ANALYSIS:Brian Cowen's hopes of finding a quick fix to medical card woes by talking with doctors are unlikely to materialise, writes Eithne Donellan
IF THE Government thought it could resolve overnight the current mess over the abolition of an automatic entitlement to medical cards for over-70s by simply talking to the Irish Medical Organisation (IMO), it had another think coming.
Taoiseach Brian Cowen went on the nine o'clock news on Friday night in an attempt to steady nerves by saying the Government would talk to the IMO about GPs accepting lower fees for treating non-means-tested over-70 medical card holders. This was so that savings of €100 million on the over-70s medical card scheme next year could continue to be achieved while allowing as many over-70s as possible to keep their cards.
At present, GPs get paid an annual capitation fee of €640 for treating non-means-tested over-70s medical card holders, compared to €160 for treating those with medical cards who underwent means tests before reaching their 70th birthday.
Mr Cowen's solution to the fallout from the Budget announcement - and only after several days of public outrage and the resignation of a Fianna Fáil TD - was to haul in the GPs who were charging too much: incidentally only because the Government in another cock-up a few years earlier had agreed to pay them exorbitant fees for treating some over-70s.
But what Cowen didn't mention was that GPs have been knocking on the Health Service Executive's (HSE) door for years, seeking to have their contracts with the State renegotiated to no avail.
In fact it was a condition of a deal reached with the IMO on the introduction of doctor-only cards in 2005 that GPs would have their existing GMS contracts reviewed. But it never happened.
The HSE claimed that, based on advice received from the Attorney General, to agree fees with a union would be in breach of competition law. So the matter has been left parked - parked until there was a crisis, that is.
Now when it suits the Government to talk, they are knocking on the door of the IMO. Whether they are welcomed in or not remains to be seen. There were mixed views among GPs yesterday on how things should proceed, though several of those contacted agreed there should be greater equity in capitation payments for all over-70 medical card holders.
Dr Conor McGrane, a GP in Balbriggan, Dublin, said he would be happy to have this issue sorted out but only in the context of a commitment by the Government to deal with other outstanding contactual issues GPs have.
He added that it was "frustrating" that the Government only wanted to talk to GPs now because they were in a spot of bother over their Budget.
The former Fine Gael TD and Wexford GP Dr Liam Twomey said Minister for Health Mary Harney couldn't expect too much good will from family doctors when the first thing she did when her back was up against the wall in the past week was blame the doctors' fees for the conundrum. He said it had been suggested to her many times that this issue be confronted but nothing was done.
Another GP, who didn't want to be named, said he expected the IMO would talk to the Government about a new fee structure for the over-70 medical card holders if a firm guarantee was given to sort out all the other problems within an agreed timeframe. He suggested a temporary agreement might be reached to pay one capitation fee for all over-70s midway between the two capitation rates currently paid, but stressed some colleagues would resist this.
There's also the possibility one fee could be offered to all GPs - as happened with the smear-taking contracts - and let them take it or leave it. However, this option could backfire if GPs decided en masse not to take it up.
One thing is for sure though, no deal will be hammered out quickly. The IMO has too many other issues it wants sorted before it will agree to renegotiate the over-70 capitation fees.
It feels the current GMS contract is too focused on dealing with acute patient care to the detriment of preventive care and management of chronic illness in the community.
The Government side hopes the IMO, in these difficult economic times, will do their patriotic duty. But whether they will or not remains to be seen. In any event no firm proposals have yet been put to the IMO.