Almost 40,000 fewer medical cards issued last year

Almost 40,000 fewer medical cards were issued last year as more people returned to work following the Covid-19 epidemic.

More than 300,000 fewer people had medical cards in 2021 compared with a decade earlier, a Health Service Executive report shows.

Overall, the number of people entitled to free GP care grew by 86,000 over the period because more people were issued with GP visit cards, which do not give access to free prescription drugs and other benefits.

Over the past decade, the number of people holding a medical card has fallen by 309,000, according to the 2021 report of the HSE’s primary care reimbursement service (PCRS). In contrast, the number holding a GP visit card increased three-fold.

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The Government has promised several times to extend free GP care to 80,000 six- and seven-year-olds; talks with doctor representatives are continuing. In last month’s budget, it promised to also provide GP visit cards to 340,000 people earning less than the median income.

Family doctors have questioned whether general practice is able to take on these additional public patients, given the low number of GPs and the high number of doctors approaching retirement.

According to the PCRS report, the number of GPs with State contracts has increased marginally over the past decade, from 2,832 in 2012 to 3,074 in 2021.

There was also a small increase in the number of pharmacists with a HSE agreement, from 1,713 to 1,915.

However, the number of dentists treating public patients slumped as large numbers exited their HSE contracts – falling from 1,730 to 1,302.

Last year, the HSE reimbursed €3.58 billion in claims from GPs, pharmacists, dentists, optometrists, ophthalmologists and other contractors who provide free or reduced-cost services to the public in primary care.

This was €333 million up on the previous year.

Fees paid to GPs grew from €605 million to €682 million.

Payments to pharmacists for drugs and medicines increased from €985 million to €1,016 million, with another €407 million paid in fees and mark-ups (€382 million in 2020).

Drug manufacturers and wholesalers were paid €989 million, up from €916 million the previous year.

More than 308,000 people were on the drug payment scheme in 2021, down more than 60,000 in a decade. Numbers availing of the long-term illness scheme increased more than three-fold, to 195,000.

By last year, the average yearly payment to GPs for each person availing of free care was €393, up almost 60 per cent on the €249 paid in 2017.

Over this four-year period, dispensing fees paid to pharmacists fell from €315 million to €305 million. In 2021, dispensing fees accounted for 31 per cent of the total cost of prescriptions. Pharmacists were paid an average €751 per medical card customer.

Under agreements with the HSE, GPs are paid fixed amounts per patients, which vary according to age and gender, including €43 for some under-six-year-olds to €75 for 16- to 44-year-olds and €369 for over-70s living in the community. Other fees are payable for out-of-hours work, practice supports and specific items such as vaccination and contraception.

Total fees paid to GPs have almost doubled over the past decade as patient numbers and the range of services provided has grown.

The number of out-of-hours consultations plummeted in 2020 and 2021 due to the Covid-19 pandemic while claims for “special service” soared.

One of the fastest growing areas of expenditure is on high-tech drugs, where payments have almost trebled in the past decade, to €991 million, and the number of people availing of them has near-doubled to 101,000.