Madam, - Your Editorial of April 19th on the A&E remarks that 100,000 low-income individuals who have lost their medical card eligibility are contributing to overcrowding in Accident and Emergency departments as they "tend to favour such facilities rather than attend expensive GPs as private patients".
What is not recognised in your Editorial is that these same patients must pay €40 to attend A&E, the same or more than they would pay to see an "expensive GP". Patients arriving at A&E with GPs' letters are exempt. It is therefore unlikely that financial constraint motivates this category of patient to bypass the GP surgery.
In reality, patients with medical cards are twice as likely as paying patients to attend A&Es and indeed GP surgeries. Although some of this can be explained by higher morbidity among medical-card patients, much of it stems from simple market dynamics. Put simply, free services are abused freely.
There can be no argument that medical-card eligibility limits must be increased substantially on grounds of both social justice and health care. However, it is foolish to conclude that an increase in medical card numbers will do anything other than put further pressure on already overstretched A&E Departments and GP surgeries.
Perhaps the time has come to rethink the whole system from the bottom up. - Yours, etc.,
Cllr LEO VARADKAR,
MB, BCh,
Senior House Officer
in Emergency Medicine,
Dublin 15.