Free care for under-fives may be inequitable but will bolster future health of nation

Free GP care for under-fives is a vote-winning proposal with serious health advantages and an ethical question mark. Just as with free university fees, the brainchild of another Labour-tinged administration a generation ago, the idea of getting the State to pick up the tab every time a toddler goes to the doctor has the virtue of simplicity and saleability.

It allows Government politicians to point to a single, clearly defined achievement in health to offset the many problems and crises in the system. And when they do so at future elections, they know from past experience that it will play particularly well on the doorstep with the middle classes who are most likely to vote.

But just as with free college fees, moral and practical issues arise. The most obvious is the lack of equity involved in providing an important service free to wealthy families when many others are struggling financially. Is it right to subvent the health needs of the children of millionaires when families on relatively small incomes find it impossible to get a medical card?

The unfairness involved will be keenly felt by people with serious illnesses such as cancer or motor neurone disease who are finding it difficult to get or keep a medical card. Almost 200,000 cards have been taken out of the system in the past year as discretion is redefined in the most minimal terms.

Aggrieved parents
Parents of children with long-term illnesses, who were promised medical cards in the programme for government, will also feel aggrieved.

The Government will point out that the proposal is but a way-station on the road to free GP care for all, promised by 2015, so any unfairness will be shortlived. The plan to extend coverage by age, starting with young children, was developed by junior health minister Alex White after legal difficulties sank earlier proposals to first provide cards to people with long-term illnesses.

White’s proposal was approved by the Cabinet subcommittee on health last July and managed to survive the pre-budget haggling of recent weeks. In fact, it has been extended to embrace children aged five and under, and not just under-fives as originally envisaged.

Legislation will be needed before today’s announcement becomes a reality and GPs have to be brought on side.

Remarkably, no talks have been held with the Irish Medical Organisation and it is unclear what use they would serve in advance of a court test of competition law due to be heard next year. Today's budget speech is unlikely to specify an implementation date, as this would only serve to increase GPs' bargaining power.

In health terms, there are clear advantages to measures that make it easier for small children to see a GP.

If all the doctor does is weigh the child in those formative early years of life, the result will be a healthier population. The early years are the time to catch problems before they develop or worsen, and family doctors are brilliantly placed to perform this work.

Another attraction of the proposal is the low cost involved. A recent report by TCD researchers for the Adelaide Hospital Society put the cost of providing GP visit cards to under-fives at €48 million.

The cost of providing full GP cards was estimated at €57 million and the report says “it must be wondered what the benefit to society would be to withhold the full medical cards from children in favour of free access to GPs only”.

Why not all children?
The report points out that it actually gets cheaper to cover the age group from five years to 15. The cost of providing full medical cards to all children in the State is estimated at €160 million. This is a drop in the ocean in a €13 billion health budget.

It all sounds too good to be true. Many hard-pressed families will be hoping today that, unlike “free” third-level education, free GP care turns out to be what it claims to be.