Reference to ‘ghost’ medical cards questioned

The comprehensive Pricewaterhouse Coopers review of the Medical Card system was reported in the Irish Examiner (Saturday, Apr 28).

Well done to PWC in identifying local health office work practices as a significant reason for the initial increases in delay in the processing of medical cards, post-centralisation.

However, nowhere in their report does it refer to the term “ghost” medical cards which headlines the Irish Examiner article and implies that the sums mentioned are solely as a result of GPs being remunerated for patients who do not exist.

The (unreferenced) suggestion that between €65m and €210m could be being paid out in respect of persons who were ineligible for medical cards, who had left the country or who had died, is a massive sum of money and deserves closer analysis.

These figures should be considered in the context of the unemployment rate climbing from 5% to almost 15% over the last four years and a total of 76,400 people of all nationalities emigrating from Ireland in the year to Apr 2011, up from 65,300 in 2009/10.

There are less than 30,000 deaths in Ireland each year and many of these would relate to recipients of the over-70s medical card. GP annual capitation payments per patient under 70 years old range from €44.68 to €133.87, depending on the person’s age group and sex.

The headlined sum is as a result of aggregating the overall unnecessary cost due to delayed notification of deaths (let’s assume worst case scenario and the average delay is lengthy 9 months), people emigrating (let’s assume 100% of them had medical cards) and ineligible patients incorrectly maintaining their cards, with the associated ancillary payments to GPs pertaining to their care.

If pharmaceutical costs are not considered, the implication is that there are between 375,000 and 1.3m “redundant” cards in a system that has less than 2m cards and in 2011 probably cost less than €450m in payments to general practice to care for the 39% of the national population that represents the oldest, sickest and most deprived in our country.

Even if the pharmaceutical expense for this population is considered and reduces the patient totals by 70%, are we still dealing with credible numbers of unnecessary medical cards?

Dr William Behan

Cromwellsfort Road

Walkinstown

Dublin 12