Doctor fees: The discrepancies in fees paid by the State to GPs for looking after elderly medical card patients could lead to doctors opting to treat only those who qualify for the higher payments, a Dublin GP warned this week. Martin Wall reports.
Dr Richard Ennis, who operates two general practices in Drumcondra and Cabra in Dublin, said the introduction of the scheme to grant medical cards to those over 70 regardless of means has had a damaging effect on primary care services, particularly in the more socially deprived areas.
The Government announced the scheme in the Budget of 2000. However, the commitment was made before agreement had been reached with doctors on implementing the scheme.
Following tough negotiations with the Irish Medical Organisation, the Government agreed to pay GPs a capitation fee of €480 per year for looking after every patient over 70 who was granted a medical card under the new scheme.
However, for patients over 70 who already had a medical card at the time (and for those who subsequently reached the age of 70), the fee for the doctor remained the same at around €105 per annum.
Dr Ennis said that the scheme was unfair as it made patients who qualified for a medical card without any assessment of their means to be four times as valuable to the doctor as those who had earlier received a card on income grounds.
Dr Ennis maintained that the deal "fractured the concept of commonality" in the treatment of patients. He said that the fall-out from the scheme could be that some GPs would be disinclined to take on patients who had the pre-existing medical card which attracted the lower fees.
He maintained that the introduction of free GP care and drugs and medicines for all over 70s in advance of the last election had been politically motivated.
He said that the Fianna Fáil and PD coalition believed that the elderly were more likely to vote than the young and that this was the motivation for the plan.
The Irish Medical Organisation has criticised the scheme and called for a more equitable extension of the General Medical Service.
However, the two-tier fee schedule for elderly patients was accepted by a large majority of doctors in a ballot.
Dr Ennis has called for a review of the scheme.
He has proposed that doctors should continue to receive the €480 annual fee for those elderly patients who have already received medical cards under the controversial "over 70s deal".
However, he suggested that the government should introduce a new rate of around €300 for new patients reaching 70 years of age as well as for those who previously had medical cards on income grounds.
Controversy over free care
The extension of the medical card scheme to everyone over 70 regardless of means was politically controversial but has also been seen as an administrative bungle.
A report by the State's financial watchdog, the Comptroller and Auditor General found that due to inaccurate databases, there had been a massive underestimation of the number of patients who would qualify for free GP care under the extension of the scheme.
Initially the Department of Health had forecast that 39,000 additional patients would receive medical cards. The actual number turned out to be more than 70,000.
The costs involved, originally set at €19 million, eventually reached €51 million.
Internal Department of Finance documents on the scheme, which emerged subsequently, suggested that the proposal to extend the medical card scheme had come directly from the Taoiseach's department, leading to claims by the Opposition that it was politically motivated.