there is no policy to abolish the awarding of medical cards on discretionary grounds or target any patient group.

The medical card scheme continues to operate in such a way that those who suffer undue financial hardship as a result of a disease or an illness are awarded medical cards. Last year I insisted on a medical team being put in place to review the position on discretionary medical cards in order that people's medical conditions would be taken into account in the context of the financial hardship to which they gave rise. While the number who hold medical cards on discretionary grounds has fallen in recent years, many individuals who previously were marginally over the normal qualifying guidelines have been granted medical cards. Only a small proportion of people with discretionary medical cards have been found to be ineligible for medical cards. While the number in this regard may be small, I in no way underestimate the difficulties caused for those who are considered ineligible.

We know that even where medical expenses have been taken into account, there will be some who are not eligible because their net income remains in excess of the guidelines, sometimes by as much as €1,000 a week. Some of the households in question include people with ongoing medical conditions and, in that context, I have asked the HSE to consider how best we can ensure such households receive all the supports available to them from the health system, within the relevant legislative parameters. The clear intention is to ensure people's entitlements to health services will be maximised to the fullest extent possible, especially where individuals may be facing significant medical expenses. This process is ongoing and I hope it will come to a conclusion in the near future.

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