A FLAT fee of €290 a year should be paid to all GPs caring for patients over 70 with medical cards, according to a report presented to Government yesterday.
The report was compiled by Eddie Sullivan, chair of the Public Appointments Service, after considering more than 70 submissions made in recent days by individual doctors, the Irish Medical Organisation (which represents GPs), the Health Service Executive (HSE) and members of the public.
In his report Mr Sullivan notes GPs get paid an average annual capitation fee of €640 for treating over-70s who automatically got a medical card without a means test, while they get paid an average of €162 a year for looking after those over-70s who already had medical cards by virtue of a means test before they reached their 70th birthday.
His report, published last evening, states the existing "two-tiered payments arrangements" introduced in 2001 when medical cards were given to all over-70s, regardless of means, favour GPs and GP practices where there are a high number of automatic entitlement medical card holders.
It also points out that the total number of medical card holders aged 70 and over has been increasing by between 2.5 per cent and 3 per cent per annum in recent years, "while those issued on an automatic entitlement basis have been increasing at over 7 per cent".
It puts the number of over-70s who have medical cards without a means test at 139,035 and the numbers with cards who previously had a means test before reaching 70 at 214,397.
"The total capitation cost for the provision of medical cards to those aged 70 and over is estimated at over €121 million, based on current capitation rates and numbers at the beginning of October 2008. The cost of the automatic entitlement cards is €88 million and €33 million in respect of the means-tested cards."
Mr Sullivan looked at several options when asked to set a single capitation fee for all GPs caring for over-70s as part of the Government's drive to save €100 million next year, having abolished the automatic entitlement by over-70s to medical cards.
His report says that to set the new rate equal to the existing average fee paid to GPs treating over-70s who were means-tested in the past (ie, €162) would "be impractical and unfair to GPs".
He states: "It could impact on the engagement of GPs in the delivery of primary healthcare and could jeopardise the primary care service which is generally recognised as playing a central role in the overall efficiency of the public health system."
On the other hand, to set the rate towards the top end of what is paid at present would be excessive, he said. "Having considered the various submissions, the existing fees and cost structure, the decision to set a single rate and the budgetary context, I have come to the conclusion that a single annual capitation rate of €290 would be appropriate and I recommend accordingly."
His report says: "This would mean increases in overall fees for some GPs and a reduction for others, depending on practice mix."
He estimates his recommendation will save €16 million in 2009.
The report says the €290 would go up when the two 2.5 per cent increases that are payable under Towards 2016 are paid and when the supplementary out-of-hours fee of €3.89 paid to GPs is included. These payments will bring the actual fee paid to GPs in due course to €308.39.
The submissions he received he said raised many interesting issues. He noted some submissions highlighted "the inherent inequity in the current two-tier system", while others "pointed out that the higher capitation rate payable for non-means-tested over-70s was an opportunity taken by many GPs to upgrade practices through investment and that the additional monies were used to cross-subsidise the amount received for means-tested patients. It was stated that reductions in capitation payments could lead to cuts in services."
Some submissions also maintained the rates payable in respect of means-tested medical cards were too low to adequately reflect the range of services provided and also stressed that the over-70s cohort requires more frequent and more complex consultations.