John Perry (Sligo-Leitrim, Fine Gael)
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Question 186: To ask the Tánaiste and Minister for Health and Children if he will address the concerns raised by a person (details supplied) regarding the medical card guidelines; and if she will make a statement on the matter. [13090/05]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Entitlement to health services in Ireland is primarily based on means. Under the Health Act 1970, determination of eligibility for medical cards is the responsibility of the chief executive officer of the appropriate health board. Other than for persons aged 70 years and over who are automatically entitled to a medical card, medical cards are issued to persons who, in the opinion of the chief executive officer, are unable to provide general practitioner medical and surgical services for themselves and their dependants without undue hardship.

Income guidelines are drawn up by the chief executive officers to assist in the determination of a person's eligibility and these are revised annually by reference to the consumer price index. However, the guidelines are not statutory binding and even though a person's income exceeds the guidelines, a medical card may still be awarded if the chief executive officer considers that his-her medical needs or other circumstances would justify this. It is open to all persons to apply to the chief executive officer of the appropriate health board for health services if they are unable to provide these services for themselves or their dependants without hardship. The Deputy is no doubt aware that a range of income sources are excluded by the health boards when assessing medical card eligibility. Many allowances, such as the carer's allowance, child benefit, domiciliary care allowance, family income supplement and foster care allowance are all disregarded when determining a person's eligibility.

As part of budget 1996, the then Government announced that "persons who have been unemployed for at least one year, who take up paid insurable employment were deemed to meet the criteria for retaining their medical cards for three years". The provision also covers participants on approved schemes applicable to the long-term unemployed, including the back to work allowance, BTWA, community employment, Jobstart, job initiative, the partnership and community group initiative and development courses such as the workplace and vocational training opportunities scheme, VTOS. The purpose of this provision was to remove disincentives to labour force participation by long-term unemployed persons. The retention of medical card eligibility is approved for a period of three years when a person or spouse of a person who has been unemployed for a minimum of one year takes up employment. In this context, time spent on the live register, approved schemes or courses for the long-term unemployed is treated as an unemployed period.

The issue of eligibility was considered in the context of the national health strategy launched by the Government. The strategy outlines a number of measures designed to improve eligibility for health services which the Government has committed itself to introducing over a number of years. Among the measures proposed is an increase in access to medical cards. In addition to the extension of eligibility to all persons aged 70 years and over, the strategy includes a commitment that significant improvements will be made in the income guidelines to increase the number of persons on low incomes who are eligible for a medical card and to give priority to families with children and particularly children with a disability. The extension of the medical card to the over 70s is wholly consistent with Government policy aimed at improving the position of the elderly.

My Department has advised the health board chief executive officers in writing last year that medical card holders should not lose their cards because of increases in social welfare rates announced in the budget. In addition, the CEOs were asked that every effort be made to ensure that both medical card holders and applicants are made fully aware that increases in social welfare payments will not disadvantage them when applying to hold or retain a medical card.

There has been a 7.5% increase on 2004 income guidelines in respect of standard medical cards which came into effect on 1 January 2005 and this increase is expected to allow approximately 30,000 new people to become eligible for medical cards. In addition, the introduction of doctor-visit cards is intended to help to overcome barriers to accessing GP services for many individuals and families who are above the standard medical card income guidelines. The Health Service Executive initially intends to set the income threshold for doctor-visit cards at 25% higher than applies for the standard medical card. It is estimated that this policy initiative will result in approximately 200,000 people becoming eligible for free doctor visits.