Ann Phelan (Carlow-Kilkenny, Labour) | Oireachtas source

I thank the Deputies for raising these important matters. At the outset, I am keen to acknowledge the work and effort of health staff that has resulted in Ireland's cancer survival rate improving consistently in recent decades. I have no doubt the national cancer strategy steering group set up to advise on developing a new national cancer strategy for 2016 to 2025 will build on positive developments.

We do not have a universal eligibility system for primary and community health services. I maintain the view that until we have universal health care and everyone is entitled to health care, we will always have anomalies and injustices. There will always be someone who is a little above the means threshold, who does not have the prescribed disease or whose condition is not sufficiently severe. As a result, these individuals will not meet the assessment criteria.

The Deputies will be aware of the publication of the report of the expert panel on medical need for medical card eligibility and the medical card process review, known as the Keane report. One key recommendation was that a person's means should remain the main qualifier for a medical card. The panel concluded that it would not be feasible, desirable or ethically justifiable to list medical conditions in priority order as a means of determining medical card eligibility. The findings of the expert panel raise questions for us as legislators about the approach of basing eligibility for health services on having a particular disease or special assessment arrangements for one disease or another.

The HSE is ensuring a more integrated and sensitive processing of medical card applications. This involves greater exchange of information between the central assessment office and the local health offices on people's medical circumstances and needs. We can see the results of these improvements. The number of discretionary medical cards in circulation has increased by approximately 76%, from 52,000 in mid-2014 to almost 93,000 at the beginning of September this year. Under the General Medical Services scheme, eligibility is granted from the date a complete application has been assessed and a decision is made by the HSE in accordance with the legislation and the national assessment guidelines. The HSE makes every effort to make timely decisions. The HSE has a target to process 90% of properly completed claims within the 15-day period to which Deputy Conway referred. The current turnaround is over 98%. This ensures a short lead time between applications being submitted and a decision being made on the eligibility of the applicant.

I imagine the Deputies will appreciate in light of the legislation that applications must be supported with a range of documentation, as outlined on the application forms. It has to be acknowledged that the processing time for incomplete applications is dependent on the furnishing of the required supporting documentation. Discretion continues to be an integral part of the medical card assessment process. If an applicant's means are above the financial thresholds, as set out in the national guidelines, the HSE routinely examines for indications of medical or social circumstances that might result in undue financial hardship in arranging medical card services and, exercising discretion, may grant eligibility for a medical card on this basis. I am aware the HSE routinely affords applicants the opportunity to furnish additional supporting information and documentation to take account fully of all the relevant circumstances that may benefit them in the assessment, including medical evidence of cost and necessary expenses.

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