Mary Harney (Dublin Mid West, Independent)

All community pharmacy contractors have a contract with the HSE which involves their being paid. In the case of the GMS, general medical services, scheme they are paid a particular fee for the first 20 items prescribed and a different fee thereafter. The payments systems are linked by computers and technology. The HSE has good data in respect of each person, what he or she gets each month and what he or she pays for. Patients pay for these as they do under the drugs payment scheme. The system will have to be adapted as it was last year when we changed the payment regime. I accept there may be a cost involved in adapting the system to deduct the 50 cent per item prescribed.

I refer to the question of whether this legislation would involve additional administrative staff and the answer is "No". By centralising the administration of medical cards we are reducing the work load in that area and taking many personnel out of the application and administrative processes, in line with what most people want, and applying them to other areas where they are required. Significant savings will come from this.

I refer to Senator Fitzgerald's comments concerning the basis on which I will make decisions. I have considered sympathetically several categories I would have preferred to exclude from the charge. However, it was not possible in every case. For example, one cannot define palliative care in such a way as to make it easy to determine when someone has a medical card for drugs for palliative care. I refer to the powers in page 5 of the legislation. I envisage asylum seekers that live on €19 per week will be excluded. The idea was to give the powers without referring to them in the primary legislation, which would be extraordinarily difficult and complex in cases involving palliative care, asylum seekers, those suffering from thalidomide and other cases where I would take a sympathetic view. Earlier, I referred to the areas covered by long-term illness cards. In particular, issues were raised about diabetics. Currently, diabetics have a long-term illness card. No Minister with responsibility for health has added anything to long-term illness cards since the 1970s. Anomalies exist and the long-term illness card together with the review of eligibility legislation for entitlement to health and social care services are being urgently reviewed in the Department. I will bring proposals to the Government later this year because we must have clarity in law about the entitlements of different groups of people. The groups covered by a long-term illness card are excluded.

I was asked about the basis on which I would increase the charge. I am introducing it at a modest level. Almost every country in western Europe, as well as Australia and the United States, provides for co-payment. I visited New Zealand recently and there is co-payment both in respect of the doctor's fee and the drugs payment for every single person who uses health services. This has been contradicted by somebody who is supposed to be a health analyst, but she is incorrect. I accept some do not agree with this proposal, but a small co-payment for prescription items is not unreasonable in the current environment. We probably would not do this if there were no financial constraints, but there are. Therefore, we must examine every possibility to maintain the level of funding for health services. Given that there is evidence to suggest a small charge changes prescribing behaviour, I hope this will affect usage behaviour, particularly where antibiotics are concerned. It will be open to the Minister under the provisions of the legislation to alter the charge or the categories excluded from it by way of regulation.