Phil Hogan (Carlow-Kilkenny, Fine Gael)
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Question 97: To ask the Tánaiste and Minister for Health and Children the number of the 30,000 medical cards which she announced in November 2004 for 2005 which will have been delivered by 2005; and if she will make a statement on the matter. [28918/05]

Eamon Gilmore (Dún Laoghaire, Labour)
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Question 114: To ask the Tánaiste and Minister for Health and Children the reason none of the 30,000 additional medical cards promised by her in November 2004 have yet been issued; if she will review eligibility limits for medical cards; and if she will make a statement on the matter. [28791/05]

Eamon Gilmore (Dún Laoghaire, Labour)
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Question 126: To ask the Tánaiste and Minister for Health and Children the number of medical cards issued in June 1997, June 2002, June 2004 and the latest date for which figures are available; if the Government will honour the pledge in An Agreed Programme for Government to extend eligibility to bring in another 200,000 persons; and if she will make a statement on the matter. [28792/05]

Joe Sherlock (Cork East, Labour)
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Question 144: To ask the Tánaiste and Minister for Health and Children when the long promised general practitioner cards will be issued; if all industrial relations issues arising from the card have now been resolved; and if she will make a statement on the matter. [28790/05]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 97, 114, 126 and 144 together.

In January 2005 I increased the income guidelines used in the assessment of medical card applications by 7.5%. In June it was apparent that the effect of rising income in our successful economy meant that the target of 30,000 additional medical cards would not be achieved. At this time I simplified the means test for both medical cards and GP visit cards. It is now based on an applicant's and spouse's income after income tax and PRSI and takes account of reasonable expenses incurred in respect of rent or mortgage payments, child care and travel to work. This is much fairer to applicants.

I announced on 13 October 2005 that the income guidelines for both medical cards and GP visit cards would be increased by an additional 20%. This means the income guidelines are now 29% higher than this time last year. This substantial increase in the assessment guidelines will allow many more people to visit their family doctor free of charge. I urge people to apply straight away for these important benefits. I understand from the HSE that issues raised by IMPACT and SIPTU, which represent HSE staff assessing applications, have been addressed.

The HSE has advised my Department that in the period from January to September this year, nearly 150,000 new medical cards were issued while just over 145,000 were withdrawn for various reasons, including death, income changes and data updates. Many people have benefited by getting a medical card for the first time in 2005.

A simple comparison of the 1997 to 2005 figures does not take account of the fact that over 104,000 invalid cards have been removed since that time following concerns which arose about inaccurate GMS lists. If allowance is made for the effect of this necessary exercise, there has been a net increase over the period of 10,000.

My Department and the HSE will continue to monitor the number of cards issued. The Government's commitment in the programme for Government to extend eligibility for medical cards will be kept under review in the light of other competing service priorities, available resources and the graduated benefits approach which I introduced with the GP visit card.

Liam Twomey (Wexford, Fine Gael)
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I would like the Minister to give a commitment on a few issues regarding the doctor only medical card and the full medical card. The doctor only medical card which is being introduced along side the full medical card is being seen as a means to give some help to those at the margins of entitlement to a medical card. Currently 1.1 million people have a full medical card and many of those patients are concerned that the Minister will try to substitute the full medical card with the doctor only medical card. Will the Minister draw up a minimum number of the population who will be entitled to a full medical card?

I would also like the Minister to clarify a statement I believe she made. She said a family comprising a mother, father and two children with an income of €850 per week would be entitled to a doctor only medical card. That would not seem to gel with the information I am getting from some of the local HSE offices when people apply for medical cards. The Minister is being a little generous and is including every entitlement going. She should make it clear that the income threshold is not €850 per week because many people will believe they are entitled to doctor only medical cards if they earn less than €850 per week which is, of course, far from the case.

Will the Minister give a commitment that full medical cards will not be substituted with doctor only medical cards in the years ahead because of this policy?

Mary Harney (Dublin Mid West, Progressive Democrats)
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It is true that somebody in those circumstances, depending on their outgoings, can qualify for a medical card. For example, the basic income is €266.50 per week with a child dependant allowance of €76, child care expenses of €220, housing or mortgage payments of €190 and travel to work of €50. We gave a number of examples last week and published the data. The whole purpose is not to have a percentage of the population on medical cards but to try to ensure whatever resources are available are targeted at those who need them most.

Incomes have risen very sharply in this economy in recent years. In fact, official data are way behind what is happening in the real economy. Although 150,000 new medical cards have been issued this year to date, there was not an additional net 30,000 because many people fell out of the net due to income or otherwise.

