Helping families who cannot afford a GP visit should be a main focus for Mary Harney, writes Padraig O'Morain
Are doctors exaggerating when they complain that patients on low incomes cannot afford to see them as often as necessary? Not according to yesterday's ESRI report on national health systems.
That report finds that the number of annual visits to the GP drops from 6.6 to 3.6 as soon as people's income rises to the level at which it disqualifies them from getting a medical card.
Better-off people generally have better health than poorer people but that alone cannot fully explain the fall-off in visits. Those who are above the medical card income limits include families in which the parents are working for the minimum wage.
Their health status cannot be much greater than that of those who are just under the means test limit. This suggests that doctors are right when they say that people put off visits to the GP because they cannot afford to pay.
A married couple under 66 years of age cannot have an income of more than about €206.50 if they want to qualify for a medical card. The "about" is due to the complexity of the means test, which is more generous if people have housing costs such as rent and mortgage or travel costs in going to work.
Families are allowed to have an extra €26 a week for each child under 16 in the medical card means test. These are very low sums indeed. For a couple to live on €206.50 a week is no easy thing. And is it possible to rear a child for €26 a week - i.e., less than €4 a day?
With a means test this stringent, it is no wonder that the number of people on the medical card has fallen by about 100,000 in seven years.
On one level, of course, this is a good thing. We are better off than we were seven years ago. Our unemployment rate is low and we have to import workers to keep the economy going.
Against that, however, must be set the fact that many of the people, both Irish and foreign, who keep the economy going are working for very low pay.
The minimum wage is now €7 per hour, which works out at €280 for a 40-hour week. If one partner in a family is working for 40 hours at this rate and another is working for, say, 15 hours, this brings their gross income to €385 a week.
They'd be a long time saving for a Cartier watch. It's pretty clear that for such a family a visit to the doctor would not be undertaken at all lightly at a cost of €35 and upwards (usually upwards) per visit.
The family would also have to pay the first €78 per month for prescribed medicines. A couple of GP visits and, say, a €50 prescription would knock quite a hole in the family budget.
Yet it is good GP care that offers the best hope of reducing the number of people arriving in casualty or being hospitalised. And doctors argue that by postponing GP visits, people are at greater risk of ending up in hospital with a condition that has worsened because it went untreated.
It is a very poor reward for being willing to go out and work for very little money to improve your family's prospects.
We have, of course, had promises that all this will be put right. Unfortunately, the promises, made in the the last two general elections, to increase the number of medical card holders by 200,000 have not been kept. That, in turn, may reflect the reluctance by many people on low incomes to go out and vote.
The Minister for Health and Children, Ms Harney, has indicated a willingness to raise the medical card income limit. Well, the limit goes up by a few euro a year anyhow but it isn't enough.
At last week's conference of the Irish Association of Directors of Nursing and Midwifery, Ms Harney said she wanted to tackle delays in A&E departments, to provide equality of access to cancer treatment services for people in the regions and to reduce the waiting lists further.
If she succeeds - and we don't yet know what precisely she has in mind - she will benefit people at all income levels.
But if a substantial increase in the numbers of people covered by the medical card at the lower income levels is not to be an equally important pillar of her policy in the two years or so she can expect to have in the job, then the impact of her efforts on the health of the nation will be blunted.
The National Treatment Purchase Fund - a PD initiative - has taken people on low incomes off the waiting list and has got them treatment for those conditions for which it works.
If she can reduce delays in A&E departments then this will also be to the benefit of the poor as well as of those on average or higher incomes. And if she can improve regional access to cancer services, few patients will say no to the opportunity.
But these measures will not help the hard-working family on a low income which cannot afford to go to the GP. Mary Harney believes in the work ethic. Here is a group of workers who deserve her attention.
Padraig O'Morain is a health and social affairs journalist