Joe Costello (Dublin Central, Labour)
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Question 64: To ask the Tánaiste and Minister for Health and Children the number of medical cards issued in June 1997, June 2002, 30 September 2004 and the latest date for which figures are available; if the Government intends to honour the pledge in An Agreed Programme for Government to extend eligibility to another 200,000 people and the commitment provided in the publication of the Estimates for 2005 that 30,000 additional medical cards would be issued from 1 January 2005; the number of the promised 30,000 new medical cards that have been issued since 1 January 2005; and if she will make a statement on the matter. [15313/05]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The number of medical cards issued and number of persons covered by a medical card for the dates are as follows. In 1997 there were 1,244,459 medical cards, or 34.37% of the population of 3,621,035. In June 2002, 1,207,096 persons had medical cards, or 30.81% of the population of 3,917,336. In September 2004, 1,151,106 persons were covered by the medical card, or 29.39% of the population of 3,917,203. In April 2005 there were 1,145,331 medical cards, or 28.32% of the population of 4,043,800.

Generally, the reduction in recent years in the number of medical cards may be attributed to the increase in the number of people in employment and also the improved economic situation nationally. Additionally, during 2003 and 2004, health boards undertook a review of medical card databases in which approximately 104,000 medical card records were removed. Many of the deletions from the databases would have been due to normal reviews but a number would have been duplicate or expired records. These reviews have led to deletions of medical card records due to duplicate entries, change of address, cases where the medical card holder is deceased or ineligibility due to changed circumstances. The determination of eligibility of applications for medical cards is a matter by legislation for the chief officer of the relevant area of the Health Service Executive. In determining eligibility, the local area of the HSE will have regard to financial circumstances and medical needs of the applicant.

In November 2004, I announced revised medical card income guidelines which were increased by 7.5 % for determinations of full eligibility, together with significant increases in respect of dependants, with a view to extending the number of medical cards by 30,000 in 2005. These guidelines are in operation since January 2005. In addition, the doctor-only card was introduced and these patients' income can be up to 25% in excess of the income guidelines used for the traditional card. The legislation required has been enacted and it is intended that a further 200,000 persons will become eligible. Additional funding of €60 million to allow these measures be introduced in 2005 has been provided.

The implications of my decision to extend medical card coverage will become apparent as the year progresses. We are determined to reach the figures. In relation to the doctor-only cards, the Health Service Executive has put in place the necessary administrative arrangements for their introduction. A public information and advertising campaign will commence over the coming days. This will indicate the process to be followed by applicants to obtain application forms and to have their eligibility assessed by the HSE. In the first instance, the executive will consider an applicant's eligibility for a full medical card in case he or she may be entitled to one. A process of engagement with the contractor and staff representative bodies is ongoing.

Liz McManus (Wicklow, Labour)
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Does the Minister for Health and Children not accept that this is a shameful record? As this country has become richer, the number of people able to avail of the medical card has declined consistently. This is not because more people are richer but because the ceiling has been kept so low by a Government that is not willing to address the great difficulty people on low incomes have in availing of health care, specifically visiting their doctor and obtaining medication. Is the Minister aware of the substantial increases in the cost of visiting a doctor and of drugs and hospital care? The second two are charges where the Government is responsible for major inflation. Yet, according to the figures the number, in real and percentage terms, of people on medical cards has dropped during the term of office of this Minister. How can she say she is introducing 30,000 new medical cards when the figures indicate a drop in the number of medical cards? Who is the Minister trying to fool? The figures relating to low income families are much worse than indicated because they include the rich over 70s.

Séamus Pattison (Carlow-Kilkenny, Labour)
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I remind the Deputy of the one minute time limit.

Liz McManus (Wicklow, Labour)
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Will the Minister be honest with the people in regard to the position with medical cards and explain how she can say she is giving 30,000 additional medical cards and stand over figures that show the number of medical cards have dropped during her time in office?

Mary Harney (Dublin Mid West, Progressive Democrats)
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As people get richer it may well be that fewer qualify. The unemployment rate was 11.5% in 1997 and is now down to over 4%. This year we increased the threshold for the traditional medical card by 7.5% which is twice the rate of inflation. The income guidelines are way out. We have used the best data available which is the Revenue Commissioners' figures. Clearly people's incomes are much higher than the increases provided for. That is the reason we are looking at this matter. I am determined that the 30,000 extra medical cards will be issued and that we reach the 200,000 GP only visit cards target. We need to move to a position where disposable income is taken into account. For example, child care costs should be allowable when calculating a person's income for the purpose of receiving a medical card. It is a complicated system in that it allows so much for travel, mortgage or rent. Obviously I want to focus on families with children. It leads to much confusion and makes the data less applicable than it might otherwise be. For next year I would like to move towards a disposable income position and if we can do it for the remainder of this year I would welcome it. We have the €60 million for that purpose and I am determined it will be spent on providing access to lower income families, particularly those with children, to general practitioner or services at that level. If we have to revise the income guidelines because people's incomes have risen faster than anticipated that is what we will do.

Liz McManus (Wicklow, Labour)
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I wish to ask one supplementary.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Briefly, please.

Liz McManus (Wicklow, Labour)
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It is a simple matter. The income levels will have to increase to a realistic rate. That is what can and should be done.

Mary Harney (Dublin Mid West, Progressive Democrats)
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A 7.5% increase is pretty good.

Liz McManus (Wicklow, Labour)
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Will the Minister state that the Government of which she is a member that promised 200,000 new medical cards has broken its promise, that it is abandoning the commitment it made to the people and will not deliver the badly needed medical cards to 200,000 people?

Liam Twomey (Wexford, Fine Gael)
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The Tánaiste gave a guarantee to spend €60 million on this issue, €30 million of which was for the doctor only medical cards and €30 million for the 30,000 traditional medical cards, all of which was to commence on 1 April or thereabouts. Given the rate of progress no medical cards will be issued before the summer. How will she spend the €60 million? Will it be spent on advertising, telling people about something they will not get until all these issues are sorted out? None of the medical cards announced last November has been issued, traditional or otherwise. That is the problem. Whatever about breaking promises, there is a litany of broken promises since the general election in 2002. No medical cards have been issued, and we are now into the summer, and neither has there been an announcement in regard to capital projects for 2005. It should be made crystal clear when these medical cards will be issued. They are a big issue.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Many cards have been issued since the beginning of the year and many new people have cards. We are issuing cards.

Liz McManus (Wicklow, Labour)
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The Minister is taking them away.

Mary Harney (Dublin Mid West, Progressive Democrats)
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No. People's income is rising faster than anticipated and the data on which these decisions are based are not as up to date as we would wish and yet it is the best available. That is the reality. Incomes are rising faster than any of us realise. Given the limited resources one has to use income data to decide what one can do.

The idea of the GP only card is to allow the widest possible number of people, particularly families with children, access to their doctor. We are aware of the huge increase in drug costs and how little can be done if we include it in the traditional way. I felt there should be graduated benefits where some get all and others get a different rate. We are determined to issue those cards this year. That is the plan and it will happen.