The increase in the provision for the health services has failed to keep pace with medical inflation, writes Dr Muiris Houston, Medical Correspondent
"The Health Strategy is failing to deliver for some of the most vulnerable people in society" said Dr James Reilly, Chairman of the Irish Medical Organisation's National GP Committee in response to the announcement on Wednesday that 200,000 additional medical cards promised in the programme for Government would not now materialise.
Twenty four hours later, substitute "health estimate" for "health strategy" and the comment is even more appropriate.
Despite an increase of 6 per cent, in real terms health services in 2003 will receive less money than this year because health inflation is running at 10 per cent. Given that health boards have struggled to stay within budget in 2002 - and in some instances had to let staff go to achieve this - bed closures and cuts in services now appear inevitable.
The single biggest increase within the health estimates - at 31 per cent - goes to the General Medical Services (GMS) Scheme. But behind this figure lies a tale of miscalculation and mismanagement which, despite the increase, effectively scuppered any opportunity to increase the number of medical cards.
This is a huge blow to the lower paid and those with young families.
The miscalculation occurred when the Government decided to extend eligibility for free medical cards to everyone over 70, regardless of income. Initially calculated to add 39,000 medical cards the actual number availing of the scheme ended up significantly higher than this.
The Minister called in outside management consultants in response to a huge jump in the cost of drugs dispensed under the GMS and the drug repayments scheme. Effectively, then, the one third increase in the budget for the GMS payments board is being spent to remedy past mistakes of a scale that suggest information management systems within the Department of Health are sub standard.
Some 200,000 people just above the eligibility limit for a medical card have seen free medical care snatched from them. They must now face increased costs for occupying a private bed in a public hospital and will also have to dig deeper every time they have a prescription filled.
The as-yet unspecified higher threshold for the drug refund scheme comes on foot of a double digit increase announced last August.
Although an additional €29 million is being allocated to cancer services, the absence of any specific reference to the extension of breast cancer screening nationwide suggests that women in the east will continue to enjoy a significant advantage over those living in the rest of the State.
An expected expansion of radiotherapy services in 2003 appears to have disappeared also.
On a positive note, the Mater Hospital will commence heart and lung transplants, and the cardiovascular strategy will be reinvigorated by the provision of an additional €7 million.
Mr Martin said last night that good fiscal responsibility would deliver the Health Strategy. That may be the case over its ten year lifetime.
But for those of us expecting to see early evidence of reduced inequality and improved access to the public health system, yesterday's figures are the equivalent of a scalpel driven straight through the heart of Quality and Fairness - A Health System for You.