Talks on 'doctor-only' medical cards break down
Almost a year after it was announced by Tánaiste and Health Minister Mary Harney, the scheme under which the 200,000 would be given 'doctor-only' medical cards is no closer to implementation.
The cards were meant to enable families on low incomes, but above the threshold for a full medical card, to visit their GP for free, although they would continue to pay for medicines.
After doctors initially threatened to boycott the scheme because of a row over how much they would be paid, their representative body, the Irish Medical Organisation (IMO), finally agreed to a deal worth €93 million in July. This was to include a series of pay increases which were already due to GPs, but also €7m worth of once-off payments for signing up to the doctor-only card scheme.
However, a fresh row has now broken out between the IMO and the Health Service Executive Employers Agency (HSEEA) over the scheme.
Labour Relations Commission talks aimed at breaking the impasse collapsed after 10 hours on Wednesday night.
Both sides immediately blamed each other. Ms Harney accused the IMO of attempting to renegotiate the €93m deal.
But the IMO insisted it had not attempted "in any shape or form" to renegotiate, instead saying it was the HSEEA which had been seeking to make changes to the deal. It also said the HSEEA had failed to give assurances that people with doctor-only cards would get full medical cards once they reached the age of 70, as is their statutory right.
"We will not be party to management's attempts to reduce the entitlement of all persons over 70 to a full medical card," said spokesman Dr Martin Daly.
But the Tánaiste denied this was the HSEEA's intention: "Everybody over the age of 70 has a statutory entitlement to a full medical card and this continues to be the position. All GP-visit card holders will obtain a full medical card at age 70."
She said it was "unfortunate" that the people the scheme was designed to help will now have to wait longer before they can avail of free GP services.
But the opposition last night expressed doubt as to whether the scheme would ever be implemented.
"This is a fiasco," said Sinn Féin health spokesman Caoimhghín Ó Caoláin. "It proves that the 'doctor-only' card was a rushed initiative designed to save the Government's face after it failed to fulfil its promise to extend the (full) medical card to a further 200,000 people."
Q: What is the genesis of the medical card row?
The battle over medical cards began with the Government's decision in 2001 to grant anyone who reached their 70th birthday automatic entitlement to a full medical card which entitled the holder to free medical treatment.
The Irish Medical Organisation (IMO), the union representing the majority of the country's GPs, objected to the deal on the grounds free medical card entitlement should be means-tested. They signed up after securing a special rate of €485 per patient granted a card for the first time on reaching the age of 70. For people who had always held a medical card, GPs continued to receive an average €170 capitation fee, even after their 70th birthday.
Persons receiving a medical card for the first time at the age of 70 were previously private patients who paid for each GP visit. The special rate was to compensate GPs for loss of income.
The IMO argues that the special premium rate which formed part of the over-70s deal should be extended to all GP visit-only medical card holders when they reach their 70th birthday. Health service employers argue the normal rate of €170 should apply and that this was part of a Labour Relations Commission agreement reached with doctors last month. They claim the IMO is now trying to re-open a deal which it already agreed to.
No. It says a basic agreement had been reached (IMO members were balloted and overwhelmingly accepted the deal) but that talks collapsed on Wednesday after management had belatedly sought to undermine the over-70s deal. The IMO claims that by only offering the standard capitation rate of €170 for GP visit card holders who turn 70, these patients will have to pay for everything but their GP visit, even after their 70th birthday.
Health service employers reject this argument. They say anyone over 70 will have a full medical card.
However, the IMO said it was not willing to accept any deal which would result in members' loss of income. By this it meant doctors were not going to accept anything less than the premium capitation rate for any medical card holders once they reached the age of 70. They wanted this guaranteed in their contract talks. Management refused, saying GPs had already voted in favour of the deal and that capitation rates would form part of a root-and-branch review of the entire GMS scheme, due to take place next month.
Despite repeated assurances from Mary Harney that doctors would not be paid extra for seeing these patients, refusal by GPs to co-operate meant she was eventually forced to backtrack and doctors were offered a once-off fee of €35 for each patient they signed up with the GP visit-only cards, in addition to their annual allowance for seeing medical card holders. It is estimated to be worth an average of €25,000 in extra fees to all doctors involved in the scheme. The offer came in a series of LRC recommendations in June, including a recommendation GPs be paid a series of overdue pay rises and benchmarking payments totalling €93m. Following the collapse of talks on Wednesday, all of these monies will be withheld.
It means the 200,000 people who should have benefited from the new GP visit-only cards are now in limbo.
It also means not only has the Government failed to deliver on its General Election and Health Strategy promise of an extra 200,000 full medical cards, it has also failed to deliver so far on what opposition parties describe as "yellow pack" medical cards, promised 10 months ago, legislated for and advertised by the Health Service Executive with a stated July start-up date.
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