Micheál Martin (Cork South Central, Fianna Fail) | Oireachtas source

I thank the Deputy for raising this issue. It reflects the hardworking nature of the Deputy in terms of the cases that come to him via his constituency office and the people he meets on a regular basis and I respect that. More generally, I would make the point that there has been record investment in health since this Government came into office. This has focused a lot on reducing costs for patients generally. We have removed inpatient hospital charges and have had the biggest expansion of access to free GP care in the history of the State, including an expansion of free GP care to children aged under eight and people earning no more than the median household income. We have reduced the drugs payment scheme costs, funded diagnostic scans for patients and agreed a new consultant contract to which approximately 1,000 consultants have already signed up.

Regarding medical card eligibility, there are approximately 1.6 million medical card holders in the country and over 623,000 GP visit card holders. Some 185,000 have access to discretionary medical cards and in many cases these are people with illnesses who would not normally qualify because of the means test but they do qualify because of the nature of their conditions and illnesses. As the Deputy noted, people who cannot without undue hardship arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card on a discretionary basis. This is then determined by the HSE.

It has always been a long-standing position of both the Department of Health and the HSE that medical cards be allocated on the basis of a means test threshold as the fairest way, as opposed to condition-based mechanisms. As the Deputy said, we have introduced discretion, particularly since March 2021. Persons who have been certified by their treating consultant as having a prognosis of 24 months or less are now also awarded a medical card. That reflects a programme for Government commitment to extend eligibility for medical cards to persons with a terminal illness.

As regards the expert panel on medical needs and medical card eligibility to which the Deputy referred, and as to whether eligibility should be determined on the basis of a particular disease or illness, that group concluded in 2014 that it was not feasible, desirable or ethically justifiable to list medical conditions in priority order for medical card eligibility. It has stuck with the means test process. Where the HSE can operate its discretion, other costs, or the costs of the illness, can be taken into account in respect of enabling a person to be eligible for the medical card.

The Deputy might have a number of cases. I would be interested in getting examples of them in order that we could reflect that or, if there are gaps in the system or in the situation we have, that that could be remedied.

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