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'I left weeping': Medical card patients are still being charged by GPs for blood tests

The HSE has said blood tests should be covered by the card and patients should report their GPs if they are charged.

Image: Shutterstock/Mahanak

Updated 12/03/18

MEDICAL CARD PATIENTS have expressed concern that some GPs around the country are still charging their medical card patients for blood tests.

Doctors have previously argued that the medical card contract was not designed to cover the amount of routine blood tests patients now need. Patients have reported being charged for the tests as far back as 2011, despite the HSE’s insistence that they are covered.

One patient, Ann Kennedy, who suffers from a serious neurological disorder, told TheJournal.ie her GP has in the past attempted to charge her for blood tests.

“The receptionist said ‘that will be €10′ and I stood there aghast. I had never been charged before. I said I had not brought any money with me and was a medical card holder. She said then I would have to come back another day when I had it.”

Kennedy said another patient saw she was distressed and offered to pay the charge for her.

“I was so embarrassed I left weeping. So far it’s never happened again.”

This incident was last year but she said her twin sister, who has similar health issues, recently changed doctors and when she went to her new GP, she was told she would have to go to St Vincent’s Hospital in Dublin to avoid paying a charge for blood tests.

The two women, who are both wheelchair users, live in Greystones.

“We have energy based diseases so we get tired very quickly. My twin doesn’t drive and there are very few people to take her in so that’s not easy. We would need tests regularly, every couple of months,” Kennedy said.

She said she has heard from a number of other patients with serious illnesses who have been asked by their doctors to pay for blood tests.

Justin Moran, head of advocacy at Age Action Ireland, said this is an issue that has been raised a number of times with his organisation.

“In some cases when challenged, people say they were told by the GP that the test is free but there is a charge for transporting it to the hospital,” he said.

Moran said not a lot of people are aware that if they are charged, they can claim the money back by going to their local health centre. However he said this is “completely impractical” for patients who have trouble getting around.

“It’s a challenge for older people to get to primary care centres and they simply can’t afford to get a taxi there. No one is going to get a taxi to a primary care centre to claim back €10 for a blood test. I’m not sure what the HSE is doing to inform GPs and deter them from doing it because in the majority of cases people just hand it over.

“€10 may not seem like that much to the HSE but it’s a great deal of money to a 75-year-old who is only getting half the State pension.”

‘A matter of concern’

In a statement to TheJournal.ie, the HSE said that under the terms of the current general medical services contract, GPs are required to provide eligible patients with “all proper and necessary treatment of a kind usually undertaken by a general practitioner and not requiring special skill or experience of a degree or kind which general practitioners cannot reasonably be expected to possess”.

“Routine blood tests, which are deemed clinically necessary by the patient’s GP are comprehended by this scope of service. It is of course a matter for the treating GP to determine in the case of each individual patient what is proper and necessary care,” the HSE said.

In circumstances where a GP, in the exercise of his/her clinical judgement, determines that a particular treatment or service requested by a patient is not clinically necessary but the patient still wishes to receive same, it is at the GPs discretion as to whether he/she imposes a charge for providing the service/treatment in question. An example of this might be an asymptomatic patient about whom the GP does not have any clinical concerns requesting a general health screening.

Last month, the Minister for Health said it is “a matter of concern” and that no user charges should apply to GP services provided to medical card patients.

Responding to a question from TD Brendan Ryan, Minister Simon Harris urged any patient who believes they have been incorrectly charge for routine blood tests by their GP to contact their local HSE health office.

“If the local office determines that the charge was inappropriate, it will inform the HSE Primary Care Reimbursement Service who will arrange to refund the cost of the blood test to patient and recoup this amount from the GP.”

Negotiations on a new GP contract are underway and are expected to address this issue. The HSE said the aim of the review of this contract is to “develop a new modern GP services contract, which will incorporate a range of standard and enhanced services to be delivered.”

21st century GP services

The Irish Medical Organisation (IMO) said its position is that routine blood tests are not covered by the current GMS Contract:

“The Department of Health and the HSE are responsible for the provision of phlebotomy outpatient clinics in public hospitals as confirmed by the Ombudsman and Information Commissioner (May 2007). Phlebotomy (blood tests) is not a service provided by all GPs and GPs individually decide on whether or not their practice will provide this additional service.

“Where a GP does provide the service patients may choose to avail of this additional service for which there may be a charge or may choose to be referred to the free public service in hospitals. It is a matter of choice for the patient.”

Dr Padraig McGarry, Chair of the IMO GP Committee said the current GMS Contract is 40 years old and does not provide for a 21st century GP service to patients.

“We are currently in negotiations with the Department of Health and the HSE on a new GP Contract and we hope that government will commit the necessary resources to provide a full range of services to patients in a GP led primary care service. All the medical evidence shows that services delivered directly to patients by GPs are better for the patient and value for money for the State with the additional benefits of reducing pressure on the hospital system,” he said.

“The current funding provided by Government into General Practice is wholly inadequate to deal with patient demand and the increasing complexity of care and more resourcing is required to both properly fund existing services and expand the range of services available to patients.”

The National Association of General Practitioners did not respond to a request for comment.

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