Finian McGrath (Dublin Bay North, Independent) | Oireachtas source

It is my pleasure to introduce this Bill to the Seanad. In A Programme for a Partnership Government, the Government set out its aim to increase access to safe and timely care as close to patients' homes as possible. We outlined that progressing this objective would be a priority for the partnership Government. In our programme, we committed to extending the entitlement to a medical card for all children in receipt of the domiciliary care allowance. This initiative was subsequently announced as part of a range of health measures in budget 2017. The Bill delivers on this important commitment in full, on time and without qualification. We also committed to reducing prescription charges for medical card holders. The Bill will see the prescription charge reduced for medical card holders who are over 70 years of age and their dependants.

The legislation has two primary purposes. First, it will ensure that all children for whom a domiciliary care allowance payment is being made will be eligible for a medical card. Up to now, more than 9,800 of the 33,000 children for whom an allowance payment is made have not qualified for a medical card. The Bill will ensure that all 33,000 children will be eligible. This scheme will be operational from 1 June, with the HSE having a paper-based and online pre-registration system in place from 1 May. This pre-registration will assist in allowing all those who wish to do so to use their new medical cards from 1 June.

Second, it will reduce the prescription charge for medical card holders aged 70 years or older and their dependants. The charge will be reduced to €2 per prescription item, with a monthly cap of €20 for an individual or family. This targeted measure will benefit nearly 390,000 over 70s and their dependants. It is expected to save this group in the region of €10 million in 2017 and €12 million in a full year. Senators will note that this reduction was implemented on an administrative basis from 1 March. The HSE issued a circular to pharmacies setting out the reduced charge and process. I will take this opportunity on the Minister’s behalf and mine to thank the HSE and pharmacies across the country for their swift implementation of this measure.

In addition, I stress the importance of delivering the Bill in March in order to place this important measure on a statutory basis.I ask for the support of Senators in achieving this benefit for all of our older citizens.

Senators will be aware that I have long been a supporter of and campaigner for the rights of all people with disabilities, so it was extremely important that A Programme for a Partnership Government contained a commitment to provide medical cards to all children who qualify for a domiciliary care allowance payment. Children in receipt of the domiciliary care allowance payment are children under the age of 16 who the State has considered to have a severe disability which requires ongoing care and attention substantially over and above that required by a child of the same age. Caring for a child with a very serious disability is a most difficult, stressful and worrying time and dealing with a diagnosis can at times require every ounce of strength from parents and guardians. That is why we are committed to ensuring that all children for whom a domiciliary care allowance is made will have access to a medical card. Provision of a medical card will undoubtedly relieve some of the financial burden these families have experienced over many years. By virtue of having a medical card, these children will now be eligible for the following services free of charge: inpatient and outpatient hospital care; GP care; prescribed drugs and medicines, subject to a co-payment; dental and aural services; and aids and appliances. In addition, parents and guardians will not be required to undergo the process of providing family financial information, expert or medical reports and additional supporting information when applying for a medical card. In other words, it makes their lives much easier. I appreciate this was a burden and the outcome was often uncertain. Providing these children with a medical card without the need for the detail required by the standard application process will ensure a quicker and easier process for parents.

To ensure that all families are treated equally, where there is one child or a number of children in a family in receipt of domiciliary care allowance and the payment is made to the same parent for each child, the legislation allows that the prescription cap of €25 per month will apply. The Government is committed to reducing the cost of medicines for Irish patients, and this includes reducing the prescription charge for medical card holders. The prescription charge was introduced in the Health (Amendment) (No. 2) Act 2010 to address rising costs in the medical card scheme. The charge is set by regulation. The current charge of €2.50 per item with a monthly cap of €25 per person or family was set in 2013. It reduces the cost of the GMS scheme by approximately €120 million a year.

Under the existing legislation, specific groups, such as asylum seekers and children in care, have been exempted from the prescription charge. While the Act provides for groups to be exempted from the charge, it does not allow the charge to be varied for a particular group. The Bill identifies the over-70s as that group and provides for a lower charge to over-70s and their dependants. The most effective use of the resources available for reducing the charge at this stage is to target a particular group of people who are under greater pressure because of their medical needs. People aged 70 and over have higher medication requirements than the general population. Patients over 70 make up just under 20% of the medical card population but receive nearly half of the drugs dispensed under the scheme. The average number of items dispensed per person over 70 is seven compared with two items per person under 70 so it is fair and just to use the resources available this year to reduce the cost of medication for this group. This is part of building a just and inclusive society. Accordingly, budget 2017 announced a reduction in the prescription charge for medical card holders aged 70 and over and their dependants. The reduction is from €2.50 to €2 for each prescription item up to a maximum of €20 per person or family per month, reduced from €25.

I will now outline the main provisions of the Bill. Section 1 of the Bill provides a definition for the purpose of reference to the Health Act 1970. Section 2 provides a definition of who is eligible for full general practitioner and other health services, namely, children in receipt of the domiciliary care allowance. Section 3 amends section 59 of the Health Act 1970 to provide that persons over the age of 70 years and their dependants will benefit from a monthly maximum prescription charge. The monthly limit of €20 is provided for in section 4 of this Bill. Section 3 also provides that, where a child, or a number of children in a family, have full eligibility for a medical card solely for the reason that they are in receipt of the DCA payment, the monthly maximum prescription charge of €25 will apply.

Section 4 amends section 59 of the Act by inserting a new section, section 59A, into the Act to allow for the variation of prescription charges and monthly expenditure cap for medical card holders over 70. Section 59A(1) identifies medical card holders aged 70 and over and their dependants as the class of persons to whom the section applies. Section 59A(2) sets the prescription charge for this class of persons at €2 per item. Section 59A(3) sets the maximum amount of prescription charges payable in a month by this class of persons at €20. Section 59A(4) provides that the Minister may, with the consent of the Minister for Public Expenditure and Reform, make regulations to vary the amounts in this section. It also provides criteria to which the Minister should have regard when making such regulations. Section 5 of the Bill states the Short Title of the Act and includes a standard provision relating to commencement of the provisions of the Act.

This Bill is all about looking after some of the most vulnerable in our society - children for whom a domiciliary care allowance payment is made and people over 70 years of age who have a medical card. By providing all children for whom the domiciliary care allowance is paid with eligibility for a medical card, the Government is addressing an anomaly where a substantial cohort of children, in the region of 9,800, were considered to need ongoing care and attention substantially above that required by a child of the same age but did not qualify for a means-tested or discretionary medical card. Providing these medical cards will help to alleviate the stress and anxiety of parents and guardians who are dealing with the medical costs associated with a child’s disability. It is very difficult so this is a major assistance to these families.

The provision in the Bill to reduce this charge for people over 70 is the first step - and only a first step - in implementing the Government’s commitment to reduce the prescription charge for medical card holders. It is targeted at the medical card holders facing the greatest burden of the charge and it is right and just that, within the constraints we face, this group of patients receive the earliest relief from the total charge.

To conclude, I am very pleased to bring forward this legislation. It is our obligation as representatives of the citizens of Ireland to look after those who need it most.