Opening Statement by the Secretary General of the Department of Health at the Committee of Public Accounts 14 November 2013
2012 Annual Report of the Comptroller and Auditor General Chapter 22 Eligibility for Medical Cards
I wish to thank the Committee for the invitation to assist in the examination of chapter 22 on the eligibility of medical cards and I welcome the opportunity to bring clarity to the legal position regarding such eligibility. As Secretary General of the Department of Health I strongly endorse the recommendations pertaining to eligibility outlined in the Comptroller and Auditor General’s report.
I would like to begin with some factual information regarding Medical Cards. It may be useful for the Deputies to know that, as of the 1st of October last, there were 1,864,509 medical cards issued by the HSE. This represents an increase of over 60% in the number of medical cards, or 700,000 individuals, since the end of 2005. Over 40% of the national population now holds a medical card, compared to 27% at the end of 2005.
Between 2004 and 2012, when Medical Card coverage rose from 27.7% to 40.4% of the population, unemployment rates rose from 4.3% to 14.4%. This indicates a high correlation between these two variables. Therefore, as the economic situation improves, resulting in more people returning to employment, we should expect to see a marked decrease in the number of Medical Cards issued.
As Deputies may be aware, the legislation governing the medical card scheme (Section 45 of the Health Act 1970, as amended) allows for persons who are unable, without undue hardship, to arrange a general practitioner service for themselves, or their family, to qualify for a medical card.
Under this legislation, the determination of eligibility for a medical card is the responsibility of the Health Service Executive. Section 45 requires the HSE to have regard to a person’s, and their spouse or partner’s, overall financial situation in view of their reasonable expenditure. The HSE gives effect to this legislation and Government policy through its Medical Card National Assessment Guidelines.
Where a person’s income is in excess of the income thresholds set out in the National Assessment Guidelines, the HSE uses its discretion to grant a medical card to a person who is unable, due to undue hardship, to arrange a GP service. In doing so, the HSE is obliged to have regard to the financial situation and expenditure of the individual and his or her dependents. To dispel any misconception that might still exist, I want to clarify that, in line with the legislation that I have just outlined, there has never been an automatic entitlement to a medical card on the basis of having a specific illness or condition, such as cancer. While there may be criticism of that approach, the correct interpretation is very clear from a reading of the legislation, which has been in place for a considerable period of time.
There is an additional arrangement available to persons aged 70 years and over to establish their eligibility for a medical card. Persons over 70 years of age can also qualify for a medical card on the basis of a gross income test. Under the legislation, individuals aged over 70 with a gross income not exceeding €600 per week qualify for a medical card. Couples over 70 years of age with an income not exceeding €1,200 per week also qualify for a medical card.
Processing of Medical Card Applications
Medical card processing was centralised at the HSE Primary Care Reimbursement Service (PCRS) in July 2011. This system now facilitates standardised, homogeneous and equitable assessment of all applications, irrespective of the origin or nature of the application. In previous years, there was a decentralised process, which led to inequities throughout the country. Medical Cards may have been awarded on a discretionary basis in some geographical areas and not in others because of the lack of a centralised, standardised approach. This resulted in regional and local areas where there were high numbers of medical cards above what one might have expected.
The assessment procedures used to determine eligibility for Medical Cards and GP Visit Cards has not changed. Rather, through the centralised processing of applications, where discretion is exercised, it is now applied equitably and consistently based on standard operating procedures, with medical officers assessing medical evidence for cost and necessary expense. The HSE has in place a process whereby a team of medical doctors unrelated to the patient assesses his/her situation and grants or declines a discretionary medical card on a medical basis. Previously, different approaches may have been used in different parts of the country resulting in inequitable distribution of discretionary cards. With this standardised process there is fair and equitable treatment for all. This ensures that the scheme operates to enable those who suffer financial hardship as a result of a medical condition, to receive the benefit of a medical card.
For the record, persons in receipt of a Medical Card may also be entitled to the following additional benefits:
- Exemption from paying the health portion of your social insurance (PRSI)
- Free transport to school for children who live 3 miles or more from the nearest school
- Exemption from state examination fees in public second-level schools
- Financial help with buying school books.
Under Section 49.1 of the Health Act 1970, as amended, there is an obligation on Medical Card holders to advise the HSE if there is a change in their circumstances that could affect entitlement to a medical card. This provision, allied with data sharing legislation which came into effect in March 2013 (Health (Alteration of Criteria for Eligibility Act) 2013) allowing the sharing of personal data between the Revenue commissioners, the Department of Social Protection, and the HSE, will result in a higher level of compliance and an overall reduction in the amount of cards issued.
In conclusion, I want to assure Deputies that there has been no change to the qualifying criteria for discretionary medical cards in the past year. Notwithstanding the need to secure savings under the medical card scheme going forward, it is very important to note that nobody who, under the legislation, is entitled to a medical card will lose it or be refused one.
Thank you for your time and I will take any questions the members of the committee may have.