Government urged to scrap some medical cards

The Government was today urged to scrap a series of medical care entitlement cards in favour of a single-tiered system reflecting a person’s health and ability to pay.

An expert group tasked with examining how the health service manages its resources and money recommended introducing a single primary care card to replace the medical card, GP visit card, drug payment cards and long-term illness cards.

A 600-page report by the expert group, chaired by Economic and Social Research Institute Professor Frances Ruane, said the scheme would be subsidised at four levels, with a proposal to cap GP visit fees at €40.

“Each card type would provide the card holder with a level of support that reflects both their income and health status, ie a graduated co-payment system,” the report stated.

The four levels are:

* Standard – available to anyone without means testing and would replace the current Drugs Payment Scheme Card which allows people not on medical cards to limit the amount they have to pay for drugs. GP visits capped at €40 euro per visit, while paying 80% of their drug fees.

* Standard Plus – open to households whose incomes are around half of the national average. It would be means tested. GP visits capped at €30 euro per visit, while paying 60% of their drug charges.

* Enhanced – open to households with an income of up to 40% of the national average. Also means tested but would be available for people with established chronic diseases and those on the long-term illness scheme. GP visits would be capped at €20 while drugs payments would be limited to 40% of the price, to a maximum of €40.

* Comprehensive – for households with incomes below 30% of the national average. Means tested. Also open to those on the high-technology drug scheme for costly medicines.

“The essence ... is that the subsidies should focus on improving access to care by those on lower incomes (but above current thresholds) and on those with diseases that require continuing treatment,” the report said.

The Irish Patients Association said it did not see a problem with a proposed tiered system but said it wanted to ensure low-income families would not be left worse off.

“Where changes are going to be made each area needs to be risk assessed, that it’s not going to have negative impact on current entitlements to patients,” chairman Stephen McMahon said.

Meanwhile, the independent expert group found health service resources are allocated in such a way as to undermine policy objectives.

It concluded that it was cheaper to target resources at preventing diseases instead of just curing, yet this was not happening. It also found Health Service Executive policy promoted transferring care from hospitals to GPs and community services yet focus tended to lean towards institutional care.

The Health Information and Quality Authority yesterday revealed findings of a survey which showed 75% of patients do not believe money in the health service is well spent.