Financial management within the Health Service Executive has been inadequate for so long that Minister for Health James Reilly introduced legislation to take charge of its budget last year. Despite that and ongoing criticism concerning medical cards from the Troika, very little appears to have changed: Dr Reilly anticipates an overrun in health spending of between €150-200 million next year.
It is an unacceptable situation. For each of the past six years the HSE has been bailed out by supplementary budgets after it failed to live within its financial allocation. Its figures and projections have been so unreliable that, this year, Minister for Public Expenditure Brendan Howlin refused to accept them in pre-budget negotiations. He caused offence to Dr Reilly who insisted there was no "black hole" within the Department of Health.
In the end, it was agreed representatives from the Departments of the Taoiseach, of Health, Public Expenditure and the HSE should oversee the implementation of €60 million in savings. Achieving this target would, according to Dr Reilly, make the health budget for 2014 “the most challenging yet”.
Delays in necessary legislation on a range of issues, in negotiations on drug costs and in dealing with an over-staffed administrative system have created long-running difficulties. But vested interests and grey voting power shaped recent developments in relating to medical cards. Distaste for a “probity drive” on medical card entitlement for the over-70s was said to be “palpable” among health officials at a post-budget meeting. Such an attitude would cause outcry if welfare officials adopted a similar approach.
Introduced by Micheál Martin as a popular vote-getter in 2001, free medical cards for the over 70s cost many times what had been anticipated. Rising costs caused Mary Harney to set an income threshold for such cards in 2008 but she failed to police it. Fewer than 4 per cent of medical cards were surrendered. Some ineligible people continue to use them for GP care and prescription drugs. Others did nothing, but the doctors they were registered with continued to be paid. In this budget, a reduction in income eligibility from €600 to €500 a week (€900 for a couple) will be accompanied by a thorough check on individual qualification.
Criticism of the planned investigation has come from the Irish Medical Organisation, from pharmacists and from nursing home owners. All of these groups benefit directly or indirectly from an opaque system that fails to monitor patient eligibility and resulting costs. Unwarranted payments are being made. The fact that the beneficiaries tend to be elderly and middle class should not matter. Sorting out medical cards for the over-70s will not transform the health system. But lax administration has to be challenged and changed.