Seán Power (Kildare South, Fianna Fail)

I thank the Senator for raising the matter and giving me the opportunity to clarify it as best I can.

I would first like to outline the basis of eligibility for services. Entitlement to health services in Ireland is based primarily on residence and means. The determination of eligibility for medical cards is the responsibility of the Health Service Executive. Other than for persons aged 70 years and over, who are automatically entitled to a medical card, such 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 should be noted that the guidelines are not statutorily binding, and even though a person's income exceeds the guidelines, a medical card may still be awarded if the Health Service Executive considers that his or her medical needs or other circumstances would justify it. It is open to all persons to apply to the Health Service Executive for health services if they are unable to provide such services for themselves or their dependants without hardship.

It should be remembered that the Health Service Executive has discretion regarding the issuing of medical cards and also that a range of income sources are excluded by the Health Service Executive when assessing medical card eligibility. Many allowances, such as carer's allowance, child benefit, domiciliary care allowance, family income supplement and foster care allowance are disregarded when determining a person's eligibility. Given those factors and the discretionary powers of the Health Service Executive, having an income that exceeds the guidelines does not mean that a person will not be eligible for a medical card, and a medical card may still be awarded if the Health Service Executive considers that a person's medical needs or other circumstances justify it.

Regarding hospital charges, it is the case that, under arrangements for public hospital services introduced in June 1991, on foot of the Health (Amendment) Act 1991, everyone, regardless of income, is entitled to public hospital and public consultant services subject only to modest statutory charges from which those with full eligibility, that is, medical card holders, are exempt.

Private patients attending public hospitals are liable for consultants' fees, which are a matter between the patient and the consultant. In addition, the patient would be liable for accommodation charges as approved of or directed by the Minister under section 55 of the Health Act 1970 once he or she explicitly exercises the option to be treated as a private patient. The requirement that patients make an explicit choice between public and private health care was recommended by the 1989 Commission on Health Funding.

Having made inquiries with the Health Service Executive regarding the case in question, the executive has advised that the individual concerned attended the radiology department in the hospital for a DEXA scan requested by the patient's GP. Furthermore, the charge in question did not emanate from the hospital itself but from the consultant radiology department. The charge was made in the form of a fee demand from the consultant radiologist. The hospital is unclear if the patient was public or private. The matter is being followed up directly with the consultant radiologist involved.

As soon as the position is clarified I will revert to the Senator directly on the matter. As the Senator appears to have all the facts available to him, perhaps he is in a position to clarify the issue I raised.