A promise by the Minister for Health, Mr Martin, to give medical cards to more people on low incomes may not be kept due to economic difficulties.
The secretary general of the Department of Health, Mr Michael Kelly, said yesterday eligibility would be extended only "as resources permit".
Mr Martin forecast also yesterday that 2003 could be a difficult year for the economy. But he said people would have to wait until the Estimates were published on Thursday for his comments on medical-card eligibility.
He signalled however some cuts were likely. The Estimates would show "the items we can go with and we can't go with" in the health sector, he said.
Both Mr Martin's and Mr Kelly's comments came on the first anniversary of the publication of the Health Strategy, "Quality and Fairness", which gave a commitment to increasing the threshold at which medical cards would be provided.
The strategy said: "Significant improvements will be made in the income guidelines to increase the number of persons on low incomes who are eligible for a medical card and to give priority to families with children and particularly children with a disability." Mr Martin said at the time he planned to extend eligibility to 200,000 extra people beginning in 2003.
But he stressed yesterday that "a tighter fiscal situation" didn't mean key elements of the Health Strategy were threatened. These included increasing bed capacity, organisational reform and medical personnel reform.
The strategy promised 650 public beds this year - 600 will be in place by the end of the year; the audit of health structures is being carried out by a team of consultants who will report in January, and the medical manpower taskforce blueprint will also be available early next year.
He added that many of the objectives set out in the Health Strategy were not dependent on funding: "I support proposals that will emanate from the Department of Finance and the Government to make sure that we correct the fiscal situation going into 2003, that we place the national finances on a sound and stable basis. That is the shortest route to ultimately getting the strategy delivered.".
He expressed concern at the dramatic increase in the rate of spending on medical card-holders under the General Medical Services Payments Scheme this year. Deloite & Touche have been asked to look at reasons for the increase and are due to report within the next fortnight, he said.
He added that payments to GPs to treat up to 20,000 people aged over 70 who were on GMS lists, but shouldn't have been because in some instances they had died, would now be recouped by the Department.
The Minister also said adults waiting longer than 12 months and children waiting longer than six months for treatment should check with their doctor to ensure they had been referred for treatment under the Treatment Purchase Fund, set up under the strategy. By the end of the year 1,900 people will have been treated privately at home and abroad under the fund.