The doctor only medical card is an initiative to have a graduated level of benefit. By providing doctor only medical cards, it allowed us to give the card to four times more people than if we stayed with the traditional medical card. I have always been a fan of graduated benefits. It means that families on low enough incomes and, in some cases, on modest gross incomes, depending on their outgoings, will not be afraid to go to the doctor because of the resource implications. In fact, the Deputy advocated such a proposal previously. Many general practitioners felt this would be a good idea, which I believe it will be.

There is no intention to substitute the traditional card with the doctor only card. We want to maintain the current regime where those on the lowest incomes, social welfare recipients, those over 70 years of age and people with particular difficulties get the full medical card and where the next layer, depending on income and particular circumstances, will get the doctor only medical card.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Does the Minister share my view that those who need the medical card the most are children and that if she wants to make a real difference in regard to health care not only in the current situation but as an investment into the future, she should address the needs of children now? Will she indicate if she has considered, proposed or has argued for at Cabinet the extension of full medical card cover to all children under 18 years of age and if not, will she explain why?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am not a great fan of universal payments to everyone regardless of means because that hits those who are not as well off unfairly, that is, if relatively rich people get the same benefits as less well off people.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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That is what has been done for the over 70s.

Mary Harney (Dublin Mid West, Progressive Democrats)
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When one applies something universally to a class of individuals — in this case, children — it can be unfair on others because one has a finite amount of resources. All the evidence suggests that the medical need is greatest among lower income families in particular. That is what we are doing with the traditional medical card and the doctor only card. Given that we increased the income guidelines by 20% last week, since this time last year, the income threshold has gone up 29%. There is a further 25% top up for the doctor only card. That should include a whole host of people who heretofore had to pay to go to the doctor. It is a welcome measure and we should review it as time goes on.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I accept the Minister's point that it is lower income families who need these cards the most. However, does she not accept the reality that there are many families on what would be regarded as moderate incomes who, because of their commitment to the workplace, namely, two earning parents, the outlay on child care, mortgages and other such expenses, which were not all together reflected even in the new configuration she announced last week, face hardship and that children suffer in such circumstances? I do not believe the Tánaiste can universally apply her earlier response and claim children are not suffering as a consequence. They are suffering and the only way to ensure all children are adequately catered for and that we invest in the health of the nation is through the extension of full medical card cover to all children under 18 years. Will the Tánaiste accept this proposal?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I do not accept this because using gross income is not a fair way of calculating entitlement. That is why there are deductions for tax purposes, such as PRSI, travel-to-work, mortgage repayments and child care. For example, a single mother with one dependent child can earn more than €584 a week and still get a full medical card depending on her outgoings. Travel to work could cost €40 a week and child care €100 a week. These can be added to her income when she is assessed for a full medical card. The new assessment mechanism will help us to target both the full and doctor-only card to those who need it most.

Liz McManus (Wicklow, Labour)
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Having heard the Tánaiste say she does not believe in universal benefits, was the reason she supported the over-70s medical card scheme to attract votes in the last general election? She seemed to be overriding her natural inclination against universal benefits. The Government promised 200,000 medical cards. When will we get them?

Mary Harney (Dublin Mid West, Progressive Democrats)
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There was a commitment on medical cards in the election manifesto of my colleagues in Government. We will get more than 200,000 medical cards with the doctor-only cards.

Liz McManus (Wicklow, Labour)
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When will we get them?

Mary Harney (Dublin Mid West, Progressive Democrats)
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We must become less fixated with numbers and target the needs of families, children and the elderly. The way the Government is doing this, particularly discounting income outgoings, will ensure many people who traditionally would not have qualified because of their gross earnings will now come into the medical card net with either the full or doctor-only card. The doctor-only card meets the needs of a substantial number of people, particularly those with children. They want to be confident that if a child is sick they can get the opinion of the doctor without worrying about costs. Often in such cases, no follow-up medication is required.

Older people have greater health needs than younger people. However, the costs of the over 70s has been high. Issues have arisen in the context of re-negotiating the GMS contract. Some elderly patients are worth more than others to particular doctors. It must be asked——

Liz McManus (Wicklow, Labour)
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The Tánaiste did the deal. Where was she then?

Mary Harney (Dublin Mid West, Progressive Democrats)
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When we introduced the doctor-only card, no special deal was done with Deputy Twomey's colleagues, notwithstanding the fact that it was sought.

Liam Twomey (Wexford, Fine Gael)
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A certain form of statistical discrimination was introduced into how people were treated if they had a medical card.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Question No. 98 has been called. It is not in order for the Member to speak.