Budget cuts to cost 40,000 their medical cards

More than 40,000 people will lose their medical cards, due to new income eligibility changes ann-ounced in the budget and further cuts by the HSE.

The HSE said that in 2013 an extra €60m would be taken from the budget for the primary care reimbursement service. This fund is used to pay doctors, dentists, and pharmacists who provide care at reduced costs to medical card holders.

The HSE plans to hit its target through extra scrutiny of medical card entitlements and by cutting back on the cover for hi-tech drugs.

The additional measures will bring the total reduction for this sector to €323m next year and leave a budget of €2.5bn.

A key component of its overall savings plan will be to reduce the fees paid to health professionals by €70m. However, it said this will be dependent on a review currently with James Reilly, the health minister. The HSE said it sought more money from this area to support other frontline services.

“The HSE board has made a decision to introduce additional cost reductions in PCRS beyond those specified in the estimate...

“By pursuing this course of action, the HSE will be able to allocate more realistic budgets to frontline services, as referenced in recent reports,” it said.

However, the HSE service plan for 2013 said there were risks associated with its strategy, because its actual expenditure will be based on the number of medical cards available and the amount of drugs prescribed.

Also, the HSE warned hospitals in the habit of running up large deficits to survive the later months of the year that budget managers could plan for a loss.

According to the plan, hospitals are beginning the year with deficits of €271m and the HSE has set aside €390m to cover this.

Voluntary hospitals have bank overdrafts that are estimated to stand at €152m and the HSE said it expe-cted this system would continue in 2013.

“No budget holder can plan for a deficit. All deficits must be addressed in the planning phase and decisions made to address these where they exist in the context of the available funds,” it said.

According to the HSE, it will start trialling a system of funding hospitals by the services they provide, known as money following the patient, in 2013. It will be rolled out properly in 2014.

“Each hospital group will be required to participate in this important preparatory step for universal health insurance implementation.”

The secretary general of the Irish Hospital Consultants Association, Martin Varley, said it was concerned that the HSE had underestimated the costs of running services. “Patient demand is growing and hospitals are finding it very difficult to care for the increased numbers due to insufficient resources,” he said.

Service plan not plain sailing

The HSE’s service plan may be published, but that doesn’t mean it’s all plain sailing from here.

As the report states itself, a series of key money-saving details in the document still run the risk of never seeing the light of day.

On page 19 of the report, 11 “potential risks to delivery” points are noted. These include an inability to lose the required staff numbers, “shortfall” of income collection, the knock-on effect of the nursing home waiting list situation, and primary care negotiations.

The latter issue centres around the fact that while GP fees have been targ-eted for a €70m cut, this plan is being staunchly opposed by the Irish Medical Organisation. On Wednesday, the union said it could result in waiting lists for GP care.

In addition, while it has been announced a number of drugs on free GP schemes will be removed to save money, the HSE cannot say which medications are involved.

In hospitals, the service plan also predicts €10m in savings via a new nurse graduate jobs scheme, to be launched today.

The Irish Nurses and Midwives Organisation and the Psychiatric Nurses Association regard these positions as “yellow pack” and have implemented a boycott of the significantly underpaid roles.

Fiachra Ó Cionnaith