Breeda Moynihan-Cronin (Kerry South, Labour)
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Question 89: To ask the Minister for Health and Children if she has issued 2007 updates on guidelines to the Health Service Executive for the procedures used for evaluating savings or investments in the means test for medical cards; and if she will make a statement on the matter. [6261/07]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Health Service Executive has detailed operational guidelines in place for the assessment of medical card applications. The purpose of these guidelines is to ensure every person entitled to a medical card or GP visit card is given the opportunity to avail of his or her entitlement and that a consistent approach is taken to means testing nationally. The guidelines include provisions dealing with how applicants' savings and investments are treated. I have not issued any instruction to the HSE on this aspect of the assessment process.

Since the beginning of 2005, the medical card assessment income guidelines have been increased by a cumulative 29%. Other significant changes which I have introduced are that applications are now considered on the basis of income net of tax and PRSI and that allowance is made for reasonable expenses incurred in respect of mortgage or rent, child care and travel to work. In June 2006, I agreed a further adjustment to the income guidelines for GP visit cards. These are now 50% higher than those used in respect of medical cards.

Liz McManus (Wicklow, Labour)
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I thank the Minister for her reply. However, the answer to the question remains unclear. According to Comhairle, no rules are set out for assessing income from savings and practices vary among health service areas. The Minister stated that rules are in place, so she might outline them.

Does she accept that guidelines are extremely important? For example, all social welfare recipients formerly qualified for medical cards but that is no longer the case. A person aged 65 who just retired may have difficulties in getting a medical card. These guidelines need to be crystal clear if such people are to be able to obtain medical cards.

Will she comment on the dramatic decrease in the proportion of people on medical cards? The proportion has fallen from 35% ten years ago to 29% now, despite the introduction of the over-70s scheme. That decrease is having a serious effect in terms of preventing people from attending their family doctors. In the Republic of Ireland, it is estimated that 18.9% of people do not visit their doctors when they should because of the costs involved, whereas the figure in Britain is 1.8%.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Guidelines are in place with regard to savings. The first €20,000 in savings for a single person, or €40,000 for a couple, is disregarded, €1 is applied per €1,000 per week for the next €10,000 and €2 is applied in respect of the following €10,000. These guidelines have either just issued or are issuing in the context of special savings incentive accounts.

Liz McManus (Wicklow, Labour)
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I take it they were not in place from 1 January.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am unclear on the matter because I have been supplied with two different notes, one which states the guidelines have issued and another which states they are about to be issued.

With regard to medical cards, some 1.3 million people hold doctor-only or full medical cards. Incomes have increased by 60% in real terms over the period to which Deputy McManus refers. The scenario was very different ten years ago, with 17% unemployment and 8% long-term unemployment. We have substantially increased the income threshold and have moved it to disposable income. In addition to the traditional medical card, a further 50% increase has been made in respect of the doctor-only card.

However, notwithstanding the advertising and public awareness campaigns which have been conducted, I continue to meet people in my constituency clinic who are unaware they qualify for medical cards. It is similar to the family income supplement in that I wish we could find another way of ensuring everyone who qualifies for the medical card is aware of his or her entitlement. A continuing programme of assessment will be required in that respect, possibly including having general practitioners target some of their patients.

I will investigate Deputy McManus's claims with regard to people on social welfare. The intention is that people will not be excluded from the medical card scheme by virtue of annual budget increases to social welfare payments.

Arthur Morgan (Louth, Sinn Fein)
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I ask that the guidelines to which the Minister refers be circulated to all Deputies. The issue regularly arises, so they could be useful.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Will I circulate them before I resign?

Arthur Morgan (Louth, Sinn Fein)
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I do not mind when they are circulated.

Mary Harney (Dublin Mid West, Progressive Democrats)
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He expects me to be nice to him.

Tim O'Malley (Limerick East, Progressive Democrats)
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It is in giving that one receives.