THE DISCRETIONARY MEDICAL cards debacle rages on with calls for resignations as the government scramble to mop up the mess of removing discretionary medical cards from children with long-term illnesses.
The next in line for a complete overhaul should be the Long Term Illness Scheme (LTI), say groups such as Arthritis Ireland, who argue there is no reasoning why some illnesses are on the list and others are not.
Mary Doherty, President of Down Syndrome Ireland, said that the conditions for the medical cards and the LTI scheme will all have to be looked at in conjunction with one another.
The Long Term Illness Scheme falls under the same remit as the discretionary medical cards – The Health Act 1970.
The HSE’s March Performance Assurance report shows that 82,825 long term illness claims were processed in March bringing the number processed this year to date is 249,896 – 7 per cent above target.
There were 276,683 long term illness items provided in March bringing the total year to date to 832,308, ten per cent above target.
While the government have promised that discretionary medical cards will now be based on medical needs, there are calls for the same criteria to be applied to this scheme.
Under section 29 of the Act, people suffering from certain conditions can get free drugs, medicines, medical and surgical appliances under the scheme.
The medical conditions that qualify under the Long Term Illness Scheme are:
- Mental handicap
- Mental illness (for people under 16 only)
- Diabetes insipidus
- Diabetes mellitus
- Cerebral palsy
- Cystic fibrosis
- Multiple sclerosis
- Spina bifida
- Muscular dystrophies
- Acute leukaemia
- Conditions arising from use of Thalidomide
The HSE announced that an expert panel of 23 medical professionals will examine which medical conditions should automatically qualify a person for a medical card. A public consultation process is also underway.
Stephen O’Farrell from Arthritis Ireland said it would be a productive move for the government to review the the LTI list at the same time.
Match the lists
“The list that the expert review panel are looking at for the medical cards should match the LTI list. It doesn’t really make sense that they don’t,” he said.
“The list needs to be updated. It has not been updated since 1970 – that is over 44 years that no additional illnesses have made the cut,” he said.
The long term illness scheme only covers the illnesses that are on the list but does not cover any illnesses that might be related.
“Rheumatoid arthritis and juvenile arthritis are not on the list – but they also have a high number of comorbidities – where a number of other conditions are prevalent because the person has the primary illness,” he said.
These include heart disease, diabetes and depression. If the person has a medical card, these would be covered, but not under the LTI scheme.
“The first thing that Arthritis Ireland are looking for is recognition that it is a long term illness, and secondly we are calling on the government to update the 1970 list to include arthritis,” said O’Farrell.
“It’s very cut and dry – it is a long term illness – it should be on the list,” he concluded.
Other conditions that have been called to be included on the list include autism and asthma.
All children with Down Syndrome are entitled to the long term illness scheme, but Down Syndrome Ireland report that some medications for common conditions such as respiratory tract infections are not always being covered, as these could happen to any child.
“Since many conditions (including respiratory tract infections) are much more common in children with Down Syndrome than their typically developing peers, Down Syndrome Ireland would argue that these medications are related to Down syndrome,” they said.
The Junior Minister explained in the Dáil that “Down’s syndrome is classed as a qualifying condition under the mental handicap heading. “Mental handicap” is not a term we use nowadays, but it is taken from the 1971 scheme”.
We are reviewing the entire operation of the LTI scheme and the classification of different conditions may be one of the issues we ought to examine. The general operation and application of the scheme is under review…
However, he also said in the Dáil:
There are no plans to extend the list of conditions covered by the long-term illness scheme.
The Department of Health said there are no plans for the LTI scheme to be reviewed along the lines of the expert panel on medical need for medical card eligibility.
The department said it is reviewing the operation of the LTI scheme.
“However, as the Minister has outlined on numerous occasions in the Dáil, there are no plans to extend the list of conditions covered by the LTI scheme,” they said.
Doherty, who had a meeting with the Minister for Health James Reilly, Junior Minister for Health Alex White and the HSE’s Tony O’Brien on Friday, said she raised the issue of reviewing and updating the list as well as the serious cost failings of the scheme.
She told TheJournal.ie that the meeting was positive and that there was an indication that changes could be made in a matter of weeks.
“It has to be all looked at together,” she said, adding that from the point of view of cost saving the scheme is “not working”.