Alex White (Dublin South, Labour) | Oireachtas source

I thank Senator Moran for raising this issue to which I have given much time, attention and thought.

Medical cards are provided to persons who are, under the provisions of the Health Act 1970 and in the opinion of the HSE, unable without undue hardship to arrange GP services for themselves and their dependants. The assessment for a medical card is determined primarily by reference to the means, including the income and reasonable expenditure, of the applicant and his or her partner and dependants. Under the legislation, determination of eligibility for a medical card is the responsibility of the HSE. The Health Act 1970 is the legislative basis upon which people are granted medical cards.

The HSE has produced national assessment guidelines to provide a clear framework to assist in the making of reasonable, consistent and equitable decisions when assessing an applicant for the General Medical Services scheme. These guidelines are publicly available and can be downloaded from the HSE's medical card website.

While there is no automatic entitlement to a medical card for persons with specific illnesses or with a disability, the HSE has discretion to award a medical card to avoid undue hardship, even where the person exceeds the income guidelines. The HSE has established a panel of community medical officers to assist in the processing of applications for medical cards on a discretionary basis where a person exceeds the income guidelines but where there are difficult personal circumstances, such as an illness or physical disability. The community medical officer reviews and interprets medical information provided by the applicant to the primary care reimbursement service, PCRS, on a confidential basis. He or she liaises with general practitioners, hospital consultants and other health professionals, as appropriate, to determine the health needs of the applicant and his or her family and dependants. The community medical officer then applies discretion, within the guidelines, to determine whether the applicant is suffering from medical hardship. This thorough process of assessment ensures medical cards are issued to medical applicants whose income is above the guidelines but where illness or disability would cause undue hardship to them in providing GP services for themselves and their dependants.

The HSE also has a system in place in relation to the provision of emergency medical cards for patients who are terminally ill or who are seriously ill and in urgent need of medical care that they cannot afford. Emergency medical cards are issued within 24 hours of receipt of the required patient details and the letter of confirmation of the condition from a doctor or a medical consultant. This can be initiated through the local health office by the office manager who has access to a dedicated fax and e-mail contact within the PCRS.

With the exception of terminally ill patients, the HSE issues all emergency cards on the basis that the patient is eligible for a medical card on the basis of means or undue hardship, and that the applicant will follow up with a full application within a number of weeks of receiving the emergency card. As a result, emergency medical cards are issued to a named individual, with a limited eligibility period of six months.

The arrangement is slightly different for persons with a terminal illness. Once the terminal illness is verified, patients are given an emergency medical card for six months. Given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure the person gets the card as quickly as possible.

The HSE ensures the system responds to the variety of circumstances and complexities faced by individuals. Where it is drawn to my attention or that of the Department or the HSE that there are problems, for whatever reason, with operating the system I have just described, I will attend to such problems and address them.

The Senator said it would be appropriate or desirable to have more discretion in granting medical cards. However, the Health Act 1970 distributes medical cards on the basis of means. That is what the law states and we must operate within the legal parameters. Earlier this year, I examined the question of universal access to GP care, which is a broader project in the programme for Government, including the roll-out of free GP care. The original proposal in the programme for Government was to start with people on the long-term illness scheme and then move on to high-tech drugs and others. There were huge difficulties and legal complications associated with awarding a medical card on the basis of an illness or condition. It was extremely difficult because of the diagnosis of particular illnesses. The basis for a diagnosis of a particular condition, illness or disability is never straightforward. It was always going to be extremely difficult to draw up new legislation that would set out a scheme for awarding medical cards on the basis of an illness or condition. That is because our system, under the 1970 Act, is based on means and hardship rather than on illness, condition and disability. I am making that point to emphasise how difficult it would be to go down that route.

I earnestly hope that we will have universal access, without fees, to GPs and primary care for every citizen irrespective of means or state of health. It is a commitment in the programme for Government and we will do it, but we obviously have to do it in stages. We want to have a preventative primary care system so that everybody will get access to it. Nothing is free because it has to be funded, but we will have universal access to GP care. That is what I want to see happening.