Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

Before I start, I extend a very special welcome to Mr. Mark McQuillan, who is job shadowing me today as part of a programme of the Irish Association of Supported Employment. He is in the Visitors' Gallery.

I thank Deputies for their contributions on the Bill. As Minister of State, Deputy Kathleen Lynch, said in her opening statement on the Bill, the Government is committed to introducing, on a phased basis, a universal GP service without fees for all children and senior citizens within the term of its office, as set out in the programme for Government and the future health strategy. It was decided to commence this by providing all children under six with access to a GP service without fees and this will be achieved at the same time as the universal service for everyone over 70.

It is fair to say very few Deputies questioned the principle of universal primary care but some questioned its phasing. Let me explain it once again. The original intention was to start with those on the long-term illness scheme. However, that scheme is not underpinned by primary legislation, dates from a circular from the 1970s and includes all sorts of unfair provisions. It includes some illnesses but not others. Diabetes, for example, is considered to be a long-term illness while motor neuron disease and asthma are not. There are serious defects in the scheme that will have to be addressed in due course. An expert group was appointed to list illnesses or diseases in order, that is, from those which should be counted first and be provided with coverage to those that would be covered later. The group found it would be unjust, unethical and impractical to create a hierarchy of diseases and a list of illnesses in order, stating one was more severe than the next. We chose the under-sixes and over 70s simply because they are the youngest and oldest in society and the ones who need to see their GP most often. It is, of course, not an end in itself. It is just the first two steps in the phased introduction of a universal service in Ireland for all children and senior citizens. This is being achieved in parallel with an extension in coverage for chronic disease, starting with asthma among children and diabetes among adults.

People ask what happens to the six or seven year old with a chronic disease or very high medical expenses. It is important to point out that 40% of people, or 1.7 million, have a medical card based on low income. The rules are not changing and nobody will have his or her medical card taken away. In addition, there is the discretionary medical card system, which provides discretionary medical cards or discretionary doctor visit cards to people who are over the income limit but who have high medical expenses or a high burden of disease. The number of people with full discretionary medial cards is now 82,000 and the number with the discretionary doctor visit card is over 100,000. That is a very significant increase on last year. We are doing these things in parallel.

The system is not perfect, however. Some people are big fans of means tests but I am not. We do not means test for education or for free travel for the elderly. The problem with the means test is that there is always somebody who is €5 or €10 above the threshold. If one increases the threshold by €5 or €10, there will be yet another person just above it. There is a similar problem with sickness tests. Nobody has been able to come up with a test that is perfectly fair to decide what level of sickness should qualify one for a benefit and what level should not. There are horrible circumstances where people are told to return time and again with more doctors' and consultants' letters to prove they are sick, and then they are told to come back when they are sicker. That is really not a nice system. Therefore, this Bill represents a significant policy departure in health care away from sickness tests and means tests towards universal health care and universality. I am very proud to be a member of a Government that is doing that.

With the passage of this Bill, 36,000 people above the age of 70 who currently have to pay to attend their GP will no longer have to worry about the cost. Medical evidence suggests there is a significantly greater incidence of multiple chronic conditions among people over 70. That is why they will benefit particularly from this measure. Some have pointed out that these tend to be the better-off pensioners. This is true but we should ask ourselves why these 36,000 pensioners are better off. Very simply, they are the ones who probably worked and paid income tax and PRSI all their lives and set aside a small amount of money to pay into an occupational pension. In return for that, however, we do not give them access to their GP but punish them for having worked for 40 years, paid their taxes and paid into an occupational pension fund. Now we are going to change that. That is actually a good step forward.

As announced two weeks ago, an agreement has been reached involving the Department of Health, the HSE and the IMO on the terms for the delivery of free GP care for all children under six. The service will commence during the summer and it will provide GP care without fees to just over 250,000 children. It will benefit not only the 250,000 children but also children under six who already have a medical card or a doctor visit card because they will benefit from the enhanced service. That enhanced service involves the management of asthma in the practice, with an annual asthma check to make sure the asthma is being treated well and that the patient knows how to use his or her inhaler and is on the right medicines. At the ages of two and five, there will be a wellness check, focusing particularly on conditions such as obesity to pick it up early and to try to deal with it. Also included will be issues such as parents smoking in the home. There will be an opportunity there and then to intervene to deal with that. It may help us to pick up some cases of neglect because if a child of that age is not going to the GP once a year, one wonders why. That children will be called to see their GP will be important.

The estimated full-year cost of the universal under-six service, including the wellness checks and arrangements for the management of asthma, will be approximately €67 million per year. The service is based on the choice-of-doctor principle and the next step is to issue the contract to GPs so they can decide whether they want to sign it. The contract will be issued in the next few weeks. The service should be ready to commence in early July. It will be preceded by a public information campaign. Provided GPs sign up online, it will be very simple because parents will be able to go online and register their child for the service. All they will need will be their child's name, date of birth and PPS number. It will be much easier than booking a flight.

Deputy Ó Caoláin asked about the cost of the service. It was originally estimated that it would cost €37 million in a full year but that was based on the existing type of service and existing fee rates. However, the fee rates are being increased because it is an enhanced service. This is a universal service. There will be no lesser service running in parallel for children from medical card families. There will be no means tests, no sickness tests, no paperwork, no payslips and no letters from doctors or consultants.

Having considered the outcome of the discussions with the IMO, I have determined that an annual capitation rate of €125 per patient under six shall apply, with enhanced capitation rates in respect of children covered by the asthma cycle of care. The new enhanced service will cost an additional €67 million in a full year, which is €30 million over and above that previously set aside.

A question was asked about the number of over-70s who will benefit. The correct figure is 36,000. The previously used figure of 10,000 was based on an estimate of population figures available at the time but we have confirmed the correct figure is 36,000.

Deputy Naughten asked about dependants of those over 70. The reference to "dependants" in the Bill is a continuation of the existing position whereby dependants of persons over 70 can get a GP visit card also. The criteria for a dependant, as applied by the HSE when assessing couples for a medical card or GP visit card, refer to the spouse, partner or children if they are under the age of 23 and dependent on the parent, if that parent is over 70. That is just to ensure dependants of people under 70 can still qualify for a doctor visit card under certain circumstances.

I thank Deputies for their contributions on the proposed legislation and I commend the Bill to the House.

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