Dáil debates

Tuesday, 5 October 2010

Infectious Disease Screening Service

Health Services

9:00 am

Photo of Joe CostelloJoe Costello (Dublin Central, Labour)
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That a budget should introduce a 50 cent levy on every item prescribed for medical card holders is the unkindest cut of all. The danger is not the quantity of money involved, but the category of patient covered. Many of the people who fall into such categories could easily find their situations deteriorating because of the bureaucratic process envisaged in the system. This provision covers a range of seriously ill, mentally ill and physically challenged people, including the terminally ill, those in nursing homes, recovering addicts, people in receipt of palliative care, diabetics, old age pensioners, Alzheimer's sufferers, the homeless and so on.

The category about which I am especially concerned is psychiatric patients. Clearly, this is an erratic category and such patients find dealing with change difficult. The greater burden of requirement placed on them by the new system will make ensuring they get and take their medicine more difficult. The idea that psychiatric patients must attend a general practitioner before a chemist seems outrageous. It inserts an extra layer of bureaucracy and is an obstacle to them. Apparently, the reason is that the GP must put a description on itemised General Medical Services, GMS, scheme paper. This is done for the purpose of dealing with the matter officially. I see no reason to bring the GP into the scenario. Why could this not be done in the chemist? There is no such thing as a standard, but going to the chemist is part and parcel of the well-worn path towards getting medicine to which mentally challenged patients are used. Sticking the GP in the middle of the process means many patients will not do it. Add to this the burden of a 50 cent levy and they will be confused and frustrated. Obstacles are being placed in their way. The danger is that many people who are seriously psychiatrically challenged will not take their medicine. This will also be the case with homeless people, alcoholics and drug addicts. Many categories of people will find taking the extra steps prescribed by the 50 cent levy difficult.

The Minister is expecting to get €25 million out of the levy and there is a cap of €10, but more than €25 million will accrue because there are many prescriptions being handed out that should not be. I am most concerned about the layer of bureaucracy being placed in front of medical card holders. Will the Minister review the levy to determine whether people could avoid the extra visit to the GP and whether the levy is appropriate to people who have difficulty dealing with the basics of getting their medicine without needing to jump through hoops?

Many carers were involved in the GMS scheme but no one who applies for carer's allowance will get the scheme. The caring side is deteriorating, as are the respite care and home help sides. The level of support is reducing constantly. We will find that people will not be able to meet the requirements and this will have serious implications for their health. Will the Minister of State review the 50 cent levy, particularly in respect of the categories to which I referred?

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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As the House knows, the Minister has introduced a prescription charge of 50 cent for prescribed items dispensed to medical card holders subject to no person or family paying more than €10 per month. The prescription charge seeks to influence demand and prescribing patterns in the GMS scheme in a modest way. Prescription charges do not apply to children in the care of the HSE who have their own medical card, to the long-term illness or drugs payment scheme, to those who receive services under the Health (Amendment) Act 1996 or to methadone supplied to patients participating in the methadone treatment scheme.

Approximately 1.6 million people have medical cards. HSE data for 2008 indicate that only 2% of families with a medical card had 20 or more items per month prescribed to them. Therefore, the Minister expects that only a small minority of families with a medical card will need to pay the €10 per month maximum charge.

Prescription charges are part of a set of key actions to achieve greater value for money in pharmaceutical expenditure. These include off-patent price cuts, reductions in wholesale and retail mark-ups that have been introduced and the preparation of legislation on reference pricing and generic substitution, which is under way.

The cost of the GMS scheme, including payments to pharmacists and GPs, is projected to be more than €2 billion in 2010. The number of items dispensed to medical card holders increased between 2004 and 2009 by more than 15 million to slightly more than 50 million items. This rate of increase, an average of 12.5% each year over six years, in the cost of supplying drugs and medicines is not sustainable. Based on trends in previous years, it is expected that the prescription charges will yield €24 million in a full year or approximately €2 million per month. Every saving achieved by the HSE will reduce pressure on funding for front-line services, including hospitals, home help and home care packages and mental health and services for people with disabilities and their families. It is important in our current financial situation that we take every step possible to provide public services efficiently, limit costs to the greatest extent possible and involve the users of resources in understanding better the value of those resources and their appropriate use. The Minister has committed to keeping the implementation and impact of the charges under constant review. I will refer the Deputy's specific concerns regarding psychiatric patients to her for a direct response.