Richard Bruton (Dublin North Central, Fine Gael)
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Question 215: To ask the Minister for Health and Children if she has costed the proposal of extending medical card cover to all children under the age of five years; and if she will introduce such cover over the five year Programme for Government. [26304/07]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I have no plans to extend medical card coverage to all children aged under five and my Department has not carried out a detailed costing exercise to estimate the cost of extending medical cards to all children in this age cohort.

In 2006, on foot of a Parliamentary Question, my Department estimated the cost of extending medical cards to children under 6 years. Based on these figures (using 2006 prices), it is estimated that the direct cost to the GMS Scheme of extending medical card coverage to all children under five would be in the region of €80m per annum.

Were eligibility provisions to be adjusted to enable a particular cohort of the population to qualify for a medical card, the actual costs arising would depend on the precise demographic profile of those additional clients. The capitation payments to GPs, for example, are calculated according to clients' age, sex and distance of their residence from the GP's centre of practice. Furthermore the effect on the General Medical Services (GMS) drugs budget and on certain other services available free of charge to medical card holders cannot be predicted with accuracy and would be dependent on the health status of the clients concerned.

The estimate of approximately €80 million does not take account of the following matters: Potential additional costs in terms of income forgone by public hospitals in respect of A & E attendance and in-patient charges; The possible cost, depending on the circumstances of the additional children obtaining medical cards, of such services as aids and appliances and public health nursing; Costs in other areas of Government in which the holding of a medical card may be used as a means of determining entitlement to services or benefits; Any offsetting effect of a potential reduction in costs under the Drug Payments Scheme.

The Programme for Government commits to the following: Indexing the income thresholds for medical cards to increases in the average industrial wage; Doubling of the income limit eligibility of parents of children under 6 years of age, and trebling them for parents of children under 18 years of age with an intellectual disability; Allowing people with disabilities to work without losing key essential medical card cover after 3 years; Implementation of an annual publicity campaign and making applications easier so as to increase uptake amongst those who are eligible for Medical Cards and GP Visit Cards.

My Department is at present considering the steps required to enable these commitments to be implemented. My Department is also examining the steps necessary to give effect to the Towards 2016 commitment to review the eligibility criteria for the assessment of medical cards in the context of medical, social and economic/financial need with a view to clarifying entitlement to a medical card.