Tommy Broughan (Dublin North East, Independent)
Link to this: Individually | In context | Oireachtas source

112. To ask the Minister for Health the number of children in receipt of domiciliary care allowance who also have medical cards in each of the years 2013 to date, in tabular form; and if he will make a statement on the matter. [44260/15]

Tommy Broughan (Dublin North East, Independent)
Link to this: Individually | In context | Oireachtas source

113. To ask the Minister for Health if he will provide automatic access to a medical card to all children who are in receipt of a domiciliary care allowance, the estimated cost; and if he will make a statement on the matter. [44261/15]

Ruth Coppinger (Dublin West, Socialist Party)
Link to this: Individually | In context | Oireachtas source

128. To ask the Minister for Health his views on extending the eligibility for medical cards to all children in receipt of a domiciliary care allowance; and if he will make a statement on the matter. [44346/15]

Finian McGrath (Dublin North Central, Independent)
Link to this: Individually | In context | Oireachtas source

137. To ask the Minister for Health if he is aware that 9,000 of the 26,000 children who qualify for the domiciliary care allowance are without medical cards, if he will end this injustice; and if he will make a statement on the matter. [44379/15]

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

I propose to take Questions Nos. 112, 113, 128 and 137 together.

Under the provisions of the Health Acts, medical cards are provided to persons who are, in the opinion of the HSE, unable without undue hardship to arrange GP services for themselves and their dependants. In the assessment process, the HSE can take into account medical costs incurred by an individual or a family. Where deemed appropriate in particular circumstances, the HSE may exercise discretion and grant a medical card even though an applicant's means exceed the prescribed threshold. Where a person does not qualify for a medical card, they may be provided with a GP Visit Card, appropriate therapy or other community supports or drugs.

The Domiciliary Care Allowance (DCA) payment is made by the Minister for Social Protection to carers in respect of a child at home under 16 years of age with a severe disability, where it has been determined that the child requires ongoing care and attention, substantially over and above the care and attention usually required by a child of the same age. Eligibility for the DCA is not based primarily on the medical or psychological condition, but on the resulting lack of function of body or mind necessitating the degree of extra care and attention required. As such it is not possible to say if a particular child or any particular medical condition or disability will qualify for a payment under the DCA scheme.

The Deputy will be aware that the report of the Expert Panel on Medical Need for Medical Card Eligibility, known as the Keane Report, recommended that a person’s means should remain the main qualifier for a medical card and that it was not feasible, desirable, nor ethically justifiable to list medical conditions for medical card eligibility. Nonetheless, it is clear that there are people – including children - with medical needs and it is important that they should be able to access necessary assistance in a straight forward manner.

Consequently, the Clinical Advisory Group on medical card eligibility was established by the HSE to develop a framework for assessment and measurement of the burden of disease and appropriate operational guidelines for the medical card scheme. However, the Clinical Advisory Group has not recommended that children in receipt of the Domiciliary Care Allowance should automatically qualify for a medical card. In advance of the Group completing its work, there are no proposals to issue automatic medical cards to one particular group.

The Government is committed to making the medical card system as responsive as possible to the circumstances of people with significant medical needs. As a result of a range of improvements, the HSE is exercising greater discretion. Consequently, the number of discretionary medical cards has increased by about 84% - from about 52,000 in mid-2014 to nearly 96,000 at the beginning of November this year.

As the DCA payment is not an element of the assessment for a medical card, data on the payment is not routinely collated by the HSE. However, analysis undertaken in 2015 shows that out of an approximate population of 1 million people under the age of 16 years, almost 450,000 held a medical card or a GP visit card. Approximately 29,000 children qualified for the DCA payment in 2014. It is estimated that about two-thirds of children qualifying for a DCA payment also hold a medical card. In addition, from 1 July 2015, all children under the age of 6 years are entitled to access a GP service free of charge, as part of the first phase of introducing a universal GP service in Ireland. It has been estimated that the average expenditure per medical card was €973 in 2013, however, it is not possible to provide the actual cost of extending a medical card to all children in receipt of DCA as it would depend on the variable nature of the individuals’ requirements as well as the number of individuals and the quantum and cost of health services that would be used.

Ultimately, the proper way to address this issue is to develop a system of universal health care, which is at the centre of Government health policy. Otherwise, whenever there are qualifying rules, there will always be a person who is above the means test, does not have the selected disease, or is not in receipt of the specific social welfare payment.