Almost one in five people with a medical problem in the Republic did not consult a family doctor because of cost, new research has found. In contrast, just 2 per cent of patients in Northern Ireland were deterred by cost from attending their doctor.
The results of a major cross-Border study of family practice presented at the annual meeting of the Irish College of General Practitioners (ICGP) in Galway last night also found that among patients who paid for medical care, it was the poorest and those with the worst health who were most affected by a consultation charge.
Dr Dermot O'Reilly and Dr Karen Thompson, of the Department of Epidemiology and Public Health at Queen's University Belfast, asked 11,870 patients on both sides of the Border the question: "during the past 12 months, was there a time when you had a specific medical problem and did not visit the doctor due to the cost?".
Some 18.9 per cent of people in the Republic, where 70 per cent of the population pay to see a GP, said the cost had deterred them from seeking medical advice, while 1.8 per cent of patients in Northern Ireland, where GP services are free, felt cost had been a barrier.
"The effects of the consultation charge are most marked in the middle of income distribution, such patients being over four times as likely to have been deterred as those in the most affluent group.
"Therefore the consultation charge may be having a detrimental effect on the health of a significant proportion of the Irish population," the doctors said.
Dr Niall O'Cleirigh, chairman of the ICGP communications committee said: "The research is a clear indication of the 'inverse care law', under which people who most need medical care do not get it."
Asked if the doctor-only medical card might help address the inequity revealed by the research, Andrew Murphy, professor of general practice at the National University of Ireland, Galway and a co-author of the cross-Border study along with researchers at University College Dublin and Trinity College Dublin, said that even if the cost issue was addressed by the doctor-only medical card, those patients with the worst health may not be eligible for the doctor-only card.
The new medical card was introduced last year by Minister for Health Mary Harney so that patients above the income threshold for a full medical card could access GP services. However, these patients do not receive free medication.
Prof Murphy pointed out that while the doctor-only medical card came into effect last year, the cross-Border research was carried out in 2003. Latest figures show that some 15,000 doctor-only medical cards have been issued.
Prof Tom O'Dowd, of the department of public heath and primary care at Trinity College Dublin, said there was a need to tell patients about the doctor-only card in a way that was targeted at the particular socioeconomic group eligible for it.
The cross-Border study also found that patients in the Republic were significantly more satisfied with their ability to access a family doctor compared with patients in Northern Ireland.
Less than one in 10 patients in the Republic waited two or more working days to see a doctor compared with almost half of the Northern Ireland patients surveyed.