Brian Lenihan Jnr (Dublin West, Fianna Fail)

I thank Senator Ulick Burke for raising this matter. Eligibility for health services is primarily based on residency and means. Under the Health Act 1970, determination of eligibility for medical cards is now the responsibility of the Health Service Executive, other than for persons aged 70 years and over, who are automatically eligible for a medical card.

Medical cards are issued to persons who, in the opinion of the HSE, are unable to provide general practitioner medical and surgical services for themselves and their dependants, without undue hardship. It is open to all persons to apply to the chief officer of the relevant HSE area for health services if they are unable to provide these for themselves or their dependants without hardship. The setting of income guidelines is a matter for the HSE.

The HSE has discretion as regards the issuing of medical cards and a range of income sources is excluded when assessing eligibility. Despite some persons having an income that exceeds the guidelines, a medical card may be awarded if the HSE considers that a person's medical needs or other circumstances justify it. It is open, therefore, to cancer sufferers, asthmatics and coeliacs to apply to the HSE for services if they are unable to provide them for themselves or their dependants without undue hardship.

The sum of €60 million was provided in the 2005 Estimates for health to improve access to primary care by providing for up to 30,000 additional persons to become eligible for a medical card, and free access to GP visits for up to 200,000 additional persons on low incomes through the introduction of a GP visit card. Parents on low incomes should no longer have to worry about the cost of bringing their child to a doctor. The estimated full-year cost of this initiative is €50 million. My Department is currently considering the nature of the legislative changes required to enable effect to be given to the decision to introduce "doctor-only" medical cards. Legislation on this will be introduced as soon as possible, with the view to the cards being made available in April. The additional funding provided enabled the former CEOs of the health boards to agree new medical card guidelines which came into effect on 1 January 2004. The guidelines were increased by on average 7.5% and for those on low income, the income allowance for each of the first two children was increased by approximately 20% and approximately 30% for the third and subsequent child. Medical card holders are entitled to a full range of services including general practitioner services, prescribed drugs and medicines, all inpatient public hospital services in public hospitals including consultants services, all outpatient public hospital services including consultant services, dental, optical and aural services and appliances.

For those who do not qualify for a medical card, there are a number of schemes which provide assistance towards the cost of medication. I am sure Senator Burke is familiar with the terms of the long-term illness scheme. Non-medical card holders can also avail of the drugs payment scheme. This scheme protects such individuals from excessive drug costs. Under this scheme, no individual or family unit pays more than €85 per calendar month towards the cost of approved prescribed medicines.

Since 1997 there has been a total additional cumulative investment of approximately €710 million in the development of appropriate treatment and care services for people with cancer. This investment has enabled the funding of an additional 109 consultant posts in key areas of cancer care such as medical oncology, radiology, palliative care and general surgeons with specialist interest in breast surgery. The funding has provided for the appointment of 245 cancer care nurse specialists across the regions. Approximately €90 million in capital funding has been invested in oncology infrastructure, including specialist equipment in radiation oncology, mammography, radiology and pathology.

The health strategy includes a whole series of initiatives to clarify and expand the existing arrangements for eligibility for health services, including recommendations arising from the review of the medical card scheme carried out by the health board CEOs under the PPF. These recommendations include: streamlining applications and improving the standardisation of the medical card applications process; providing clearer information to people about how and where to apply for medical cards; and seeking out those who should have medical cards to ensure they have access to the services that are available.