"The Government has considered the position regarding medical cards for those aged 70 and over in the context of the position outlined by the Taoiseach over the weekend.
The Government have decided to set a new income threshold for medical cards in respect of persons aged 70 and over such that all of those whose (gross) weekly income is €700 (€36,500 pa) or less for a single person, or €1,400 (€73,000 pa) for a couple will continue to have a full medical card.
In addition, those with incomes above the threshold experiencing difficulty in meeting their medical needs will be eligible to apply for a medical card under the HSE's discretionary medical card scheme. The new arrangements will not require those currently eligible to undergo a means test. All persons aged 70 or over will be notified of the new arrangements but only those with incomes over the new threshold will be required to notify their circumstances to the HSE. New applicants after 1 January, 2009 will be subject to a means test. This is consistent with the Government decision to end the arrangement whereby medical cards were automatically issued, without a means test, to all of those aged 70 and over. The relevant legislation enacted in 2001 will, accordingly, be repealed.
The Government are satisfied that the savings required by the budgetary framework will be achieved through the ending of automatic entitlement to a medical card for those with incomes in excess of the new threshold, through the setting of a new capitation rate in respect of patients aged 70 and over, and through economies in drug usage. The Government have consulted the Irish Medical Organisation on the position arising from the Taoiseach's public statement. The IMO have, in the course of discussion, stressed the potential for significant savings in drug costs, without compromising on patient care. Accordingly, the Government have decided to establish a process of intense engagement with the IMO and those with particular expertise in this area, under the chairmanship of Dr Michael Barry, to develop recommendations for good practice which will secure safe and effective prescribing for patients while maximising the potential for economy in the use of public funds.
The initial report from Dr. Barry will be prepared by 1st December. The Government are satisfied that there is significant scope for savings arising from this prescribing initiative.
In this context, the Government have decided to introduce a new single capitation rate for participating doctors in the Medical Card Scheme who are caring for patients aged 70 and over. This will be payable in respect of all such patients, without distinction as to status.
The Government have appointed Mr. Eddie Sullivan, former Secretary General, Public Service Management and Development and current Chairperson of the Public Appointments Service, to recommend a new rate for consideration by the Government. In making his recommendation Mr. Sullivan will have regard to the need to secure savings in capitation payments and the scope for savings in respect of drug costs. Account will also be taken of submissions to be made by the IMO, by the HSE and by such other parties who may choose to make a submission by Friday next, 24 October. Mr Sullivan's recommendation will be considered by the Minister for Health and Children and by the Government at its meeting on Wednesday next, 29 October.
The consultation which has taken place with the IMO has occurred within the framework of the Competition Act. The Government are satisfied that the scope of the engagement by General Practitioners in the delivery of primary healthcare, and the significance of primary healthcare for the overall efficacy of the public health system, makes a more direct form of engagement with the representatives of General Practitioners both necessary and desirable. Accordingly, it is the intention of the Government to pursue appropriate amendments to Section 4 of the Competition Act 2002 to enable the representative body of GPs, the IMO, to represent its members in negotiations with the HSE and the Department of Health and Children in respect of the services provided to the public health service in a manner consistent with the public interest. This will not affect in any way the status of the IMO or other representative organisations in respect of medical services other than those delivered by agreement with the public health service. The legal provision to be made will be subject to consistency with EU competition rules."
Tuesday, October 21st, 2008