Leo Varadkar (Dublin West, Fine Gael)
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The HSE has a system in place for the provision of medical cards in response to an emergency situation for persons with a serious medical condition in need of urgent or on-going medical care that they cannot afford and persons in palliative care, who are terminally ill. With the exception of terminally ill patients all medical cards, granted on an emergency basis, are issued on the basis that the patient is eligible for a medical card on the basis of means or undue hardship, and will follow up with a full application within a number of weeks of receiving the medical card eligibility. Eligibility, in these circumstances, is granted to a named individual for a period of six months. These are issued within 24 hours of receipt of the required patient details and a letter which confirms the medical condition from a doctor or consultant.

Under the Health Act 1970, eligibility for a medical card is founded primarily on the undue financial hardship test. The Act obliges the HSE to assess whether a person is unable, without undue hardship, to arrange general practitioner services for himself or herself and his or her family, having regard to his or her overall financial position and reasonable expenditure.

In certain circumstances, the HSE may exercise discretion and grant a medical card, even though an applicant exceeds his or her income threshold, where he or she faces difficult financial circumstances, such as extra costs arising from an illness. Social and medical issues are considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services. The HSE affords applicants the opportunity to furnish supporting information and documentation to fully take account of all the relevant circumstances that may benefit them in the assessment, including medical evidence of cost and necessary expenses.

The Deputy may be aware of the "Keane" Report of the Expert Panel on Medical Need for Medical Card Eligibilitywith a key recommendation that a person’s means should remain the main qualifier for a medical card. It also recommended that it is neither feasible nor desirable to list conditions in priority order for medical card eligibility.

It is clear that there are people with medical needs and it is important that they should be able to access necessary assistance in a straight forward manner. Greater discretion is being exercised by the HSE as evidenced by the number of discretionary medical cards in circulation, which has increased from about 52,000 in mid-2014 to over 102,000 at the beginning of March 2016.

On foot of the Keane Report, the HSE established a Clinical Advisory Group to develop clinical oversight and guidance for the operation of a more compassionate and trusted medical card system. The Director General of the HSE, on accepting an interim recommendation of the Group, made a decision to award medical card eligibility to all children under 18 years of age with a diagnosis of cancer from 1 July 2015, with the card to be held for a period of five years. The Clinical Advisory Group is continuing its work on the development of guidance on assessing medical card applications involving significant medical conditions.

We do not have a universal eligibility system for primary and community health services. Until we have universal health care and everyone is entitled to health care, one will always have anomalies. There will always be somebody who is just above a means threshold, or who does not have a prescribed disease, or whose condition is not sufficiently severe and, as a result, these individuals will not meet the assessment criteria.