Diagnosis awaited in medical cards war

WHEN a patient asks for a second opinion and is given the exact opposite diagnosis than what was first provided, it’s fair to say they should be concerned.

So when an entire country is faced with the same prospect, a sense of panic is more than understandable.

Step forward the HSE and the Irish Medical Organisation, both of which continue to put forward vastly different versions of the ongoing discretionary medical card dispute.

The latest set-to took place on Wednesday, just as the HSE was launching a €150,000 public awareness “information campaign” to clear up “confusion” over the issue.

During an at-times heated two-hour briefing, senior HSE officials stressed the campaign — which includes national adverts and the dedicated website medicalcard.ie — has been designed to clear up “misunderstandings” about how the budget-imposed €113m medical card cuts will affect the public.

The message from the HSE was a continuation of their previous claims: The cuts will only hit people who should not have cards in the first place, and there has been no change in policy over who can access medical card help.

The IMO response was equally blunt: The HSE is “lying” and the cut will cause a “purge” of genuine medical card holders.

So, who is telling the truth? And how do the facts stack up?

Has there been a change in medical card eligibility criteria?

Since the Irish Examiner first revealed the discretionary medical cards issue in early July, the HSE and Health Minister James Reilly have been at pains to insist that there has been no clampdown on who can receive the State-funded help. The claim was repeated on Wednesday by HSE officials — the head of the primary care reimbursement service, Paddy Burke, and primary care director, John Hennessy. However, as the IMO and individual doctors are correct to point out, this is not 100% accurate.

As the HSE has only recently admitted, a number of guidelines on which medical card eligibility policy is based have been altered.

Since late last year a small home improvement expense (often used to make houses more suitable for a patients’ need), a €50 travel to work cost, and childcare expenditure are not taken into account when the HSE checks whether a patient qualifies financially for support.

For over-70s medical card applicants, a couple living together and a single person used to qualify if they earned up to €1,400 and €1,200 a week respectively. However, this now stands at €900 and €500.

These issues impact on how policy is implemented, meaning the policy has — despite the claims — been changed.

In addition, the HSE’s own service plan for this year said medical card “policy changes will lead to a reduction of approximately 40,000 medical cards as a result of changes to income calculations, including those of over-70s”.

To date, just under 50,000 medical cards have been axed.

General and discretionary medical cards are as easy to get now as they were in the past:

The HSE has pointed to the fact 106,000 medical cards were handed out to new patients this year, including 23,000 discretionary cards, as proof there are no hidden hurdles being put in the way of applicants.

However, other HSE figures also give credence to concerns being raised by GPs and consultants. Last year, the HSE reviewed 365,200 medical cards — a figure which jumped to 428,000 this year.

During the same period, the number of general cards which were received by patients who successfully appealed initial rejections rose from 30% to 40% — indicating a tougher stance being taken initially by those in authority.

The HSE has said there is nothing untoward in the increase and that it is mainly because of the changeover to a centralised national application system from the previous regional approach, meaning some current cards have to be re-assessed.

However, there is still no information available on how many discretionary medical card applications have been received, refused and successfully appealed. Coupled with the increased checks, it has given rise to a belief among doctors that it is more difficult to access help.

The probity scheme is meant to tackle ‘redundant’ or illegitimate cards and, as Health Minister James Reilly says, no one who genuinely needs help should worry:

It is entirely fair for the HSE to remove medical cards from people who are deceased, have left the country, or who no longer need them. Of the near 50,000 cards withdrawn this year, the HSE said 3,992 were held by people who have since died, while just over half had incomes up to 200% higher than financial eligibility rules.

Some GPs may be reluctant to admit this because part of their State income comes from the number of medical card holders on their books. However, doctors are still right to raise concerns over the likely impact of the €113m “probity” cuts linked to this issue.

In 2013, the HSE was tasked with cutting €20m in “probity” card checks. While the head of the PCRS, Paddy Burke, said “this [cut] has been done” the figure for next year is 600% higher.

If the cuts to redundant cards have been achieved, how can an extra €113m be taken without impacting on legitimate cases?

Until an agreement on the real state of play is reached, vulnerable patients will be given two completely different diagnoses about what is facing them. Either GPs/patient groups are wrong or the HSE’s diagnosis is wrong.


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