James Lawless (Kildare North, Fianna Fail)
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327. To ask the Minister for Health the steps his Department is taking to address the evolving issue regarding the current standards for what illnesses qualify as 'long-term' for those looking to avail of the long-term illness scheme; if it is possible to update the list of illnesses that fall under the remit of being a 'long-term illness' in order to coincide with modern standards, statistics and research; and if he will make a statement on the matter. [25926/24]

Stephen Donnelly (Wicklow, Fianna Fail)
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The Long-Term Illness (LTI) scheme was established under Section 59(3) of the Health Act 1970 (as amended) which provides that arrangements may be made for the supply without charge of drugs, medicines or medical and surgical appliances to persons suffering from a prescribed disease or disability of a permanent or long-term nature.

Various regulations were made in the 1970s prescribing 16 conditions covered by the scheme. Further information regarding the conditions covered can be found at:

.

However, it is also important to remember that the LTI Scheme exists within a wider eligibility framework.

People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card. In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. Medical card eligibility is primarily based on an assessment of means and is not granted on the basis of any particular condition.

In certain circumstances the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances, such as extra costs arising from illness. The HSE afford applicants the opportunity to furnish supporting documentation to determine whether undue hardship exists and to fully take account of all relevant circumstances that may benefit them in assessment, including medical evidence of costs and certain expenses.

The issue of granting medical or GP visit cards based on having a particular disease or illness was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the Expert Group’s advice, a person’s means remains the main qualifier for a medical card.

In circumstances where an applicant is still over the income limit for a medical card, they are then assessed for a GP visit card, which entitles the applicant to GP visits without charge.

Under the Drug Payment Scheme, no individual or family pays more than €80 a month towards the cost of approved prescribed medicines. The Scheme significantly reduces the cost burden for families and individuals who are not eligible for a medical card but who have ongoing expenditure on medicines.

Since 2020 there has been a focus by this Government on expanding eligibility and improving the affordability of healthcare. This has delivered a significant expansion in eligibility across a wide range of areas, including:

• The Free Contraception Scheme launched September 2022 for women aged 17–25. This was extended to 26–year-olds in January 2023, then to women aged 27-30 from 1 September 2023, and most recently it was extended to women aged 31 from 1 January 2024. The Scheme will be further extended to women aged 32-35 from July 2024.
• Successive reductions in Drug Payment Scheme thresholds, which now stands at €80 per month.
• The removal of public in-patient charges in all public hospitals: for children under 16 years of age from 21 September 2022, and for adult public patients from 17 April 2023.
• The expansion of free GP care to include children aged 6 and 7 since August 2023.
• The introduction of Free IVF treatment since September 2023.

1. to review the existing framework to clearly assess what is working well and fit-for-purpose, and
2. to inform policy options and proposals to enhance eligibility and access to services based on robust evidence and focused on improving health outcomes.