Five months on, there is huge confusion over the medical card scheme for over-70s, writes ALISON HEALY.
ONE ELDERLY woman lies awake in bed at night, worrying that she and her blind husband will lose their home help and day care services if their medical card goes.
Based on their meagre income, they have not become ineligible since the automatic entitlement to the medical card for over-70s was abolished on December 31st. To be ineligible, an individual’s weekly gross income must be more than €700, or €1,400 per couple. However, that gives her no peace of mind as she frets about the value of a small parcel of land rented out to a neighbour.
Another woman is worried because she did not get the letter sent by the HSE in January to all those over-70 medical card-holders, setting out the new conditions. She wonders if this means her name has been wiped from the medical card list. The HSE says the letters were sent to each person’s last known address but she has lived in her home for nine years and received no information.
A 76-year-old man believes his medical card will be withdrawn because of his property interests but he refuses to declare his income to the HSE as requested. The value of his investments and pension has collapsed in the past six months, and he says he will have nothing left if he has to pay €60 to his GP every few weeks, on top of his prescription costs.
“Let them come looking for it if they want the card that badly,” he says.
It is five months since the Government changes to the medical card scheme were first announced but Age Action Ireland says there is still “huge confusion” over the issue. The original proposals have been watered down but the organisation is still calling on the Government to reverse its decision to remove the card from a small percentage of over-70s.
Its spokesman, Eamon Timmins, questions whether the cost and effort of trying to take back the cards can be justified and he says major savings have already been made with the introduction of a lower capitation fee for GPs.
“Of course the Government should never have gone down this road. There is anger but most of it is confusion and fear,” Timmins says. “Older people are very, very dependent on the health services and they have more to fear from a decline in health services than others.”
Losing access to home help and other community care services is a real fear for many people, according to Age Action Ireland.
While these services are not dependent on the patient having a medical card, card-holders are given priority. And with ongoing cutbacks to these services, even medical card-holders are not getting the supports they need.
More than 10,000 new medical cards were issued in January as the dole queue lengthened. However, HSE audits and spot checks have removed thousands of other cards from the system as the medical card lists are being brought up to date.
Labour health spokeswoman Jan O’Sullivan says people whose medical cards could be downgraded to a GP visit card are terrified of the time lag between surrendering the medical card and getting approval for the card that entitles them to free GP visits.
“And the issue is, how much are we actually saving from all of this? Is it worth it?” she asks.
The Government estimates that about 20,000 over-70 year olds are over the income limit and should relinquish their medical cards. A HSE spokesman says “several thousand” have already surrendered their cards.
The figures are still being collated so he cannot give more specific information, but details on the numbers returning the cards should be available next week. “All the indications are that a very significant number of people have taken the step and we commend them for their civic duty,” he says.
O’Sullivan says she would never advise someone to break the law by holding onto a medical card they are not entitled to, but she urges the HSE to tackle the matter in a sensitive way, particularly where applicants are close to the income cut-off point.
So what happens if someone is over the income limit but doesn’t give up the card and still attends their GP for free medical care?
Family GPs say they certainly won’t be policing the issue for the HSE.
Dr Niall O’Cleirigh of the Irish College of General Practitioners says it’s not up to doctors to decide if someone is eligible for a medical card or not. They have no plans to go through their patient files, identify those over 70 and start asking questions about incomes and entitlements.
“If a card has been deleted, we should be notified of that,” he says. “Otherwise GPs will continue to provide care as normal.”
The HSE says the matter will be dealt with on a case-by-case basis. If a spot check finds that an ineligible medical card holder is continuing to use the card, then the individual’s circumstances will be fully examined, the spokesman says.
Age Action Ireland says a major public information campaign is the only thing that can save the scheme from total disaster. “What we are being told by the HSE now is completely different to what we were being told weeks ago,” Timmins says. “It all depends on who you talk to. We need clarity. This is absolutely crazy. I don’t know where it’s going. It’s mind-boggling.”
The HSE spokesman is at pains to say that the HSE and Minister for Health Mary Harney have no desire to hound elderly people and says the HSE has done all in its power to inform the public on the issue. The HSE is happy to address any outstanding issues raised by bodies such as Age Action, he adds.
Age Action Ireland fears that older people will think twice about going to a GP if they have to pay for it. “Then a chest infection turns to pneumonia and ends up with acute hospitalisation. And then we are down to that dreadful phrase – bed blockers,” Timmins says.
“The whole thrust should be to treat people at the most suitable level, but instead we are going down this road of taking away incentives for older people to see their doctor.”
Log on to hse.ie for details of changes to the medical card scheme