Róisín Shortall (Dublin North West, Labour)
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Question 113: To ask the Minister for Health and Children the allowances, in addition to the income threshold cut-off points, that will apply to medical card applicants over 70 in 2009; and if regular medical expenses will be permitted to form a standard part of the means test, as with other medical card applicants. [37615/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Government recently announced, as part of its budget proposals, the withdrawal of automatic entitlement to the medical card from people aged 70 years and over and the introduction of new income thresholds for entitlement to a medical card for those aged 70 and over of €700 (gross) per week for a single person and €1,400 (gross) per week for a couple.

Any savings up to €36,000 (single)/€72,000 (couple) will be disregarded and only interest from savings above these figures will be considered as income for means testing purposes. Income will not be imputed from property (whether a family home, a holiday home or any other property) for means testing purposes, unless it is rented, and only the net rental income will be included as income. The income to be assessed will be the gross income, less any cost necessarily incurred associated with the property and such cost may include insurance premia, loan/mortgage repayments, maintenance, etc. Only dividend payments will be considered as income for means testing purposes in the context of shares and investments.

Medical expenses will not be considered as part of the initial means test. However, when a person's means are in excess of the relevant income guidelines, the Health Service Executive may issue a medical card on a discretionary basis, having considered if the applicant would otherwise be caused undue hardship in providing general medical and surgical services for themselves and their dependants.

Pat Rabbitte (Dublin South West, Labour)
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Question 114: To ask the Minister for Health and Children if the contract signed with the Irish Medical Organisation to allow persons over 70 years automatic entitlement to medical cards provides that general practitioners' payments may not be changed without the explicit agreement of the IMO; if she will outline what those payment terms were then and what they are today; if she will lay a copy of the contract in the Library of the Houses of the Oireachtas; and if she will make a statement on the matter. [37618/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Under the General Medical Services (GMS) Scheme general practitioners hold one of two contract types, i.e. the Fee per Item contract (first introduced in 1972) or the Capitation contract (effective from 1989). These contracts reflect the agreed outcomes of negotiations between my Department and the GP representative body, the Irish Medical Organisation.

Over time, provisions additional to the 1972 and the 1989 GMS contracts have been supplemented on foot of agreements between the Department of Health and Children, the Irish Medical Organisation (IMO) and the Health Boards/Health Service Executive (HSE) by way of circulars issued by my Department. Automatic medical card eligibility for persons aged 70 and over came into effect on 1 July 2001. The terms of the agreement were contained in a circular issued by my Department on 3 August 2001. I will make arrangements for a copy of the GMS GP capitation contract and circulars to be placed in the Library of the Houses of the Oireachtas as requested by the Deputy.

The annual GP capitation rates as of 1 July 2001 and 1 January 2008 in respect of persons aged 70 and over living in the community issued with a medical card for the first time regardless of income and persons aged 70 and over in private nursing homes (approved by the HSE) for continuous periods in excess of five weeks are set out in tabular form below.

In addition to the capitation fees outlined above, participating GMS GPs may receive additional payments under a range of headings.

Section 41(2) of the 1989 GMS contract states "The terms of this contract shall be subject to alteration every three years in accordance with the outcome of a review of the agreement between the Minister and the Irish Medical Organisation on arrangements for the provision of services under Section 58 of the Health Act, 1970, which review may be conducted by a third party". It is not stated in the 2001 Circular, which introduced automatic medical card eligibility for persons aged 70 and over, that GPs' payments cannot be explicitly changed without the agreement of the IMO.

Legal advice received by my Department and the HSE in 2006 and 2007 confirms that there are significant competition law issues which must be taken into account in reaching any agreements and in particular in fixing fees regarding the provision of health services by self-employed professionals.

The Government is satisfied that the scope of the engagement by General Practitioners in the delivery of primary health care and the significance of primary health care for the overall efficacy of the public health system makes a more direct form of engagement with the representatives of General Practitioners both necessary and desirable. Accordingly, it is the intention of Government to pursue appropriate amendments to Section 4 of the Competition Act 2002 to enable the representative body of GPs, the IMO, to represent its members in negotiations with the HSE and the Department of Health and Children in respect of the services provided to the public health service in a manner consistent with the public interest. The legal provision to be made will be subject to consistency with EU competition rules.

Michael McGrath (Cork South Central, Fianna Fail)
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Question 115: To ask the Minister for Health and Children the reason a person (details supplied) in County Cork was refused a medical card. [37624/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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As the Health Service Executive has the operational and funding responsibility for the medical card benefit, it is the appropriate body to consider the particular case raised by the Deputy. My Department has therefore requested the Parliamentary Affairs Division of the Executive to arrange to address this matter and to have a reply issued directly to the Deputy.