Seanad debates

Wednesday, 11 December 2013

Health (Alteration of Criteria for Eligibility) (No. 2) Bill 2013: Committee and Remaining Stages

 

1:15 pm

Photo of Alex WhiteAlex White (Dublin South, Labour) | Oireachtas source

The Government has to make savings. Despite the required savings in the health sector in 2014, we know it will still be an extremely challenging year for the health service. Maintaining safe and quality health services will be as much a priority of the Government in 2014 as it has been in 2013, as will ensuring fairness in the measures that will have to be taken and that the burden is spread in a just fashion, not adversely affecting those who are most vulnerable in communities. The Government has done the best job possible in ensuring that will be the case.

The less well-off who account for four fifths of the over-70s population will not be affected by this legislation. The Government recognises that the living costs of an individual living alone are more than half the living costs of a couple living together. Expenditure does not necessarily diminish relative to the number of people in a household. In that context, the over-70s income limit for a single person has been reduced proportionately less than that for a couple. This is not new or unique to this legislation, as I indicated on Second Stage. For instance, the State pension is €230 per week for an individual and €436 for a couple. There is the provision of the living alone allowance, with an extra payment for those in receipt of social welfare pensions. Differential income limits also apply in the case of medical cards for persons aged under 70 years. In the assessment of supplementary welfare allowance, a differential rate applies whereby the rate for a dependent qualified adult is not half the personal rate of the applicant. Under the Insolvency Service of Ireland guidelines, there is not a significant extra sum allowed per month for a couple compared to a single person.

Senator Fidelma Healy Eames referred to medical costs. I accept that costs are a factor in assessing anyone’s means. However, this is a means test to determine eligibility. In these circumstances, it is reasonable to have regard to economies of scale as between a couple and a single person such that there would be differential limits.

I take Senators Colm Burke’s and Feargal Quinn’s point on the review process for medical cards. Senator Colm Burke referred to a case brought to his attention and what appeared, sometimes, to be repeated requests for information. It is a difficult issue. The HSE has a responsibility to ensure the resources we have available are spent properly and that those entitled to a medical card retain it, but those who are not so entitled ought not to retain it. This is not a reflection on the case raised by Senator Colm Burke. However, there needs to be a reasonably robust review system in place. Is it necessary for us to make repeated requests? The HSE and the PCRS, primary care reimbursement service, have taken a sensitive approach to this issue as best they can. It is a pity and does surprise me that people are still finding out from their pharmacist that their medical card has been withdrawn. I am advised that in the review process there is a three month letter of notice followed by a one month letter of notice. People receive notice well in advance. There is also a procedure under which a person’s doctor can extend the period by three months. Fail-safe mechanisms are in place. If the system is not working properly, I welcome Senators drawing to our attention ways by which it could be improved.

Senator Feargal Quinn stated we should not single out those over 70 years of age. We are not singling them out. We have a review process across the board. It is not targeted at those over 70 years of age, which would be unacceptable.

Anyone who loses out by this change in eligibility and is affected by the revised income limits will still be able to access his or her GP for free. Persons aged over 70 years whose gross income is above the revised limits may still apply for a medical card using the standard net income means test which is open to those in the general population who believe it applies to their situation.

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