No ‘ethical’ alternative to current means test system for medical cards

The medical card system’s controversial focus on patient finances will stay — but only because the dwindling health budget prevents an "ethical" alternative, and there is no clear way to favour one condition over another.

The Government’s long-awaited expert panel report on how to reform the service is set to draw the conclusion when it is published later this month.

A leaked version of the report — which was signed off by HSE director general Tony O’Brien and given to the Department of Health on Tuesday — has made a series of recommendations after four months examining the scandal-hit service.

However, while the top-line conclusion will anger affected patients, the report summary — seen by the Irish Examiner — has stressed there are previously unstated reasons why the current system will not be altered.

According to the report:

- A lack of adequate ways to “measure the burden” of individual conditions means Government plans to compile a list of illnesses guaranteed the help is not possible;

- To do so risks “inequity” of care based on diagnosis and fragmenting the service, an issue that would not be “ethical” given the “finite resources” in health;

- Instead, the report said “financial hardship or means testing should remain the main discriminator”, in line with the rest of the EU;

- In addition, “the general population” should be more closely involved in the “ethical and social issues arising from access to healthcare in the context of finite resources”.

The report was called for by then minister of state for primary care Alex White in May after a year-long campaign to reform the medical card system and a backlash in the local elections. It is based on the views of a 23-person independent expert panel, which has worked on the issue for four months, and more than 2,000 public submissions.

The findings — which will not be formally published until after the October 14 budget due to ongoing cabinet discussions, and the two by-elections four days earlier — mirror comments made by Health Minister Leo Varadkar in July on the difficulty in compiling a list of priority conditions.

However, Our Children’s Health campaigner Peter Fitzpatrick said officials must ensure “the system is changed” and is not still based on a “rigorous financial audit of sick people”.