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

It is important that Deputies understand the facts, and do not twist them so as needlessly to frighten people.

Since the Government came into office, approximately 6% of those who held medical cards issued on a discretionary basis in March 2011 have been found ineligible. In other words, the vast majority still have a medical card.

Of those who had medical cards issued on a discretionary basis in March 2011, approximately one third still have a medical card because the Health Service Executive has exercised discretion. Moreover, nearly 50% of them still have a medical card because their income is below the guideline and there is no need for discretion to be applied. However, that does not suit the story from the Deputies opposite. The balance, approximately one eighth of the total, lost eligibility as they did not respond to the renewal notice, did not complete the review process, were deceased or other family members were awarded a card.

I assure Members that I am very concerned about these cases. As a medical doctor, I know only too well the worry and practical difficulties that can result from the loss of a medical card, especially for those who have had a card for some time. However, I also have an obligation to ensure that the health system operates within the law as it stands. Unfortunately, that means that in some cases, even when medical expenses are taken into account, the household's net income remains over the guideline amount and often by several hundred euro a week. I also have an obligation to ensure that discretion is applied fairly and this was not the case in the past. For example, in 2009, while three medical cards were issued on a discretionary basis per 1,000 of the population in County Meath, the equivalent number in north Cork was 53, that is, more than 17 times as many. Was that fair or equitable? I do not believe this situation is acceptable and nor does my party or the Government. That is why the Government is committed to ending the unfair two-tier health system and to bringing in universal access to primary care under a universal health insurance policy. However, I realise that some of the households affected include people with ongoing medical conditions. As I wish to ensure a supportive and compassionate response in such instances, I have asked the HSE to consider how best we can ensure these families receive all the supports that are available because in many instances, medical needs can be met without a medical card and without recourse to a means test.

The Government remains committed to delivering a fair, safe and high-quality health system in which people can access health services on the basis of their medical need rather than on their ability to pay. It is making progress and although it is not there yet, the Government has provided funding for the increased number of medical and GP-visit cards issued since it came into office. This funding means that at present, 42% of our population has access to GP services without charges. Moreover, the Government has done what its predecessors did not even try to do, which is to reduce the high costs in the health system in order that more people can be treated and can be treated more quickly and better. I am determined to press ahead with the most radical reform of the health system in the history of the State. The Government is working hard to end the inefficient and inequitable two-tier system it inherited and to replace it with a fair, safe and high-quality health service, supported by universal health insurance where access to services is based on need and not on ability to pay. This is right for the health system. It is right for the health service staff who have worked so hard, making significant personal sacrifices to reduce costs, while delivering better outcomes and most importantly, it is right for patients and all users of the health service.

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