Stricter rules for medical cards on the way

TOUGH new eligibility criteria for medical cards are being considered as the numbers seeking free GP and medical services climb to record levels.

Already 39% of the population — more than 1.6 million people — are covered by a medical card or a GP-visit card and briefing documents prepared by health officials for Health Minister Dr James Reilly show the figure is expected to hit an unprecedented 43% later this year.

That’s up from 29.5% of the population at the end of 2005, before the recession and the return of high unemployment. The Health Service Executive (HSE) is forecasting a 10% increase in the numbers with full medical cards and an 18% leap in GP card numbers during 2011.

Based on those projections, medical and GP cards will cost the cash-strapped health service €2.38 billion in 2011 compared with €1.97bn last year, leaving an extra €410 million to be found to fund the schemes.

A national centralised processing system set up last year for medical card applications was meant to save €10m a year but even that potential contribution has not been achieved. The briefing notes say the savings are “not materialising due to unanticipated additional demand for medical cards”.

A major review of eligibility criteria was begun by the last government and the briefing documents highlight the fact that medical card income thresholds “have not been increased since October 2005”.

It has also emerged that the Department of Health is looking particularly at the way cohabiting couples are assessed. It is also believed the range of services available under the full medical card — which will cover 40% of the population this year — will be restricted, following on last year’s move to curtail dental treatments.

About half the costs of the schemes relate to the purchase of prescription drugs but a quarter relate to payments to GPs who have warned that they cannot take any reduction in their fees as the soaring numbers are already putting them under considerable strain.

Once the percentage of the population covered by the schemes hits 40%, GP representative body the Irish Medical Organisation is entitled to renegotiate its medical card contract with the health service.

Cork GP and IMO vice president Dr Ronan Boland said the IMO had written to Mr Reilly seeking a meeting, with the medical card situation being a key topic.

“A lot of practices are under significant financial difficulty and there’s already anecdotal evidence of doctor and nurse numbers being cut and hours being cut. Both in terms of manpower and working hours, to actually look after an increasing body of patients with this entitlement (medical cards) does present a very considerable challenge,” he said.

Another fear is that the increase in applications will jam the national processing centre, which will not be fully operational until this summer, and which saw a backlog of applications and delays last year. But a HSE spokesperson said: “There have been significant improvements. They have set a 15-day turnaround target for applications and they are meeting that for the vast majority of cards.”