The Government has announced a new flat fee of €290 a year to be paid to all GPs who care for patients over 70 with medical cards.
The new fee structure will achieve €16 million in savings, it contended, in addition to the €20 million the State will save because 20,000 people over 70 with incomes over €35,000 will no longer be eligible to hold a card.
At its weekly meeting yesterday, the Cabinet accepted the recommendation by Eddie Sullivan, a former senior official with the Department of Finance. The new fee structure will be included in the Finance Bill, to be published on November 20th.
The new single fee will replace two separate schemes for over-70s. The current arrangement pays an average of €161 to those over 70 who qualify on the basis of a means test. For those who have qualified on grounds of age since 2001, the annual fee is much higher, an average payment per patient of €640 per year. The schemes have long been criticised as being inequitable.
Minister for Health Mary Harney described the new fee as "a fair and sustainable use of scarce taxpayers' resources".
"The unintended inequity in the present arrangements, whereby different GP practices receive different fees for the same number of patients over 70, will end," she said.
But Fine Gael and Labour both excoriated what they called the small savings now being estimated.
Fine Gael health spokesman James Reilly said Mr Sullivan's report showed Ms Harney could have found alternative savings before the Budget "instead of targeting elderly people as a soft touch".
Jan O'Sullivan of Labour said a small saving had to be judged against the detrimental effect the move would have on the health of the elderly. "Is this Government going to abandon the progressive principle of universal access to primary care and put at risk the health of more than 20,000 elderly people for a savings of just €16 million?" she asked.
A former general secretary, Mr Sullivan was asked to examine the issue only seven days ago, after the Government announced it was reversing its decision to withdraw the automatic card for over- 70s. He received 70 submissions from interested parties, including the Irish Medical Organisation and the HSE.
Some 140,000 people are eligible for age-related medical cards, while a further 215,000 patients hold means-related medical cards.
The new arrangement will save a total of €36 million, according to the Government, compared to the €100 million envisaged by the original decision to withdraw automatic entitlement. The €64 million shortfall, a spokesman said, would be achieved by a shift in prescribing policies towards cheaper generic drugs.
However, in his report, Mr Sullivan notes that the €290 annual fee will increase by 2.5 per cent under the terms of the Towards 2016 agreement. It will bring the actual fee paid to GPs to €308 over time.
A group under the chairmanship of Dr Michael Barry will examine possible economies in drug usage and is due to report on December 1st.
The IMO did not comment last night. It is understood to have sought a higher capitation fee in its submission. Due to competition law, it is expected individual GPs may be allowed accept or reject the deal.