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Terminally ill patients will no longer have their medical cards reviewed

An array of changes to the medical card system were announced today.
Nov 25th 2014, 5:13 PM 21,090 47

Health care announcement Source: PA Archive/Press Association Images

THE MINISTER FOR Health has announced a raft of changes in how medical cards are given out and retained.

Leo Varadkar said today that the HSE will enhance the operation of the process to “make it more sensitive to people’s needs”.

  • The biggest change announced today will offer further protections to terminally ill patients who will no longer have to go through the medical card review process.

That decision has been welcomed by the Irish Hospice Foundation, whose CEO Sharon Foley said the previous yearly renewal process was “very upsetting for patients and their families.”

  • In the case of discretionary medical cards – where an applicant is above the financial threshold – media at today’s announcement in Dublin were told that the Irish system was unique globally.

“Using ‘burden of illness’ as the basis [of medical card distribution] isn’t being done anywhere else in the world,” said Professor Frank Keane, who chaired an expert panel on medical cards, whose report was also published today.

‘Burden of illness’ or ‘medical hardship’ are principles which afford medical cards to patients who may have significant financial means, but whose medical condition may cause a serious burden to their families and work lives.

Medical Card System. Pictured Minister Source: Sam Boal/Photocall Ireland

  • Another significant part of today’s plan will empower GPs to use their discretion to reinstate medical cards for a period of four months, and in some circumstances, one year.

Minister Varadkar also said this afternoon that last summer’s controversy over medical card changes required the government to “reconsider how the whole system works”.

“Having done so, with the help of the Expert Group, we have concluded that a financial means-test remains the fairest way to assess eligibility. But we also need an enhanced assessment process which takes into account the burden of an illness or a condition.

From now on, wider discretion and greater humanity will be exercised in such cases.

Minister of State Kathleen Lynch said the discretionary medical card issue was one which had “exercised a lot of people – and rightly so.”

Medical Card System. Pictured (LtoR) M Minister Leo Varadkar, Prof Frank Keane, and Minister of State Kathleen Lynch at today's announcement. Source: Sam Boal/Photocall Ireland

Varadkar, however, took the opportunity to repeat his support for universal health care in Ireland, saying: “If everyone was entitled to health care, we wouldn’t have to do all this.”

The Health Minister also pointed out that new legislation may be required to implement the various new provisions in today’s plan.

A ten-point action plan has been put in place to ensure improvements, he added:

1. A GP’s power to extend medical cards in difficult circumstances will be strengthened.

2. Those who are terminally ill will not have their medical card reviewed.

3. The assessment process will be enhanced to take into account the burden of an illness or condition. 

4. There will be a greater sharing of information between the ‘medical card central assessment office and the local health offices’.

5. People on a discretionary card will keep that card until at least the scheme is improved. 

6. People not on a medical card will be able to get therapies and/or appliances from the HSE if and when they are needed.

7. There will be one, integrated process to apply for a medical card or a GP-visit card, as well as the Long-Term Illness Scheme and the Drugs Payment scheme. 

8. There will be offices set up across the country to help people make their applications.

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9. An advisory group has been established to develop guidance on assessing applications involving significant medical conditions. 

10. The Department and the HSE will consider the best way to make medical aids and appliances available to persons who do not hold a medical card, the provision of services to children with severe disabilities, and to enable people with particular needs to have these met on an individual basis rather than awarding a medical card to all family members.

Medical Card System. Pictured Minister Source: Sam Boal

The ten measures were decided upon after recommendations were set out in two reports, also published today.

Following their publication, the HSE and the Department concluded it would not be “feasible, desirable nor ethically justifiable” to list medical conditions in priority order as a means of determining medical card eligibility.

Widely but cautiously welcomed

Doctors have given the changes a “cautious welcome” but warned that people on discretionary cards are still in danger of losing them.

Dr Ray Walley, chairman of the IMO, pointed out the difficulty that would be faced in seeking to withdraw discretionary cards from people who currently have them.

“It is extremely difficult to withdraw a medical benefit that people currently enjoy and I would urge the Government to think very long and hard before they seek to terminate any existing medical card.”

Down Syndrome Ireland welcomed what it called the new plan’s enhanced “discretion and humanity”, and the Jack and Jill Foundatoins said it’s initial reaction was one of “cautious optimism.”

Additional reporting by Sinéad O’Carroll.

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