Maire Devine (Sinn Fein)
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I raise this matter because, over time, it dawned on me that what is happening seems to be unfair and inequitable. If one gets sick with a serious illness, obviously one's income will not match the outlay for treatment. That outlay is €800 for any inpatient treatment over 12 consecutive months. I have been helping patients to apply for medical cards because they have been given bad news about the state of their health and what they need to do. The Minister of State will be aware that it takes time for medical cards to be declined, issued or appealed. Another area that needs to be explored is trying to keep the interim guys at bay until a decision is made about the medical card applications. Patients are granted medical cards that do not apply retrospectively to the date of application so the forms that they fills in about their income and outgoings do not take into account the additional costs of being sick such as transport, medication, different diets or whatever. Those forms are sent in at the time the patient realises they are sick and need a medical card. The medical card takes weeks, if one is lucky, to be granted and, if it is granted, it is dated from the time that the decision is made, as opposed to retrospectively when the patient began receiving treatment from the health services.

Could the Minister of State examine this? I asked the HSE whether it retains data on this. This is about the interactions between the medical card section and the finance section of the HSE which issues bills. It is grossly unfair. When one applies for other benefits or supports from the State at times of need, they are retrospectively applied to the time of application. It is from the time the decision is made in this case. I am interested in the Minister of State's response.

Jim Daly (Cork South West, Fine Gael)
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I thank the Senator for raising this matter. As she will be aware, under the Health Act 1970, as amended, eligibility for health services is based primarily on residency and means. The Act provides that all persons ordinarily resident in the country are eligible, subject to certain charges, to public inpatient hospital services. The current public hospital statutory inpatient charge is €80 per day, subject to a maximum of €800 in any period of 12 consecutive months and the outpatient charge for attendance at an emergency department is €100.

All persons accessing an emergency department and public inpatient services in a public hospital are liable for the statutory charges, subject to a number of exemptions, including where a person is a medical cardholder. While medical cardholders are exempt from hospital charges, the exemption is only valid from the date of issue of the medical card. Patients, therefore, continue to be liable for any charges which occurred before a medical card has been issued. It should be noted that in cases where patients who are terminally ill, in palliative care or who are seriously ill and in urgent need of medical care that they cannot afford, the HSE has an effective system in place for the provision of emergency medical cards. They are issued within 24 hours of receipt of the required patient details and the letter of confirmation of the condition from a doctor or a medical consultant.

Given the nature and urgency of the issue, the HSE, which has responsibility for the national medical card unit, has appropriate escalation routes to ensure that the person gets the emergency medical card as quickly as possible.

I fully understand the sentiment behind the raising of this issue, but I am sure that the Senator can appreciate that not every application for a medical card will be approved.The national medical card unit receives approximately 39,000 medical card and GP visit card applications each month. A large percentage of these will be deemed unsuccessful for reasons such as the provision of insufficient information or failure to meet the qualifying means threshold. Therefore, the exemption from hospital charges is only valid from the date of issue of the medical card. This position is in compliance with the legislative framework. It is important to note that every effort is made to process medical card applications as quickly as possible in order to ensure that those who are eligible do not encounter a financial barrier to accessing healthcare. In that regard, the national medical card unit has consistently met its key performance target, which is to have 95% of complete medical card applications assessed for eligibility within 15 days. I have been assured that there are currently no delays in the processing of medical card applications.

I hope this clarifies the matter for the Senator. I assure her that the charging of fees and the processing of the medical card applications operate in a fair manner within a legislative framework.

Maire Devine (Sinn Fein)
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I thank the Minister of State for his response. Unfortunately, I do not think it is what is needed. We need to look at the applications. The Minister of State stated that almost 40,000 applications are made each month and that many are deemed invalid for one reason or another. We need to get data on this in order to be satisfied that we are going in the right direction. The main point I am making is that there is a need for fairness and equality in retrospectively accessing health or other social welfare benefits that are afforded to those in need. Retrospective access is possible when every other type of application is made for supports or benefits, but it is not possible in the case of medical cards. One could have a great deal of intensive inpatient treatment over a 15-day period. In many cases, the period is even longer because people have to reapply or obtain additional information they were unable to provide in the first instance. Vulnerable people with serious medical conditions do not need this extra hassle. I am of the view that what is happening is discriminatory.

Jim Daly (Cork South West, Fine Gael)
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While I acknowledge the point the Senator is making, I emphasise that one does not need to be sick or be going to hospital in order to apply for a medical card. People are free to apply for medical cards on any given day and at any given time. They are encouraged to do so. Decisions are based on people's means. Many individuals make applications long before they go near a hospital or receive treatment. I have outlined the emergency procedures that allow decisions to be made within 24 hours as long as sufficient documentation is available. I am not sure that changing the entire system to accommodate perhaps two or three people who are caught in the scenario the Senator is talking about can be justified. I do not want to put a number on it.

Maire Devine (Sinn Fein)
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It would be much more than two or three.

Jim Daly (Cork South West, Fine Gael)
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As a percentage, it would be minuscule-----

Maire Devine (Sinn Fein)
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This is why we need the data.

Jim Daly (Cork South West, Fine Gael)
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If we were to change the entire system for everybody, it would have substantial financial consequences for the health service. It is all very well to say that this would be a good idea, but from where would we take the money? Should we take it from the nursing home sector or the mental health sector? At the end of the day, we have a finite budget. We have to take all of these factors into consideration when we examine proposals of this nature.

Denis O'Donovan (Fianna Fail)
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I am sure the Senator will raise the matter again.