Irish Medical Organisation

Medical cards and health cuts - 'This Week' on Radio One featuring Dr Ronan Boland

Sunday 27th November 2011

Below is the transcript of an extract from 'This Week' on RTE Radio One. Various interviewees consider some of the proposed health cuts and measures for budget 2012.

Presenter (Gavin Jennings):
But first to those budget cuts to be announced in full next Monday and Tuesday and with more and more people out of work and an aging population there are more people than ever reliant on medical cards to pay for their healthcare.  With more spending cuts on the way can the current system survive?  Avril Hoare has been finding out.
Avril Hoare (journalist):
At the end of 2008 the then Fianna Fail/Green Government did a major u-turn after attempting to withdraw the automatic entitlement to medical cards for the over seventies.  Far from being a push-over they protested in their thousands outside the Dàil taking their anger out on Junior Minister Marie Hoctor. 
Marie Hoctor TD:
As the Minister for Older People I am very sorry and somewhat compelled to come here today… (Crowd jeering drowns her words out)  
Avril Hoare:
The question is, is the current Fine Gael/Labour Government prepared for a similar explosive reaction if as has been reported Health Minister James Reilly is considering a fifty euro annual charge for a medical card.
Audrey Dean:
Incredulity and just total shock

Avril Hoare:
That’s Audrey Dean, Social Justice and Policy Officer with the St. Vincent DePaul.
Audrey Dean:
These are the very families that you should be supporting to access healthcare.  Look it, in Ireland there are very very clear health inequalities and they’re totally got to do with how much money you have at your disposal.
Avril Hoare:
If a fifty-euro charge was levied on every medical card it could bring in a considerable amount of money.  The medical card and community schemes will cost more than one point eight billion euro this year and more than a third of the population is covered by medical card.  As RTE’s Health Correspondent Fergal Bowers explains.
Fergal Bowers:
Well I mean the medical card scheme came in in the 1970s and, you know, free GP care for people covers about over thirty percent of the population, over one and a half million people are covered for it.  It’s means tested so really it’s people with little or no income.  I mean if you’re going to introduce changes and there have been changes over the years to it, were you now charge a sum of fifty euro a year, that’s quite a substantial change and that’s a lot of money for someone who has little or no income.
Avril Hoare:
Minister Reilly is reportedly considering a range of cuts to secure savings of around five hundred million euro in the health budget next year.  With the medical card charge one option being explored.  Patricia Conboy is Director of the umbrella organisation Older and Bolder; she says such a charge would go against Government policy and promises.
Patricia Conboy: 
The concern that Older and Bolder has about the application of charges at the moment is that it flies in the face of the mandate that the Government has been given, which is to introduce a one tier system of healthcare and which is to ensure that everyone in the population has access, free at the point of access, that is to your GP and to a medical card.  

Avril Hoare:
When they took office back in March the Fine Gael/Labour coalition outlined in the Programme for Government reforms to the Health Service that would see the introduction of free GP care for all by 2015.  A week in office and the Health Minister also promised to scrap the fifty-cent per item prescription charge for medical cardholders.

