Is medical card move just 'stroke politics'?

  • Niall Hunter, Editor

Let's not feel too guilty about conducting an oral examination of the Government's 'gift horse' granting of GP visit cards to all children five and under.

As we wipe wipe away the tears of gratitude, we would do well to ponder the grim truth that pretty much everything that happens in healthcare is dictated by politics, expediency, and of course, money.

In principle, the Budget provision to provide free GP treatment for all under fives is positive in terms of population health.

You may argue then, that picking holes in this scheme is simply being churlish. Well, there are some good reasons for being a churl* about this particular issue.

Getting proper access to GP services has been a constant bugbear in our health system, through good economic times and bad.

Those on low incomes who are just above the income limit for medical cards but who cannot afford GP visits have, until now, been frozen out when trying to access vital GP care for themselves and their children.

The unfortunate thing about the 'optics' of total population schemes is that the rich as well as the poor benefit from them, leading to obvious questions about health inequalities, especially at a time of economic retrenchment.

With the recession, while medical card numbers have undoubtedly grown as the economy continued to decline, the numbers of 'working poor' excluded from free GP care by our health service eligibility lotto has also grown.

Including these previously excluded lower income patients, as well as those genuinely hard-pressed middle class people on higher but ever-diminishing incomes, will therefore be welcomed.

However, there is definitely more than a taint of stroke politics involved in this new dawn.

In many ways the latest eligibility extension is a move designed to save the Labour Party's collective skin in the opinion polls, and a 'good news' item for a health minister presiding over constant financial retrenchment for two and three quarter years.

And since the two Government parties, particularly in the Dublin area, are after middle class votes, they will not be too concerned that some people relatively lightly touched by the recession will no longer have to fork out €60 per GP visit for their child.

While the granting of free GP care to under fives will certainly alleviate some hardship for many, it will still not correct the glaring inequalities that remain in our health system.

It resembles a doctor applying a sticking plaster and giving two paracetamol to a person with a broken leg while ignoring that the patient is still in considerable pain.

The Government knows this, but it also knows that there is little 'not to like' at this stage in a scheme where every small child gets free GP care. But there is, of course no such thing as a free lunch.

The public, in its euphoria over the medical card extension, might forget for a minute about the fact that hundreds of millions of euros will again be sliced off the health budget this week and that serious questions about quality and safety in the health service are being raised after over one fifth of the budget has been taken away in five years.

The public may, the Government hopes also briefly forget that we are still some way off having free GP care for everyone and having proper access to all types of care under a universal health insurance system.

People might push to the back of their minds, too, the fact that the children of judges, lawyers, politicians and hospital consultants will get free GP care for their children while some less fortunate people who really need medical cards will still not get them or will have them taken away.

The extension of medical card eligibility to benefit 240,000 families comes against the background of a continually broke health service, in which sick and vulnerable people usually have to bear much of the health cuts burden.

The cost of providing the under fives scheme will be partly met by taking full medical cards off older people and others and raising prescription charges in this week's budget.

Already, thousands of chronically ill and vulnerable people have had their 'discretionary' medical card taken off them, something that the Government seems to be in denial about.

The Government will argue that the under fives medical extension is an important step towards rectifying some of our more glaring health inequalities.

However, despite recent improvements, the health system still has huge access problems.

To give one example, as a result of the new scheme, many parents on lower incomes will now more readily be able to take their sick children to see a GP from next year.

However, if the GP discovers that the child may have a serious illness and requires hospital care, but the parents do not have private insurance, the child will go on a lengthy public waiting list for an outpatient appointment.

A glance at the outpatients waiting list at Crumlin children's hospital shows that there are currently nearly 4,600 children waiting over a year to see a consultant in a public clinic.

Other examples of major access and care provision problems include:

* Waiting lists for treatment in public hospitals have grown by 115% in a year.

* 87,000 adults and children currently waiting over a year for an outpatient appointment.

* The HSE is considerably behind targets for the provision of home help hours so far this year.

* 1,800 patients are currently on waiting lists for cardiac rehabilitation care.

* Staff cuts are having a damaging effect on maternity services.

* Thousands of people with disabilities are having to wait long periods for access to vital services, following what has been described as an 'avalanche of cutbacks.'

*Uncertainty prevails over whether free under fives GP care will eventually lead to a universal healthcare system, as promised by around 2016.

* 2,160 acute and long-stay public hospital beds closed.

Another key point in any debate about the under fives medical card eligibility extension is that, realistically, it will not be introduced without the agreement of the doctors' union, the IMO.

The IMO has made a good point about some patients being left behind while rich people's small children will get free GP care.

However, despite its moral objections to free GP care for under fives in the current circumstances, we must not forget that the IMO is a union and ultimately, its argument is about money for its members.

GPs have had swingeing fee cuts imposed by the Government in recent years, their workloads are increasing, their private income is decimated.

It's difficult to see the IMO waving the new scheme through without trying to extract some price from the Government, as they did a decade ago when the over 70s medical card extension was introduced.

Current Health Minister James Reilly knows this all to well, as he was IMO GP leader when a lucrative deal for GPs was granted in line with the over 70s medical card extension.

The IMO at the time effectively swallowed its qualms about rich older people getting free care while many poor people were being denied medical cards.

The problem of getting GPs on board this time around could prove to be a thorny one, given the state of the public finances.

The situation is complicated further by the fact that the issue of whether GPs can negotiate fee rates at all under competition law is to be decided in the courts early in the new year.

While the Government may get some short-term 'good news' traction from the under fives move and it will be welcomed by many, there is some way to go before James Reilly starts delivering the equal access health service that was promised as part of a 'democratic revolution' back in February 2011.

* Churl - a rude and mean-spirited person.

Free GP care for under fives














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