Over a quarter of those once entitled to free medical care now no longer getit free, writes Maev-Ann Wren.
The Government's failure to increase income eligibility ceilings for medical cards, combined with the increased medical charges announced last week, will mean that many more families and individuals will not be able to afford medical care. It would appear that the Government has calculated that the low-paid who fail to qualify for medical cards form a constituency which it does not need to court.
The proportion of the population eligible for medical cards on income grounds has now fallen to 27.7 per cent, the lowest level since the GMS scheme was introduced in 1972. The inclusion of over-70-year-olds who would not qualify on income grounds introduced in 2001 increases the percentage on medical cards to 29.7 per cent this year. In 1977 nearly 39 per cent of the population was covered by the scheme.
In a state which is highly unusual in Europe in charging for primary medical care, access to free primary care has become more restricted as national wealth has grown. Individuals on incomes above €138 a week and married couples on over €200 fail to qualify for cards. Each child adds an additional €25 to that ceiling so that a family of four fails to qualify on an income of over €250.
While medical card holders face no charge for GP and hospital visits or for medication, people on low incomes who no longer qualify for medical cards and who are uninsured must pay GPs' fees, hospital overnight and A&E charges and must pay up to a monthly threshold for their medication.
So low are the income limits for cards that this year a GP visit and a €20 chemist bill could cost over 40 per cent of the weekly income of a single person and nearly a quarter of the income of a family of four earning just above the eligibility limits for cards. Yet, in 1900 Irish general practitioners charged working class patients 2s6d for a visit - a lot at the time, but only one-eighth of the weekly income of a building labourer
Today a 10-day hospital stay, at a charge of €40 per night subject to a €400 maximum, could consume over two-thirds of the monthly income of an individual and 37 per cent of the monthly income of a family of four.
With the increased charges announced last week, families and individuals who just fail to qualify for medical cards will see even greater proportions of their incomes going to medical care. While the eligibility ceilings for medical cards increase in line with inflation, the Government's failure to increase them in line with rising incomes, even rising social welfare rates, has caused the sharp decline in the proportion of the population who qualify for cards.
The Minister for Health announced last week that the overnight hospital charge and the charge for attendance at A&E would rise from €40 to €45 , a 12.5 per cent increase. The amount which an individual or family must pay on medication before reimbursement has risen from €70 to €78 , an 11 per cent increase. It can probably be anticipated that GPs' fees will also rise by more than inflation.
The medical card eligibility ceilings may rise next year by as little as 2.3 per cent, the annual rate of inflation in the year to date. Many more families and individuals will no longer qualify for medical cards next year. Given the rate of increase in charges, the proportion of their income which could be consumed by medical care will go up considerably. Thus, a 10-day hospital stay might account for up to 73 per cent of the monthly income of a single person living alone and up to 40 per cent of the income of a family of four.
With the raised threshold for refund of drug costs, medication could account for 13 per cent of an individual's monthly income and for seven per cent of the income of a family of four. Basic antibiotics such as Augmentin typically cost €17.40 for a child's course and €19.30 for an adult's. Flixotide, a preventive medication for childhood asthma, costs €46.70, so parents on low incomes cannot afford prevention for their children's condition.
Voluntary groups testify that many people on social welfare will not seek low-paid work because they fear the loss of their medical cards. People on lower incomes who must pay fees unavoidably neglect their health, doctors observe. In one recent survey of male patients in their 50s, 25 per cent reported that either they or a member of their household were putting off going to see the doctor because of the cost. Charities such as St Vincent de Paul regularly assist poor families in paying doctors' fees.
In his 2000 annual report the chief medical officer, Dr Jim Kiely, proposed that all children should receive free GP care. "Specific policy measures which redistribute resources, provide opportunities and services for families with children, especially poor children, will do most to create better child health. For this reason, basic universal health provision, such as free access to primary care for all children, should be considered."
When the Minister for Health disclosed in 2001 that he had no plans to extend eligibility for medical cards that year or the following year, there were protests from voluntary groups, the trade unions and the IMO, which estimated that 250,000 people could not then afford treatment. Fianna Fáil backbenchers objected. At the launch of the Government's strategy for primary care in 2001, Micheál Martin had said he planned to extend medical card eligibility to 200,000 extra people, beginning in 2003. This was, however, dependent on "budgetary matters". The overall health strategy stipulated that any extension of medical card eligibility would be decided "in the context of the prevailing budgetary situation".
Now, two years later, the Government appears to have calculated that this is an issue which will fail to ignite public outrage, although in its 2002 election manifesto Fianna Fáil promised to "extend medical card eligibility to over 200,000 extra people, with a clear priority being given to families with children".