Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

It is my pleasure to introduce Second Stage of the Health (General Practitioner Service) Bill 2015 to the Seanad. The Bill will provide for a universal GP service to be made available to all persons aged 70 years and older. This is the second phase of introducing a universal GP service in Ireland which builds on the under-sixes first phase. Together with the under-sixes phase, the second phase will see more than 300,000 children and senior citizens who currently must pay to see their GP no longer having to decide whether they should spend €50 to visit their GP. This phased extension of universal coverage will come as a relief to many young families and pensioners. Under the new legislation, access to a GP service will be provided for all persons over the age of 70 years on a universal basis. This will replace the existing GP service arrangement for those over 70 years where their income must be assessed before they can access a GP without charge. Their dependants, including spouses or partners, under the age of 70 years will continue to have access to a GP service without fees where they meet the existing income limits.

The Government remains committed to the introduction of a universal GP service for the entire population in line with the programme for Government. As set out in its statement of priorities 2014– 16, it prioritised those over 70 years in the next phase of the roll-out of free access to GP care. It is now living up to that commitment.

General or family practice is often viewed as the core of primary care. The GP plays a crucial role as gatekeeper for the whole health system. The generalist and patient-centred GP approach guides the patient through the referral process and the health care system. It is widely considered that a well developed system of primary care has beneficial effects on the health care system as a whole. As previously announced, the Government decided to commence the roll-out of a universal GP service for the entire population by first providing all children under six years and, second, persons over 70 years with access to a universal GP service. The decision to prioritise those aged over 70 years next for the roll-out of a universal GP service had regard to the significant prevalence and co-morbidity of chronic diseases in this population cohort. Therefore, there is a significant benefit to be achieved from improved GP access in terms of health and well-being.

There are approximately 400,000 people in Ireland over the age of 70 years. It is estimated that about 36,000 people over the age of 70 years must pay to attend a GP because they are not covered by a medical card or a GP visit card. Medical evidence suggests there is a significantly greater incidence of multiple chronic conditions among persons over the age of 70 years. This emphasises the benefit of access to GP care without fees for persons in this age category. It is important to be clear that nothing will change for people over 70 years of age who have or who are eligible for a medical card. They will continue to receive all of their other medical card entitlements as normal.

We must move towards a health system based on universality of access which must be sustainably funded to enable the provision of services to meet health needs. While we recognise that a move from a means-based eligibility system to a universal-based system of health coverage is challenging, the Government is in the process of reorienting the health system from one that only treats sick people to one that keeps people well. That is why we believe a universal system is the best option. It can be argued that the existing eligibility system has become overly complex which has resulted in people focusing on the assessment process rather than the provision of services. We should not lose sight of the fact that the key issue is that an ill person should be able to receive primary health services. At the same time, we must stay committed to completing the most radical reform of the system in the history of the State to develop a universal system that will treat all according to their health needs, not their means.

I will briefly outline the main provisions of the Bill. Section 2 amends section 58 of the Health Act, 1970 to remove all individuals aged over 70 years from the scope of the means-tested service based on holding a medical card or a GP visit card. Instead, all persons over 70 years will automatically qualify for a GP service and it will not be necessary to hold a means-tested medical or GP visit card.

Section 3 amends section 58A of the Health Act, 1970 which sets out the existing GP service arrangements for those over 70 years to provide access to a GP service for all persons over the age of 70 on a universal basis. Section 58A(1) establishes a new universal arrangement for the HSE to provide a GP service without fees for all persons aged 70 years and over who are ordinarily resident in the State. The HSE will also provide a GP service for the dependants of such persons where the existing income criteria are met.

Subsections (2) and (3) outline the income conditions that the person over 70 years must meet for his or her dependants who are under 70 years to qualify for a GP service without fees. The dependants of a single person over 70 years will qualify if the income of the person over 70 does not exceed €700 per week. Alternatively, the dependants of a married person aged over 70 years will qualify if the combined income of the couple does not exceed €1,400 per week.

In general, the remaining subsections maintain the existing administrative practices of the GP service for those over 70 years. Subsections (4) to (7), inclusive, deal with the application process, the decision-making process and the provision of information. In line with current arrangements, subsection (8) requires the HSE to provide assistance for persons over 70 years in making an application, if needed. Subsections (9) to (12), inclusive, address the income limits and the calculation of gross income. Subsection (13) provides that the HSE, in so far as practicable, will offer a choice of GP to an individual.In conclusion, this legislation will deliver universal GP care to a second age cohort. By the summer, all 800,000 of those over 70 and children under six will be able to visit a GP without facing a financial barrier. This Bill represents another step towards a universal GP service for the entire population of our country. I commend the Bill to the House and I look forward to hearing the views of Senators.