The announcement of a new medical card system by Minister for Health Leo Varadkar follows the controversy over discretionary medical cards which resulted in a setback for Government parties in the local elections. Up to 15,000 discretionary medical cards, which had been removed by the Health Service Executive (HSE) in eligibility reviews, were subsequently reinstated.
There is merit in many of the recommendations. Discretionary medical cards awarded on the basis of terminal illness will no longer be reviewed which should prevent many of the heartless decisions made by bureaucrats in recent years.
Strengthening family doctors’ discretion to extend medical card eligibility in certain circumstances and for a limited time is a belated recognition that doctors have an important role in the review process. It will especially help older people and the disabled who may experience difficulty in meeting review deadlines. A return to more localised HSE input into decisions should also improve sensitivity to individual needs and make the new system fairer.
In a related move, the Minister also announced that patients without a medical card can now access aids and appliances. By instructing the HSE to provide free occupational therapy services and essential aids to daily living to those above the medical card income threshold, he is acknowledging the significant barrier to independent living created by the previous restriction. Properly funded and resourced, this move could facilitate earlier hospital discharge as well as preventing avoidable hospital admission.
While acknowledging the need for an enhanced assessment process which takes into account the financial burden of an illness, the Government has heeded the advice of the Keane review group not to implement a medical card eligibility system based on a list of diseases. And it remains committed to the eventual introduction of universal healthcare, reflected in the 2015 HSE service plan’s allocation of 25 million euro for the introduction of free GP care for children under 6, with an additional 12 million euro for GP care to people over 70.