Despite denials by Government, many people on low incomes, often with considerable health problems, are refused medical cards. Georgina O'Halloran reports
A quarter of a million people cannot afford to attend the doctor and access basic medical care in this country, according to a representative of general practitioners.
Dr Martin Daly, chairman of the Irish Medical Organisation's (IMO) GP Committee, says the chronic lack of medical cards means GP care is becoming unaffordable for a significant minority of people.
"There has been a drop of almost 100,000 medical cards in the system since 1997. While 37 per cent of the population had medical cards in 1997, today only 28 per cent of the population hold cards," Dr Daly says.
"The Government recognised this was a problem in 2001 and promised 200,000 more medical cards. The same promise was reiterated before the 2002 election." he adds. However, no more cards have been issued in overall terms, aside from small increases in some areas.
Dr Daly notes: "It has caused enormous hardship for people at the margins of income eligibility. They present late in illness and neglect chronic illness care because of cost."
The absence of a medical card is particularly problematic for people with chronic illnesses such as heart disease and diabetes.
"If you don't look after someone who has diabetes now, they have an increased risk of developing problems in the future, such as heart disease, stroke and kidney failure," he says.
Most people have lost their cards because of the low-income threshold. A single person, living alone is only eligible for a medical card if he or she earns no more than €142.50 per week, just a little over half the minimum wage.
Meanwhile the income threshold for a married couple is €206.50, with an extra €26 for each child under 16 years old.
"Much of the current problem with the scheme can be traced back to political interference," Dr Daly says.
"In 2002 it was decided not to means test all the over 70s, and there is a strong suspicion that people at the lower end of income eligibility have been squeezed out of the medical card scheme to subsidise the over 70s deal."
According to Dr Daly, while the medical-card scheme was created in the early 1970s to provide care for those with low incomes, the vast majority of medical-card recipients today are either people who are on social welfare, over 70 or suffer from a chronic illness, who qualify for cards under exceptional circumstances.
Most people in these categories generally need a lot of medical care and as a result general practitioners are finding themselves unable to cope with demand.
Dr Greg Kelly, a Fianna Fáil Councillor and GP in Castlerea, Co Roscommon, says the category suffering most are parents on low incomes with young children, particularly babies, because they have frequent illnesses like chest infections and respiratory illnesses.
"If a child happens to have asthma, people on low incomes are extremely hard hit because the medication is extremely expensive.
"An inhaler can cost up to €60 or €70 and generally there is more than one child with asthma in a family. Some people just can't afford to get ill," he said.
The IMO position is that medical cards should be issued to all people on or below the minimum wage and it is urgently calling for the Government to make the 200,000 medical cards promised before the 2002 election available.
However the general consensus is, at this stage, it will be a cynical exercise of giving medical cards back to those who lost them.
Dr Tom O'Dowd, professor of general practice and head of the Department of Community, Health and General Practice at TCD says good primary care is crucial to the health service because if you don't have it, it forces people to the hospitals.
IMO president Dr James Reilly agrees.
"If these people had medical cards they would look after their health, there would be less attendance at the A&E [accident and emergency], they would spend less time in hospital and less days would be lost from work. People who are healthy contribute to the Irish economy."
He also says the income eligibility threshold levels are very problematic.
"Clearly the eligibility threshold is crazy, as people on less than the minimum wage don't have access to basic medical care. The thresholds need to be doubled or tripled."
Meanwhile, a spokeswoman for the Department of Health and Children told the Health Supplement the Government is committed to extending medical card coverage and is focusing on people with low incomes, and giving priority to families with children, particularly those with disabilities.
However, no date for extending the coverage has been decided as of yet. The threshold levels are constantly being updated and special provisions are made to look after people who suffer from chronic illnesses, but whose incomes exceed the threshold, she pointed out.
"Income guidelines to determine a person's eligibility for a medical card are drawn up each year and are revised annually in line with the Consumer Price Index."
"Having an income that exceeds the guidelines does not mean that a person will not be eligible for a medical card.
A medical card may still be awarded if the Chief Executive Office considers that a person's medical needs or other circumstances would justify this."