Health authorities have failed to raise awareness over people's entitlement to the new doctor-only medical card, writes Carl O'Brien, Social Affairs Correspondent
Giving them away should have been the easy bit. Yet, after a battle to secure funding for doctor-only medical cards, followed by a protracted row with GPs over their introduction, just 4 per cent of the promised 200,000 GP visit medical cards have been issued.
The reasons behind the low take-up have sparked a debate which has hissed and fizzled in recent weeks as claims and counter claims are made over who is responsible for the fiasco.
Opposition parties have been blaming the Government and Government appears to have been laying the blame at the door of health authorities. Moreover, health authorities have grumbled privately at the Government's handling of the medical cards issue.
Away from the political clamour, there appear to be simple reasons behind the low take-up: either the income thresholds are too low for people to be eligible, or else there is a lack of awareness over the issue.
"People don't know about them - that's the feedback we're getting," says Prof John Monaghan of St Vincent de Paul. "Part of it may be to do with a perception that you lose your entitlements when you enter employment . . . It's no coincidence that Séamus Brennan is starting a campaign to increase the uptake of the Family Income Supplement [ FIS] at the same time."
Another issue is that card-holders, who may have become ineligible for a medical card in the past, don't realise that they may be eligible once again following new income and assessment rules.
For several years the Government failed to increase qualifying income limits for medical cards in line with pay inflation or rises in social welfare payments, meaning an estimated 100,000 low-income people lost their entitlement to the card.
Suddenly, and belatedly, the Government has been moving to provide increases in income guidelines for both full and doctor-only medical cards. Income thresholds, for example, have risen by more than 20 per cent in the past 12 months. Also, a new assessment system based on net disposable income rather than gross income was introduced earlier this year.
The new disposable income rules, which also apply to the new GP visit cards, mean that "reasonable expenses" for childcare, mortgage or rent and travel to work will be allowed before applicants' net income is calculated.
With an election looming the Government is moving quickly to try to spread the good news about people's entitlement to the card.
Last week the Taoiseach and Tánaiste launched a new website, www.medicalcard.ie, to encourage the public to apply for a medical card or doctor-only card.
Yet, despite this accelerated activity, there is no getting away from overall decline in the proportion of the population with full medical card cover since the coalition Government came to power in 1996.
Back then, almost 35 per cent of the population had medical card cover.
This has now fallen to 25 per cent. As the Labour Party has pointed out, more than 380,000 people would need to be issued with full medical cards today to achieve the levels of cover available 10 years ago.
The Government now hopes it can try to help reverse that trend as it embarks on an awareness campaign which will seek to ensure that the 30,000 full medical cards and 200,000 doctor-only cards promised in November 2004 can actually be handed out.
MEDICAL CARD
Disposable income rules (which also apply to the doctor-only cards) mean that "reasonable expenses" for childcare, mortgage or rent and travel to work will be allowed before applicants' net income is calculated.
The cut-off points for the full medical card mean that a single person aged up to 65 living alone can earn no more than €153.50 a week after tax to qualify, while a single person up to age 65 living with family can earn no more than €136.50 a week.
Higher thresholds apply for people aged 66-69 years: €168 if the person lives alone and €144.50 if they live with family. The threshold for a married couple aged up to 65 years is €222, increasing to €248.50 if they are aged 66-69.
Although everyone aged 70 and over is entitled to a medical card regardless of income, this card does not cover spouses. In the case of a married couple where one person is over 70 and one is under 70, the person under 70 will be means-tested according to the guidelines for married couples.
DOCTOR-ONLY MEDICAL CARD
Families and individuals with incomes of up to 25 per cent over the existing medical card eligibility thresholds qualify for doctor-only medical cards which, as the name suggests, entitles them to free visits to their GP.
Under the rules for the new doctor-only card, the income thresholds are higher. A single person aged up to 65 can have net disposable income of up to €192 a week and still qualify, while if the person lives with their family they can earn up to €171.
These cut-off points rise to €210 and €181 respectively for people aged 60-69.
Married couples can earn up to €277.50, rising to €311 for the older age group.
However, the HSE, which administers the card, has indicated it will not be completely strict about these income limits.
HOW TO APPLY
A single application form for both cards is available from the HSE's website (www.hse.ie), phone line (1850-24 1850) or from health centres.
Forms should be sent to the local health centre. Those refused a card can request a review of their case or contact the appeals office.