Bernard Durkan (Kildare North, Fine Gael)
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10. To ask the Minister for Health if consideration has been given to raising the income threshold for qualification for medical cards, with particular reference to persons who may be suffering from life-changing or life-threatening conditions; and if he will make a statement on the matter. [26657/23]

Bernard Durkan (Kildare North, Fine Gael)
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This question seeks to amend the qualification levels for medical cards with particular reference to those people who may be suffering from life-changing or life-threatening conditions.

Stephen Donnelly (Wicklow, Fianna Fail)
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We have jumped forward significantly in the questions.

I thank the Deputy for his question and recognise his ongoing advocacy on this topic, in particular to ensure that as many people as possible have access to medical cards and, or, GP cards. Medical card provision is primarily based on financial assessment by the HSE, with each applicant assessed on qualifying financial thresholds in accordance with the Health Act 1970. The issue of granting a medical or a GP visit card based on having a particular disease or illness, which is part of the Deputy's question, was examined in 2014. The HSE's expert panel on medical need and medical card eligibility concluded that there was not an ethical basis to list medical conditions in priority; in other words, there is no hierarchy of suffering. We have had very constructive and well-intentioned debate in the House over many years; for example the call comes up as to whether patients with a cancer diagnoses should automatically get a medical card. While one would love on a human level to cover everybody's costs when they get a diagnosis of cancer or something else, the expert group came back to say that there was no ethical justification to say "Yes" if a patient is diagnosed with cancer, and "No" if he or she is diagnosed with motor neurone disease. Therefore, we have to stay away from a hierarchy of disease. Essentially, the most transparent and the most ethical and equitable way to do it is to base it on income thresholds. As colleagues will be aware, then there are particular circumstances in which patients who are particularly sick can make an additional application. One of the areas where we have extended it - and I credit John Wall for his tireless advocacy on this - was if somebody had a terminal diagnoses, we extended the diagnoses period from 12 months to two years. Critically, that treats all patients, all disease and all sickness in the same way.

Bernard Durkan (Kildare North, Fine Gael)
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I ask that consideration might be given to the fact that it is quite a considerable time since the income thresholds were adjusted. They need to be adjusted now in line with the cost of living and other compelling reasons. They also need to be adjusted on the grounds that when a household receives indication that a patient, be he or she the bread earner or not, and when it is considered that the shock to the system and to the household budget is fairly considerable in any event, and that there are many calls and charges on the household which would not ordinarily apply, I ask that further consideration be given to the fact that the family finds itself in this position. The family members are worried about their health issues and the reduction in the family income as well. On that basis, I ask that the income thresholds be reconsidered.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy. We have to keep these things under constant review, particularly as part of the Estimates process. I can confirm that there has been an increase in the number of medical cards since the 2019 figures. Therefore, the numbers are going up rather than being suppressed because of inflation, for example. There has been a 1.4% increase in medical cards and a 6.6% increase in GP cards compared with 2019. As the Deputy will be aware, we are hopefully in the final few weeks of negotiation with the Irish Medical Organisation, IMO, on an additional 400,000 to 500,000 GP cards and that is going to make a big difference. It will the first time in the history of the State that half the population will now have full State-funded access to general practice. It is a really important move. Obviously, we have listened very carefully to the GPs and are putting in substantial increases in financial supports for them as part of that, while being highly cognisant that GPs are already under a lot of pressure.

Bernard Durkan (Kildare North, Fine Gael)
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I also draw attention to the fact that some patients may be suffering from a hospital misadventure, which places considerable burden on the family in financial ways, as well as due to the trauma within the family of such a situation. I plead that consideration might be given to awarding a full medical card to those patients in the interim period because they should not have to wait until a court case decides, maybe four, five, or ten years later, when it is impossible to address the situation of diminishing income within the family.

The last point I make is that I agree the number of medical cards is growing, as is the population, and therefore more people are coming into the bracket. However, I go back to the last financial review of the eligibility for medical cards and ask the Minister if he might consider having that reviewed again.

Catherine Connolly (Galway West, Independent)
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Before the Minister responds, Deputy Bruton wanted to come in.

Richard Bruton (Dublin Bay North, Fine Gael)
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I can understand the Minister's point about GP card and the drugs refund covering a lot of cases but medical appliances are a different situation. People who do not qualify for a medical card face huge uncertainty in accessing needed medical appliances for certain conditions. If the entire system cannot be reviewed, would it be possible that medical appliances would get some form of a different structure for dealing sensitively with people who have particular needs for such supports?

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank both Deputies. We have to keep an open mind to patient cost generally. One of the priorities for the Government has been reducing healthcare costs for patients. We increased the medical card thresholds for the over-70s; we are looking at about half a million more GP cards; we have introduced free contraception and will go further in September when we will introduce State-funded IVF. We have abolished inpatient hospital charges for now for children and for adults; and we have reduced the drug payment scheme threshold from €124 to €114 and down to €80. We can certainly keep all of this under consideration. One of the pillars of our drive towards universal healthcare is that when people need access to care, it is affordable. It is one reason I am so keen we bring in these extra GP cards. Right now, the State funds about 40% of the population's access to GPs. We have people on higher incomes who can afford to see the GPs. We have a bunch of people in the middle now who really cannot afford to see the GPs. They cannot afford the €65 to visit the doctor and that is the group we are going to target now with these extra GP cards.

Catherine Connolly (Galway West, Independent)
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Are we going forward or going back? Deputy Bruton was not here but I will allow him in.