Friday 15 December 2017

Should your illness or your income get you a medical card?

OH dear, less than two weeks into the job and it appears new Minister for Health Leo Varadkar has already put his foot in it.

The shoots-from-the-hip politician's comments in recent days on medical card eligibility have incensed some patient groups.

Minister Varadkar has essentially said that suggestions to base the medical card system on someone's health instead of their financial needs are unrealistic and unworkable.

However, he stressed he will wait until an expert review panel reports in September before making any firm decision on the matter.

Patient groups representing very sick children have insisted the Taoiseach must now clarify if the reforms mooted after the discretionary medical card fiasco will still happen.

So who is right?

Should the Health Minister stick to the careful 'stay out of trouble' political formula of saying he will examine the matter in detail and ensure those most in need receive the care they require?

Or do we want him to be honest about the challenges of changing long-standing existing legislation?


The current medical card system in Ireland is based on giving free care to those in most financial need, with a long-term illness scheme and discretionary cards for those in severe medical need who are outside the thresholds.

This has long been regarded as the fairest way to allocate finite health funding.

Yes, it is clear the system desperately needs to be overhauled and appears to be too harsh now on those who would previously have received discretionary cards for serious illnesses.

But do we really want a system that is based on medical need and not ability to pay?

We are due to move to a system of universal health insurance by 2019 - if it happens - so should we tinker with eligibility now when the HSE is in such a precarious financial position?

There are very vocal patient groups who believe we should and given the severe illnesses of the patients they represent it is hard to disagree.

However, if the current system was working properly they should be entitled to the care they need.

Should patients who can afford this care get it for free? The silent majority may not think so but are afraid to insist the current system is fairer.

Those with chronic illnesses were originally supposed to get free GP care first, back in 2012, but this was eventually dropped due to the difficulties of selecting what illnesses should qualify, and ultimately the cost.

This shows that extending care on the basis of medical need is a difficult process. You will never manage to keep everyone happy as the Government has to draw the line somewhere and some conditions will not qualify.

However, that doesn't mean the Minister shouldn't try to reform the current system and make it more sympathetic to those in most medical need. He can make things better but dialogue needs to happen - both with patients and those who provide patients with care, i.e. GPs, pharmacists, nurses, etc.

So, less pronouncements and more behind the scenes work, please Minister.

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