HSE denies medical card cull

  • Niall Hunter, Editor

The HSE has denied that there has been a dramatic slowing down in the granting of new medical cards.

Paddy Burke, head of the HSE's medical card scheme, today denied there had been a slowing down in the issuing of new medical cards and said there had been no instruction to slow down the issuing of cards. He said this year the HSE had issued 106,000 new medical cards.

However, official figures show that the total number of people with full medical cards and GP visit cards only increased by around 2,400 between last December and August of this year, indicating that while tens of thousands of new cards may have been granted, this has been offset by a significant number being taken out of the system.

The IMO claimed the HSE was misleading the public about the contentious issue of medical cards being withdrawn from vulnerable patients.

Mr Burke told a media briefing that one of the reasons the medical card applications scheme was centralised was to deal with any waste or fraud within the system. He admitted there had been a surplus of cards issued in the first six months of 2012 compared to 2013.

John Hennessy, Director of Primary Care with the HSE. said there had been no attempt to 'blackguard' people on their entitlements to medical cards and medical officers who looked into applications for discretionary cards had been under no instructions to tighten up eligibility criteria.

The HSE has launched a new strategy to provide clearer information to the public about the issuing of medical cards. This includes a major advertising campaign, extra resources for the HSE information line, greater support on the HSE's website, more training for staff, and a new information leaflet.

According to the HSE, assessment for full medical card or GP visit cards is based in income thresholds. However, in cases where people are above the income limit, the HSE can apply discretion where due, for example, to serious illness or disability, undue hardship would arise from the costs of the illness in the absence of a medical card.

HSE officials told the press briefing today that difficulties in granting or renewing discretionary cards can arise where the gap between the threshold for the family concerned can be multiples of their income.

However, the HSE has stressed that in these cases it will try in so far as is possible to allow the applicants concerned to meet the criteria and 'push them over the line'.

The HSE can also automatically grant an emergency medical card for a six month period where a person is confirmed by their consultant to have a terminal illness.

However, officials at the press briefing today, while denying that there had been a tightening up in the issuing of cards, admitted that there had been reviews of cards in the system and stressed that there was a need for accountability.

These reviews have included the removal of cardholders from the system following a review of patients who had not accessed medical card services for some time.

Mr Burke said giving someone a medical card was essentially like giving them a 'medical credit card' on which considerable expenditure could be run up, and therefore, there had to be an audit trail.

However, he said while there was now greater accountability and audit, there had been no change in policy in relation to medical cards.

Mr Burke said the only recent changes in medical card eligibility guidelines were those made in the past two Budgets, relating to the allowability of home improvement grants and travel to work expenses in assessing income, and in relation to income criteria for over 70s.

There had also been a change in the organisation of the medical card system, and it had been centralised and standardised since 2011. This had led to a major speeding up of the application process for cards.

Recent HSE figures show that the number of discretionary full medical cards issued has dropped by nearly 10,000 so far this year, although GP visit discretionary card numbers have increased.

The total number of full and GP visit medical cards in the system increased by 165,259 between 2011 and 2012. However, since the end of 2012, the number of full and GP visit medical cards has only increased by 2,400.

Given the HSE figure of 106,000 new medical cards being issued this year, the year-on-year medical card figures would therefore indicate that at least 100,000 cards may have been taken out of the system over the past year.

It is unclear how all these cards have been removed from the system.

According to figures provided by the HSE, this year, 428,000 medical cards have been reviewed and of these 9,891 were found to be no longer eligible, with another 3,992 cardholders found to be deceased, while 35,733 people who were contacted by the HSE did not respond or provide enough information for the review, resulting in the suspension of their cards.

Dr Ray Walley, Chairman of the IMO's GP Committee said the HSE 'spin' could not disguise the fact that the HSE was still committed to taking medical cards away from thousands of people who have traditionally had a medical card and who are utterly dependent on them for their medical care.

"The HSE is clinging desperately to their claim that the eligibility criteria haven’t changed."

However, Dr Walley said while the actual criteria had not changed, the application of the criteria had changed.

"That’s not good enough, and the public won't accept it."

Dr Walley said that the focus on eligibility criteria was a distraction.

"How can you explain that nothing has changed to an elderly patient who is losing the card she is dependent upon?  The bottom line remains that the HSE is withdrawing medical cards from people who have a huge dependency on them and this will cause untold misery and pain and hardship for thousands of people.  Patients who lose their cards will also have to face significant costs in terms of medicines prescribed as well as the loss of other benefits."

Asked at the press briefing today if all the doctors going public on their patients losing cards were simply wrong or misinformed, HSE officials said it was the job of doctors to advocate for their patients.

The new HSE medical card information campaign is costing €150,000.

HSE promises better info on medical cards


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