A health system with compassion?

Medical card changes

Our relatively new Minister for Health, Leo Varadkar, is a bit like Bovril – you either love him or can’t stand him. There is little or no in-between.

But even those who find the minister’s occasional cringe-making utterances hard to take must be inclined to acknowledge that he has taken on his new role with a degree of calm reassurance rarely seen among ministers for health.

Former Taoiseach Brian Cowen once described the health ministry as ‘Angola’, yet Varadkar appears to be taking it all in his stride, ignoring the naysayers and getting on with building a health service for the 21st century.

His latest development includes a ten-point reform plan for the medical card system. The reforms will introduce a single application process within the HSE for all medical cards and other medical schemes. An enhanced assessment process for medical cards is also to be introduced to take account of the burden of a serious illness.

General practitioners are also to be given extra powers to extend medical card eligibility for certain patients in difficult medical or financial circumstances. Best of all, medical cards given to people with terminal illnesses will no longer be reviewed. That must be a huge relief for people caring for their loved ones who are gravely ill. It is more than enough to try and help a dying family member without having to worry about the medical bills.

The HSE will also be empowered to provide people with therapies or appliances, in the absence of a medical card, if that is what they need.

Mr Varadkar said the new medical card system will be fairer and more humane and it is hard to argue with that. The plan is for the HSE to develop what it describes as a “single, integrated process for people to apply for a medical card, GP visit card, the Long-Term Illness Scheme and the Drugs Payment Scheme”.

But what about the in-betweeners – those not financially eligible for a medial card but nonetheless faced with huge medical bills because of a chronic condition or one that requires expensive medication? They have for decades been the forgotten victims of Ireland’s health system.

They, at last, are being acknowledged. The HSE and the Department of Health are to examine the best way to meet the needs of these people. Let us hope this will not turn into yet another well-intentioned report gathering dust. There are 72,000 people holding a discretionary medical card. It is important to keep in mind that, of the 25,000 medical card applications this year so far, 17,000 have been given on a discretionary basis. What the plan endorses, most of all, is the importance of GPs exercising discretion when it comes to giving medical cards to patients in their care. They – after all – are at the coalface and the ones who know best the patients who should be given free care.

The rules are also an acknowledgement that the Cabinet has got it wrong in the recent past. Perhaps, at last, we may shortly be able to celebrate a health system as compassionate as the medical staff who run it.

More on this topic

Medical cardholders in poorest households spend 10% of income on private health insuranceMedical cardholders in poorest households spend 10% of income on private health insurance

Cancer patient vows to keep fighting to end  practice of reviewing medical cards of terminally ill patientsCancer patient vows to keep fighting to end practice of reviewing medical cards of terminally ill patients

HSE clarification on medical cards for terminally ill patients welcomed by Irish Hospice FoundationHSE clarification on medical cards for terminally ill patients welcomed by Irish Hospice Foundation

Top-earning GP received €1.1m from medical cardsTop-earning GP received €1.1m from medical cards


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