Minister James Reilly:
That is certainly something I have undertaken to do and something that I believe was not a wise policy decision to take in the first place because if you put any barrier between patients and their prescriptions you are likely to get less compliance, that is they won’t take their medicines.
Avril Hoare:
And this week it was reported that he was considering increasing it from fifty cent per item to two euro per item.  This is of course speculation, we’ll have to wait for the budget to find out where the cuts will come, but GPs say any extra charges on medical cardholders will have a detrimental effect on their health.  Dr. Ronan Boland is President of the Irish Medial Organisation.
Dr. Ronan Boland:
Creates a real problem when they either don’t access a medical card in the first place or they have delays in getting that medical card because of administrative delays or costs because patients don’t, either don’t present for treatment or they present late for treatment, inappropriately late and in many cases even when they do present it’s not just the cost of going to the doctor they’re worried about, it’s the cost of medication that they require.
Avril Hoare:
A full medical card entitles the holder to free GP access and to the reduced cost of prescribed medication.  There is also a GP visit only card which has fewer benefits and there was talk this week that in future more people will get this type of card rather than a full medical card.  Here’s RTE’s Fergal Bowers again.
Fergal Bowers:
At the moment we’ve got about one point five million people covered by the medical card and then about a hundred thousand people who have the doctor only card, which is valuable one but give you a little bit less, they still have to pay for their medicines.  The GP only card came in in 2005 and what they seem to be talking about at the moment, again these are all discussions, is that they’re going to change the eligibility so that more people would get a GP only visit card rather than a medical card, so it will probably become harder to get a medical card.
Avril Hoare:
Recently the Government announced it was pushing ahead with its plans to reform the Health Service by abolishing GP fees for the more than fifty thousand patients registered as having long-term illnesses by next March.  Again it was reported that this too could be deferred in an effort to save money.  GPs say they’ve already taken cut to the payments and allowances they receive from the state.  Dr. Ronan Boland of the IMO, which represents doctors, says they can’t take another round of cuts.

Dr Ronan Boland:
There have been huge cuts.  GPs have been subject to cuts the same as everybody else has.  Cumulatively we’ve just, we’ve just actually had what is in effect the forth round of cuts with announcement of reductions in fees in the immunisation schemes and if you add them all up you’re totalling cuts of in excess of one hundred and twenty million euro, which have been imposed on the fees payable to practise.
Avril Hoare:
One area that some say could be looked at is the income eligibility threshold for the over seventies.  A single person over this age can apply for a medical card while in receipt of a weekly income of up to seven hundred euro.  A couple can have a weekly income of up to fourteen hundred euro and still be eligible for a medical card.  For those under the age of seventy, a single person living alone and earning over one hundred and eighty four euro a week doesn’t automatically qualify for a medical card.  Patricia Conboy of Older and Bolder says older people who can afford to pay should and that everyone should have access to primary healthcare on the basis of need and contribute on the basis of ability to pay.

Patricia Conboy
In terms of the medical card for older people, they are indeed means tested.  What we would like to see is a progressive taxation system so that better-off older people, who are in a minority though they do exist I acknowledge that, should pay in that way through the taxation system.  We’re entirely in favour of a more equal distribution of income and a more equal distribution of contribution to the health system and we recognise that the best way to do that, the most effective way to do that is actually through he tax system. 
Avril Hoare:
Another way of saving money is though centralising the processing of medical cards in line with the Croke Park Agreement.  The HSE says more than eighty percent of all medical card applications are processed within the fifteen working day target.  But Dr. Ronan Boland of the IMO says doctors are telling him of lengthy delays and he wonders if this is a deliberate cost saving measure.
Dr. Ronan Boland:
I would have to say in all honesty that there’s a growing feeling abroad amongst many of my colleagues that it’s the difficulties that, to some extent it suits the HSE not to sort these difficulties because if the patient is denied a medical card to which they are entitled for one, two or three or four months, that’s one, two or three or four months during which the state is not funding a practise to look after that patient and during which that patient doesn’t have an entitlement to get their drugs paid for.

Avril Hoare:
And for those who already have medical cards there’s the possibility looming that they will have to pay a fifty-euro per year charge for that card.  Audrey Dean of the St. Vincent DePaul says that while to some that’s not a lot of money, to the poorest in our society it’s a cost they should not be expected to meet. 

Audrey Dean:
Taking fifty euros, it may sound like not a lot over fifty-two weeks; I understand that to a lot of listeners who can afford it.  But I can tell you when all our members and an awful lot of them are out there every, every week standing in kitchens where there is nothing in the fridge, when there is huge distress brought about by a broken item in the house, very expensive school books, energy bills, when there isn’t enough to go around another source of anxiety is not the way forward.

That was Audrey Dean of St. Vincent DePaul ending that report by Avril Hoare with me in our studio is the Minister for Health Dr. James Reilly…     

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