Medical Card question and answer

Thank goodness for that – the Government has finally got sense and stopped those upsetting reviews of medical cards? Not quite, it has only stopped reviewing medical cards where discretion had been used to take account of medical circumstances. There are almost 80,000 discretionary cards issued out of a total of 1.9 million medical cards.

The HSE will still be reviewing the majority of cards to ensure people are still within the income guidelines for eligibility.

But at least we won't see any more of those awful cases in which children with serious illnesses have been deprived of their cards? If anyone has a card obtained on discretionary grounds, they can rest easy because the review of such cards has been suspended. This suspension could last years as it is likely to take some time before a new approach is drawn up and legislation enacted to give effect to it.

I'm glad that the Government has done the fairest thing and stopped the review process. All it wanted to do anyway was save money. It is true that the last budget set a target of €113 million for "probity" savings from medical cards, though this figure was subsequently reduced to €23 million.

The suspicion, therefore, was always that reviewing medical cards was about saving money, not making the assessment for eligibility more uniform through centralised processing, as the HSE claimed.

Yet it remains the case that there are significant regional variations in the awarding of discretionary cards. As Minister of State Alex White pointed out yesterday, you were six times more likely to have a discretionary card in Co Cork than in Co Meath. The approach of the HSE was disgraceful wasn't it, with patients being asked if their MS had "got better", or whether their child "still had Down syndrome"? Numerous appalling stories emerged during the recent controversy which appeared to show that some applicants were treated with ignorance, if not callousness.

However, the HSE says it has checked its records and stands over the behaviour of staff. It says people were asked about their medical circumstances to see if these had changed, not to prove that their lifelong condition was still there.

What is the new approach the Government is planning for the award of medical cards? Despite their name, medical cards are issued on grounds of income. Now the Government is planning to change this so that a person's medical condition would also be taken into account. Legally, this is a fraught area. Which conditions? How severe a condition? Who does the assessment?

A few years ago, the Government had to abandon plans to extend free GP care to people with long-term illnesses because of legal difficulties; now it’s heading down the same road again. This could take years.

And while medical card holders gain from this announcement, other health service users will ultimately have to pay for it.

Over €600 million is being taken from the health budget this year, on top of €4 billion in cuts and savings over recent years.

The only way to ease the pressure on the service and provide more entitlements is to spend more. And that, because it would need higher taxes, is politically impossible.