Brian Hayes (Dublin South West, Fine Gael)
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Question 97: To ask the Minister for Health and Children if, in view of her support for greater use of general practitioner care in the treatment of chronic conditions to keep people with such conditions out of hospital, she will provide free GP visits for people with asthma who do not have medical cards to enable them to avail of the flu vaccine which is recommended for people with their condition and for whom the cost of a GP visit to obtain the vaccine may be prohibitive or a disincentive; and if she will make a statement on the matter. [19270/07]

Brian Hayes (Dublin South West, Fine Gael)
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Question 98: To ask the Minister for Health and Children the number of the promised 200,000 doctor only medical cards that have been taken up in the past 12 months; her views on extending this scheme to people with chronic illnesses to enable better management of their condition in the community; and if she will make a statement on the matter. [19271/07]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 97 and 98 together.

The criteria for those who should receive the seasonal flu vaccine are set by the National Immunisation Advisory Committee, a Sub Committee of the Royal College of Physicians of Ireland, which advises me and my Department. It is recommended that those considered to be at risk of influenza related complications should go to their G.P. for vaccination. The "at risk" groups include persons with specific chronic illnesses requiring medical follow-up, including moderate or severe asthma. There is no charge for either the vaccine or the administration of the vaccine for those in the "at risk" group who have a medical card or GP visit card. GPs who are contracted by the Health Service Executive (HSE) to provide services to General Medical Services (GMS) Scheme patients receive a special item of service fee for administering the influenza vaccine to GMS patients, i.e. medical card and GP visit card holders. This fee is in addition to the capitation fee paid for all GMS patients on a GP's panel. Where a patient is in an "at risk" group but does not have a medical card or GP visit card, there is no charge for the actual vaccine as the vaccine is supplied free of charge to GPs by the HSE. The fee for administering the vaccine is a matter between the GP and the patient.

The assessment of eligibility to medical cards and GP visit cards is statutorily a matter for the HSE and is determined following an examination of the means of the applicant and his/her dependants. Under Section 45 of the Health Act 1970 medical cards are provided for persons who, in the opinion of the HSE, are unable without undue hardship to arrange GP medical and surgical services for themselves and their dependants. Section 58 of the Health Act, 1970, as amended, provides for GP visit cards for adult persons with limited eligibility for whom, in the opinion of the HSE, and notwithstanding that they do not qualify for a medical card, it would be unduly burdensome to arrange GP medical and surgical services for themselves and their dependants. Persons aged 70 and over are statutorily entitled to a medical card, regardless of income. In all other cases an assessment of means is undertaken. In assessing eligibility, the HSE use guidelines based on people's means, which includes their income, certain allowable outgoings and the effect of other factors such as medical costs incurred by an individual or a family which may impact on people's ability to meet the cost of GP services.

Non-medical card holders whose illness is not covered by the Long Term Illness Scheme can use the Drug Payment Scheme, which protects against excessive medicines costs. Under this scheme, no individual or family unit pays more than €85 per calendar month, or approximately €20 per week, towards the cost of approved prescribed medicines. The scheme is easy to use and significantly reduces the cost burden for families and individuals incurring ongoing expenditure on medicines.

Since the beginning of 2005 I have introduced a number of significant changes to the manner in which assessment for medical cards are undertaken. The assessment guidelines have been increased by a cumulative 29% and more so in the case of dependant children. Applications are now considered on the basis of income net of tax and PRSI and allowance is made for reasonable expenses incurred in respect of mortgage/rent, childcare and travel to work. Also in 2005 I introduced the GP visit card as a graduated benefit, with the specific purpose that people on moderate and lower incomes, particularly parents of young children, who do not qualify for a medical card would not be deterred on cost grounds from visiting their GP. The range of GP services available to holders of a GP visit card is the same as is available to persons who hold a medical card. The income guidelines used by the HSE to assess applications for GP visit cards were initially 25% higher than those used in assessing applications for medical cards and from June, 2006, the differential has increased to 50%. The aforementioned changes in the assessment of medical cards also apply to GP visit cards. I have no plans to extend statutory entitlement to GP visit cards to people with asthma or other chronic conditions.

Between January 2005 (1,145,083 ) and June 2007 (1,243,466) an additional 98,383 people have medical cards. As at 27th June 2007, 77,844 persons held a GP visit card. Thus since January 2005, an additional 176,227 people have free access to GP services.

The arrangements for the provision of publicly funded GP services, including those provided to medical card and GP visit card holders under the GMS Scheme, are currently under review. It is my wish that the new arrangements would ensure the provision of high-quality, person-centred services, potentially including the management of certain chronic conditions, and for the maximum proportion of people's healthcare to be met in the primary care setting.