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Opinion: 'The medical card review scheme is a shambles'

I have a significant physical disability; my experience over the past seven months proves that medical card fiasco rumbles on.

Vivian Rath

WE WERE LED to believe the medical card fiasco was over, when Minister of State at the Department of Health Alex White announced a U-turn in May 2014. My experience over the past seven months proves that to be a myth, little has changed.

I have a significant physical disability and over the past two years I have spent considerable periods of time in hospital. Despite these difficulties, I have a positive ‘can do’ attitude. I have worked and contributed to society and acted as an advocate for change in my community. My medical card is an essential support and allows me to live life to the full.

In February 2014, I was informed my medical card was being reviewed. It wasn’t a discretionary card so, the review continued oblivious of any ‘U-turn’.

A medical card review involves a means assessment and completing a rather onerous form. I faced administrative delays, multiple requests for information and requests seeking the same information in alternative formats, along with communication failures. The process was energy sapping and incredibly frustrating. After six months, multiple letters, forms, phone calls and emails to the HSE, numerous consultants letters and bank statements, my review still hadn’t progressed.

I completed a degree in pharmacology, a masters in business, and am working my way through a PhD – big words, form filling and research are part of my life. Yet the review process put me to the pin of my educational white collar. The Better Life Index found that older people, those who are underemployed and those who have less education and income have poorer health. I am confident that many in these socio-economic groups struggle with this application process. These are the groups within our society that the HSE most needs to support, so why is the process made so difficult? When the policy to establish the HSE was conceived, I cannot believe they imagined it would end up being such a bureaucratic nightmare.

Whilst waiting for my card to be reviewed, I applied to the Department of Social Welfare for the Disability Allowance; it was approved in three months, far shorter than the seven it finally took the HSE to review my existing medical card. I informed the HSE of the DSP approval, they ignored my communication.

During the process, my card was suspended without notice. I was no longer entitled to free medical attention and I had no income. I emailed the HSE on numerous occasions to enquire where to avail of care as my condition had deteriorated. I received no response to my question. I was now reliant on my family, robbed of my dignity and independence – independence which I had, throughout my life, strove to maintain. The HSE guidelines state that the HSE is ‘committed to focusing on continuous quality improvement’ and ‘facilitating and supporting access to services when a person needs them’. My experience demonstrates otherwise.

As a society, we have to ask ourselves: is this what we want from our public services? Is this an acceptable way to treat the most vulnerable in our communities? I never expected to become so ill so quickly, I hadn’t planned for it. At only 30 years of age, I didn’t foresee a day when I would be too sick to get out of bed. I didn’t expect to see my career go down the drain, my studies to stop and my social life to fall off a cliff. It can happen to any of us.

Research shows that higher life expectancy is generally associated with higher health care spending per person. As budget day looms, the Minister for Health must think very carefully before making cuts to the health budget. My experience and reports by the PAC and C&AG highlight that there is an obvious problem in the processing of medical cards by the HSE and an urgent re-organisation is necessary. Work is required to deal with the delays in handling applications; to improve communication between departments; dealing with the card holder or simply just treating the citizens of this State with dignity and respect.

Many of the letters I received from the HSE ended with the line ‘Failure to respond by X date, will result in your eligibility being cancelled’. This tone certainly isn’t best practise in customer service and put me under unnecessary stress. I feel that a tone of respect, caring and helpfulness would be far more appropriate. The expert panel which has been organised to review the medical card scheme needs to take urgent action, because for many people who require a medical card, time is not a luxury they can afford.

Vivian Rath is a PhD student in TCD, researching the experience of students with disabilities at third level. He tweets at @RathVivian

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Vivian Rath

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