Govt halts medical card reviews

The Government has decided to suspend immediately all reviews of discretionary medical cards, following months of controversy over patients with serious illnesses and disabilities having their cards reviewed, downgraded or removed.

It has also said it plans to change the current law on the granting of medical cards to allow people to be automatically granted a card if they have designated medical conditions, rather than basing eligibility solely on income, as is currently stipulated in legislation.

In a statement, the Department of Health said the Government was 'very aware of the public concern in relation to the issue of medical cards'.

The Department said the HSE Director General had been instructed to suspend all reviews of medical cards where discretion had been exercised to take account of medical circumstances.

The HSE and the Government had until recently been defending these medical card reviews.

However, more recently, a senior HSE official and Government Ministers had been critical of the way some reviews were being carried out in cases where discretionary cards were held by people who were seriously ill or disabled.

It was reported that in some reviews, patients were being asked whether they still had life-long illnesses or disabilities.

The HSE, in a statement earlier this week, claimed that in some cases people were 'misconstruing' requests for up to date medical information where eligibility for cards were being reviewed.

The Department of Health said today that the Cabinet Committee on Health had decided to develop a policy framework governing medical card eligibility 'in a manner that will also take account of medical conditions'.

The HSE is to establish an expert panel to examine the range of conditions that should be brought into consideration. 'This process will include the development of a new legislative framework as necessary'.

In light of this decision, the HSE Director General will now suspend reviews of medical cards where discretion had been exercised to take account of medical circumstances, the Department said.

The Department of Health has also been mandated by the Government to develop a policy paper on the further roll-out of GP care free at the point of access in the context of the move to universal health insurance.

Health Minister James Reilly is to present a memorandum to Government setting out the next steps in this process.

The HSE said today that medical card reviews, where an individual's card has been granted on a discretionary basis, currently underway, will be suspended 'and no further reviews will be commenced pending the outcome of the development of the new policy framework by Government'.

Asked whether people who had their discretionary cards removed or downgraded recently as a result of these reviews will have them restored, the HSE told 'the changes required by the individuals who have lost their medical card - so that they might be entitled to a medical card on the basis of medical condition - will form part of the development of the legislative framework and the work of the expert panel'.

The HSE indicated that these patients who have recently lost their cards would not have to wait a lengthy period to get them back under a new system based on medical need.

It added that the majority of those who have lost their medical card recently following a review would have been granted a GP visit card and/or would come under the Long Term Illness Scheme.

Under the current system, discretionary medical cards are normally given where a person is over the medical card income threshold but is deemed to need a card due to undue financial hardship because of their specific health circumstances.

Under recent 'probity' measures initiated by the Department of Health and HSE, discretionary medical card reviews were stepped up, apparently on the basis that in some cases cards were believed to have previously been granted in circumstances where they ought not to have been.

These probity reviews, however, led to considerable distress and hardship for thousands of discretionary medical card holders, often with serious medical conditions and disabilities, many of whom suffered removal or downgrading of their medical cards.

While the number whose discretionary cards were axed was relatively miniscule in terms of the 1.9 million regular and discretionary medical cards in the system, the political fallout for the Government on this issue has been considerable.

The new system currently being considered by the Government is likely to lead to the drawing up of a list of specific serious medical conditions and disabilities which would warrant an automatic medical card being granted.

There are around 80,000 discretionary medical cards in the system at present.

This would remove the stipulation that cards may only be granted on financial means and, presumably, remove any 'grey areas' over who is and is not eligible, as well as the need for regular eligibility reviews.

As the current medical card legislation bases eligibility solely on means, it would have to be amended.

An anomaly here is that the current Government previously abandoned plans to initially introduce free GP care on an illness basis, citing legal difficulties. These legal snags will now have to be tackled again in any resolution of the discretionary cards issue.

The Government was finally forced into action on discretionary medical card reviews after this became a major issue in the recent local and European elections, contributing to a huge drop in the Labour party vote.

The patient support group Arthritis Ireland welcomed the Government's decision on medical cards.

The charity said it was now calling on the HSE to ensure that arthritis patients on expensive treatments, such as high-tech biologic therapies, are given medical cards straight away.

Arthritis Ireland recently revealed that 60% of people with arthritis who have or had discretionary medical cards admitted they had been taken away or placed under review.

The Irish Cancer Society, which had revealed that cancer patients had had their cards reviewed or removed, also welcomed the Government's decision.

"This is a shift in health policy in Ireland governing medical cards," said Kathleen O'Meara, Head of Advocacy and Communications with the Society.

"Up to now, a discretionary medical card has been given on the basis of 'undue financial hardship'. It seems from this announcement that for the first time, people will be assessed on their medical need rather than their financial circumstances."

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[Posted: Thu 29/05/2014]


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