Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I thank the Senator for raising this Commencement matter, which I am taking on behalf of the Minister, Deputy Donnelly, whose script I will read. If I have time I will also give my own opinion, which I would like to on this one.

Person-centred care is an existing core value of the health service, where everyone living in Ireland and considered by the HSE to be ordinarily resident here is entitled to either full or limited eligibility for health services. Persons with full eligibility, those who hold medical cards, can generally access a wide range of health services without charge.As of January this year, there are over 1.5 million medical card holders and over 530,000 GP visit card holders. Eligibility for medical cards is provided on a statutory basis under the Health Act 1970 and based primarily on means. The Act obliges the HSE to assess whether a person is able, without undue hardship, to arrange GP services, having regard to his or her overall financial position and reasonable expenditure. The HSE assesses each medical card application on a qualifying financial threshold. This is the amount of money that an individual can earn a week and still qualify for a card. It is specific to the individual's own financial circumstances.

The Minister for Health's focus continues to be on ensuring the continued operation of an appropriate and effective medical card system which aims to provide support and access to health services when needed. If an applicant's income is over the limit for a medical card or GP visit card, he or she may still qualify for a discretionary card. The HSE may, and I use the word advisedly, exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where he or she faces difficult financial circumstances, such as costs arising from the illness. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services.

I can advise the Senator that since 1 December 2018, the medical card earnings disregard for persons in receipt of a disability allowance has increased from €120 to €427 per week and applies to the assessment processes for both single persons and families. This measure gave effect to one of the key recommendations of the Make Work Pay for persons with disabilities report and enables persons in receipt of the disability allowance to have a higher level of earnings and still retain their medical card. I can assure the Senator that the Minister for Health endeavours to ensure the medical card system is responsive and sensitive to people's needs. The Department of Health keeps medical card issues, including the current medical card income thresholds, under review and any proposals are considered in the context of any potential broader implications for Government policy, the annual budgetary estimates process and legislative requirements.

Last Friday morning I met a farmer of 72 years of age and his wife who is not yet 70. This is his third time applying for a medical card. He is over the threshold by X number of euro but at the same time his wife suffers from a serious underlying health condition. In cases like this there is need for flexibility, particularly with the self employed and in the farming sector. The Senator referred to prosthetics. The price of a prosthetic can be up to €20,000. Many people cannot afford that. Even if one has private health insurance, it is not covered. There are certain needs, such as the example I have just given where people do need a medical card. People of that age have a life-altering experience. They were probably hale and hearty and all of a sudden things have changed dramatically. After having an amputation it can be up to a year later that a person needs to be fitted for a prosthetic. That is not taken into consideration. That is why those people need flexibility. We need to look at a budgetary piece where VAT is removed on the income that people are paying who find themselves in this situation.