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

I thank the Senator for raising the issue. We have the details of the particular case to which the Senator refers but it would be inappropriate to discuss an individual’s circumstances in public in the Seanad. I know Senator Moran agrees with that. However, I understand from the HSE that this application was unsuccessful as the means were in excess of the qualifying threshold for a medical card or GP visit card. I have been advised by the HSE that additional information has been provided and the case has been referred for a discretionary review.

The Senator will be aware that, in accordance with the Health Act 1970, as amended, full eligibility and a medical card are awarded to persons who are, in the opinion of the HSE, unable without undue hardship to arrange GP services for themselves and their dependants. That is the reason the letters received by the individual refer to dependants. In accordance with the Act, the assessment for a medical card is determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependants. Where deemed appropriate in particular circumstances, the HSE may exercise discretion and grant a medical card even though an applicant exceeds the income guidelines but where they face difficult financial circumstances, such as extra costs arising from an illness.

The Senator is aware of the Keane report, to which she referred on several occasions, on the expert panel on medical need for medical card eligibility, published in November 2014. A key recommendation of the report was that a person’s means should remain the main qualifier for a medical card. That was the main issue of contention. It has been repeatedly stated that one cannot issue medical cards or GP visit cards for condition-specific reasons alone. It also recommended that it is neither feasible nor desirable to list conditions in priority order for medical card eligibility. The rationale behind the recommendation will be clear to the Senator. On foot of the report, my Department and the HSE are undertaking a suite of measures to improve the operation and administration of the medical card scheme. A number of those are already in place and are having a positive impact on how the scheme operates.

A key element of the programme is the work of the clinical advisory group on medical card eligibility which was established by the director general of the HSE. The group has been tasked with developing a framework for assessment and measurement of the burden of disease and appropriate operational guidelines for the medical card scheme. The clinical advisory group made an interim recommendation to award medical card eligibility to all children under 18 years of age with a diagnosis of cancer. The director general of the HSE accepted that recommendation and it has been implemented since 1 July 2015. The clinical advisory group is continuing its work on the development of guidance on assessing medical card applications involving a significant burden due to an illness.

I am pleased to advise the Senator that, on foot of these reforms, the HSE is exercising greater discretion. That is evident in the number of discretionary medical cards in circulation which increased from approximately 52,000 in mid-2014 to nearly 96,000 at the beginning of November this year. Until we have universal health care and everyone has eligibility for health services, one will always have anomalies. There will always be someone who is just above the means threshold, who does not have the prescribed disease or whose condition is not sufficiently severe and, as a result, those individuals will not meet the assessment criteria. Universal health care, to which I am committed, is the only solution to address this issue. However, as Senator Moran can see from the reply, we are taking another look at this application.