Who will get the new medical cards, what do they entitle you to and why have so few been issued? Claire Shoesmith reports
With only 9 per cent of the promised doctor-only medical cards in circulation 18 months after their introduction, it is fair to assume that something isn't going to plan. Not only is the Irish Medical Organisation (IMO) in dispute with the Government over the cards' existence, but confusion also abounds as to who is entitled to use them and for what.
Add to that the fact that the Health Service Executive (HSE) won't even give a rough outline of what level of income needs to be earned - saying only that it's 50 per cent above the required minimum income for a full medical card and claiming it will assess each case individually - and it's not really surprising that there's some confusion.
Data released last month from the Primary Care Reimbursement Service, which is part of HSE, showed that as of the beginning of May, only 14,651 of the cards had been issued.
According to the Department of Health, this figure had risen to about 18,000 at the end of June, still a long way short of the 200,000 promised by Minister for Health Mary Harney in her November 2004 Estimates.
So why is the take-up so poor? The answer to this seems to relate to confusion, for the most part, and the fact that most people are unclear as to whether they qualify for a doctor-only medical card.
While the HSE refuses to give out figures for who is eligible and who isn't, saying it will only lead to more problems with one person being granted a card and another on a similar income but with different personal circumstances not, the Department of Health, which is funding the card, has issued guidelines.
According to the department, a married couple or single-parent family under the age of 65 with dependent children is entitled to a doctor-only card if their weekly disposable income - the money left in your purse after tax and PRSI contributions, reasonable rent or mortgage payments; and childcare and travel-to-work expenses - is €400 or less. Under the same guidelines, a single person aged 65 and living alone is entitled to a card if their disposable income is €276 or below. These cut-off points increase with the age.
While more details can be found on the Department of Health's website, it's hard to assess who will and who won't qualify with such broad guidelines.
The HSE agrees and says this is the reason it hasn't given out figures and is simply urging people to apply and see what happens. "It's not a case of sitting at home and guessing whether you will be eligible," says a HSE spokeswoman. "We are urging everyone to apply and let our local branches decide."
According to the HSE, every case will be treated individually and assessed on a local level. In that case, it's not surprising that such a small number of cards has been allocated - it is difficult to imagine them having the time to assess 200,000 individual cases.
So, if you are lucky enough to have your situation assessed and to be found eligible, what can you expect to receive? Not a whole lot, actually. The card provides for exactly what it says in its name - visits to the doctor only. Unlike the full medical card, this variant does not entitle you to free or cut-price drugs. Neither does it allow you to attend casualty free or to receive any sort of after-care treatment, such as physiotherapy.
However, according to the HSE's website, if you are granted a doctor-only medical card, you may also be entitled to a drugs payment scheme card and so should apply for one of these too.
According to Harney, the doctor-only medical card is designed to help people on moderate incomes to visit their GP free. "Graduated benefits", the Minister claims, are better than one group of people having full entitlements and another having none. However, at the time of the first announcement, the cards were described by former IMO president Dr James Reilly as leaving patients "high and dry" once they had left the GP's surgery.
The main debate, however, lies with the word moderate and who determines its meaning. It is also important to note that your entitlement to the card is reviewed periodically and it may be that while you qualify at one point in your life because of childcare costs, you may lose this right once your children grow up and attend school or leave home.
If you think you may be eligible, what should you do?
Forms are available from your local health centre or health office, as well as on the HSE's website at www.hse.ie, or call 1850 24 1850 for more information.
In the future, an instant calculator for people to assess their own eligibility will be available on the HSE's website, but this function is not yet up and running. If you are rejected for a card and don't agree with the decision, you can appeal to your local health office.
It is worth noting that the same application form is used for both the medical card and the doctor-only card, so if you apply for a full medical card and are found not to be eligible you may in fact be given a doctor-only card instead.
Sample of guidelines on Department of Health website:
Maximum disposable income:
Single person living alone - up to 65 years: €276.
Single person living with family - up to 65 years: €302.
Married couple/single parent families with dependent children - up to 65 years: €400.
Single person living alone between 66 and 69 years: €302.