Medical Cards – Topical Issues Debate

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Speech by Dr James Reilly TD, Minister for Health.

I wish to thank the Deputy for raising this issue.  Under the Health Act 1970, persons who are unable, without undue hardship, to arrange GP services for themselves and their family can qualify for a medical card, having regard to their overall financial situation and reasonable expenditure.

The HSE can only award medical cards in accordance with the Health Act and, therefore, it must assess the overall financial situation of the applicant and his or her spouse or partner. The HSE gives effect to this legislation through its Medical Card National Assessment Guidelines.

“Undue hardship” is ascertained through an assessment of financial means. It is not legally possible to award a medical card by virtue of an illness or a disease.

However, where an applicant or a member of the family has an illness or disease, medical costs and necessary expenses arising from that condition are taken into account in the assessment process for a medical card.

Thus, people whose means are above the income limits but who face genuine hardship in providing GP care for themselves and their dependants may qualify for a medical card.

Recent media reports have referred to the reduction in the number of discretionary medical cards. Let me again stress that there is no policy to abolish the awarding of medical cards on discretionary grounds or to target any patient group. The medical card scheme continues to operate so that those who suffer undue financial hardship as a result of disease or illness are awarded a medical card.

While the number of people who hold medical cards on discretionary grounds has fallen in recent years, many people who previously were marginally over the normal qualifying guidelines have been granted medical cards under those guidelines.

Only a small proportion of people with discretionary cards have been found to be ineligible for a medical card.

However, we know that even where medical expenses have been taken into account, there will be some people who are not eligible because their net income remains in excess of the guideline.

Some of these households include people with on-going medical conditions, and in that context I have asked the HSE to consider how best we can ensure that such households receive all the supports available to them from the health system, within legislative parameters. The clear intention is to ensure that people’s entitlements to health services are maximised to the fullest extent possible, especially where individuals may be facing significant medical expenses. This process is on-going and I hope that it will come to a conclusion in the near future.