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IT was inevitable the free-for-all over-70s’ medical card proposal introduced in 2002 would end in tears.
It was ill conceived from the start.
Political expediency on the part of the Government, on the one hand, and avarice on the part of the organised medical profession on the other ensured this outcome.
To understand the present difficulty one needs to know what went on at the time.
1. GPs are paid an annual capitation fee for medical cards irrespective of the frequency of consultation. This fee, while calculated on a yearly basis, is paid monthly.
2. Prior to 2002, means-testing was applied to all applicants irrespective of age. This was subject to variation depending on specific medical needs. Most people over 70 qualified on this basis and the cost of these medical cards to the State was fixed and agreed.
3. For political expediency, in 2002 it was decided to give the medical card to all over-70s irrespective of means. In order to implement this it was necessary to get the agreement of the organised medical profession who negotiated the GMS contract on behalf of GPs.
4. It must be remembered at this stage of the argument that most over-70s were already entitled to a medical card. The Government, in its wisdom, estimated that only about 30,000 people would benefit. Imagine its surprise when it discovered the number was 140,000. Surprise turned to shock when it became obvious the medical card of a retired Taoiseach would cost the State three times that of a retired labourer.
5. The medical organisations negotiated with Government a fee for the additional non-means tested cards of some three times the fee for means-tested ones. The argument for this was that people over 70 would require more attention than the general population. This of course is true.
What got lost in the miasma is that the medical needs of a retired Taoiseach, judge, bank governor or, whisper it, a retired medical consultant or GP would be deemed of greater value to the provider than those of a retired labourer. In fact, it is accepted that the medical needs of those in the top social class are less than that of those in lower socio-economic groups.
6. Doctors, who should have known better than to create a two-tier medical card scheme, and thus a three-tier health service, had their own motives. Political greed on the one hand, simple avarice on the other.
7. The solution is to remove healthcare from the political agenda. Management and audit of the health service have reached such proportions that the cost of providing actual care is but a fraction of total expenditure. Every medium-sized town has numerous HSE offices. I know of one town that has 13 of them — 11 are leased on a long-term basis.
Each office houses administrators who oversee provision of services and audit everything within sight, including each other. Many of the functions undertaken belong in the Department of Social and Family Affairs. It suits to include their cost in our ‘health spend’.
Delivery of a health service, both primary and hospital-based, is best left to non-government agencies.
Health insurance for all is the answer. These companies would be well able and well motivated to monitor and audit the health service providers.
The insurance premiums would be paid by each individual with the State providing 100% subvention to those most in need and a pro-rata subvention to all.
The problem with this is what to do with the 100,000-plus people in the HSE. That is what we elect government to do. For once, let it bite the bullet.
Dr Billy Christopher
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