Dáil Éireann - Volume 492 - 16 June, 1998

Other Questions. - Medical Cards.

10. Mr. J. O'Keeffe asked the Minister for Health and Children the plans, if any, he has to introduce medical cards for all those over the age of 75; and, if so, when this will be introduced. [14166/98]

Mr. Cowen: Entitlement to health services in Ireland is primarily based on means. Under the Health Act, 1970, determination of eligibility for medical cards is the responsibility of the chief executive officers of the appropriate health board. Medical cards are issued to persons who, in the opinion of the chief executive officer, are unable to provide general practitioner, medical and surgical services for themselves and their dependants without undue hardship.

Income guidelines are drawn up by the chief executive officers to assist in the determination of a person's eligibility and are revised annually in line with the consumer price index. It should be noted that these guidelines are higher for persons aged 66 to 79 and higher again for those aged 80 and over. However, these guidelines are not statutorily binding and even though a person's income exceeds the guidelines, a medical card may still be awarded if the chief executive officer considers that the person's medical needs or other circumstances would justify this. Medical cards may also be awarded to individual family members on this basis.

In view of this special provision previous Governments did not feel it was justifiable, on health policy grounds, to extend an automatic entitlement to a medical card to any specific group without any reference to their means, as a general rule, particularly in view of the many areas of pressing need in the health services and the limited resources available to meet them. It is open to all persons to apply to the chief executive officer of the appropriate health board for health services if they are unable to provide these services for themselves or their dependants without hardship.

Notwithstanding the arrangements referred to above, the Government has identified as a key priority in An Action Programme for the Millennium a review of medical card eligibility for the elderly and large families, and my Department has asked the chief executive officers of the health boards to consider the commitment and to give their views to the Department as to how the commitment might be implemented, and the implications, financial and otherwise, of their proposals. [674] The chief executive officers intend to submit their views to the Department shortly.

Mr. J. O'Keeffe: Do I take it the Minister is unsympathetic to the proposal to extend medical card eligibility to those over the age of 75? Will he accept that there are now only 30,000 or so in that category and that eligibility could be extended for approximately £7 million? Will he accept it is a reasonable proposition to extend free medical treatment to people over the age of 75?

Mr. Cowen: I am not unsympathetic to the argument that it should be considered. It was mentioned, uniquely, in our programme and was not in the programme of any previous Government. I cannot be accused of being unsympathetic to a proposal that is now getting consideration for the first time. The general rule is that, because of the pressing needs on the health services, we do not decide on eligibility for medical cards beyond income eligibility. There are income limits but a residual discretion is available to the chief executive officers in cases where people are above those limits. In relation to the principle, I am far from being unsympathetic but I am anxious to get the views of the chief executive officers on this matter before decisions are taken.

Mr. J. O'Keeffe: The Minister mentioned in his reply that a review of medical card eligibility was currently under way. That was a commitment in the Fianna Fáil manifesto before the election and I suggest it is time the review was completed. Will the Minister indicate when he expects the review to be available?

Mr. Cowen: The commitment I referred to is the programme for Government. The review is almost complete and I hope to have it in the next month or so. The reason I am seeking the review is to determine, during the course of this Government, if and when we can go down this road. That will depend on a range of issues but the fact that the matter is getting detailed consideration makes this Government unique in that it was not considered by any previous Government.

Ms Shortall: In relation to people over 75 who do not have medical cards, will the Minister accept we are talking about a small number of people who have occupational pensions? Many of these people worked for more than 40 years, contributed to an occupational pension and then received their social welfare pension, which took them above the threshold. Will the Minister agree that on the grounds of fairness to those people who have never been a burden on the State they should now be granted medical cards in the final years of their lives as I believe is their right? Rather than just passing the buck as a delaying tactic and looking for the views of the chief executive officers of health boards, the Minister [675] should take the proper action and grant these people their entitlement.

Mr. Cowen: With respect, the Deputy accused me of passing the buck but that is inconsistent when one considers that the previous Government never considered this question. I presume the Deputy believes this is a right to which people were entitled prior to 26 June last. In the previous four years her party was in Government and did nothing about it. Far from passing the buck, this Government is giving the matter detailed examination. I am not unsympathetic to the case. Once I get the information from the chief executive officers I will consider the position with a view to resolving it. I agree with Deputy Shortall that there may be a case in regard to many of the people in receipt of small State pensions in addition to their old age pension. That is the reason this matter was included both in the manifesto and in the programme for Government.

Ms Shortall: What is there to examine? The Minister knows the figures.

Mr. Cowen: We do not know the figures.

Mr. J. O'Keeffe: It does not take more than 12 months to examine a relatively simple issue. Elderly people tend to suffer ailments and can feel insecure without a medical card. That is the reason we are pressing the issue with the Minister. He said he expects the review to be completed in a month or so. Will he ensure it is published so that we can discuss the issue in a rational manner because we will all be informed by the views expressed in the review?

Mr. Cowen: I cannot give a commitment in relation to publication until I examine the report.