Questions on the improvements to the Medical Card System

Minister of State for Primary and Social Care Kathleen Lynch and Minister for Health Leo Varadkar have welcomed steps by the HSE to enhance the operation of the medical card scheme and make it more sensitive to people’s needs, especially arrangements relating to the issuing of medical cards on a discretionary basis.

Q: What is the overall objective of the improvements?

People who have a serious illness or other health condition can be confident that in future the HSE will make a sensitive and careful assessment of all of their circumstances in deciding on their eligibility for a medical card. The HSE will take a number of steps to improve the operation of the medical card system, particularly for people with significant medical needs.  Some of these are already being put into effect.

Minister Lynch said: “The HSE is comprehensively reforming how the medical card scheme operates so that it will be easier for people to understand and will provide a high-quality customer service. People with a serious illness who hold a discretionary card can also be reassured that they will retain their card pending implementation of the actions to improve the operation of the scheme.”

Q: How is the system going to work?

The HSE is taking ten actions to improve the operation of the medical card system, particularly for people with significant medical needs:

  • An enhanced assessment process which takes into account the burden of an illness or a condition;
  • The greater exchange of information between the medical card central assessment office and the local health offices;
  • People with a serious illness who hold a discretionary card can also be reassured that they will retain their card pending implementation of the actions to improve the operation of the scheme;
  • The power of GPs to extend medical cards in difficult circumstances will be strengthened;
  • A clinical advisory group is being established by the HSE to develop guidance on assessing applications involving significant medical conditions;
  • While the new system is being developed, medical cards given to people with terminal illnesses will no longer be reviewed;
  • The HSE will be empowered to provide people with therapies or appliances if that’s what they need, even in the absence of a medical card;
  • The HSE will develop a single, integrated process for people to apply for a medical card, a GP visit card, the Long-Term Illness scheme, and the Drugs Payment Scheme;
  • Access points will be established around the country in health offices to support and assist people to make applications;
  • The HSE will consider the best way to make medical aids and appliances available to persons who do not hold a medical card, the provision of services to children with severe disabilities, and to enable people with particular needs to have these met on an individual basis rather than awarding a medical card to all family members.

Q: How did these improvements to the system come about?

The Ministers’ announcements are in conjunction with the publication by the HSE of two reports – one the report of the Expert Panel on Medical Need for Medical Card Eligibility and the other the external review of the Medical Card Process, undertaken by Prospectus and Deloitte. Minister Varadkar said: “The medical card controversy of last summer required the Government to reconsider how the whole system works. Having done so, with the help of the Expert Group, we have concluded that a financial means-test remains the fairest way to assess eligibility. But we also need an enhanced assessment process which takes into account the burden of an illness or a condition. From now on, wider discretion and greater humanity will be exercised in such cases.

Q: What reassurances are in place for those who hold a Medical Card on a Discretionary Basis?

People who had their discretionary cards reissued during 2014 will continue to hold their cards. The reinstatement of discretionary cards on a temporary basis will be extended pending the implementation of the actions to improve the operation of the scheme. The HSE will exempt the holders of discretionary medical cards with medical conditions from random reviews. The HSE will not carry out standard reviews of discretionary medical cardholders who are terminally ill.

Q: What other measures other than those already outlined above will be put in place to improve the system?

The HSE has appointed a senior manager to lead the reform of the systems for handling medical card application and reviews, with a focus on a high-quality customer service and easy-to-understand information and processes. Improved communications and information will be developed and provided for the public, health sector staff and health advocacy groups to ensure a better understanding of people’s entitlements and the rules of the medical card scheme. A clinical advisory group will shortly be established by the HSE to draw up guidance on assessing applications involving significant medical conditions so as to take account of the burden and needs of the condition and to ensure that appropriate services are provided to people who need them. The HSE will ensure that GPs can temporarily extend the validity of discretionary medical cards where sensitive renewal is appropriate.

Q: Will the improvements make the application process easier?

The development of a single, integrated process for people to apply for a medical card, a GP visit card, the Long-Term Illness scheme, and the Drugs Payment Scheme will allow for an easier application process. The establishment of access points around the country in health offices to support and assist people to make applications.

Q: What will happen next?

The Ministers will continue to oversee the implementation of these actions and will welcome feedback from service users and stakeholder groups.  If further improvements are deemed necessary, these will be considered.   The Ministers have also asked the HSE to examine, with the Department of Health, the best way to meet the needs of people with significant medical conditions who need the support of the public health system.  This work includes considering the best way to make medical aids and appliances available to persons who do not hold a medical card, the provision of services to children with severe disabilities, and to enable people with particular needs to have these met on an individual basis rather than awarding a medical card to all family members.

Minister Varadkar said: “The more that I have studied the issue of eligibility for medical cards, the more I have become convinced that the only solution is universal health care. No matter what means-test you apply, whether financial or medical, there will always anomalies and there will always be people just above the threshold. However, I am convinced that this new system will be fairer and more humane than the one it is replacing.”