Oct 31, 2005

Medical cards for GP Visit costs in Ireland

Within a few weeks, the new GP visit card will be appearing in Ireland- hopefully entitling 200,000 people to free visits to their GPs.

The card has had a difficult birth, delayed initially by a lengthy battle with the Irish Medical Organisation (IMO) about its implementation.

Mary Harney, the Minister for Health, wanted to introduce the cards as part of her favoured approach to graduated benefits.

“I am a fan of graduated benefits,” she said. “Too often we see benefits where people either get all or nothing and that is neither right nor fair. With the GP visit cards, free GP services are now available to four times the number of people, that it would cost to give full medical cards to.”

But the IMO doctors took some convincing on the logistics of the system. Last month, the IMO and Harney finally reached agreement.

But the next problem was just around the corner. Harney had set the income threshold for the card at 25 per cent above that of the medical card, and she had promised that about 200,000 people would benefit from the card. But the numbers didn't add up. It soon became apparent that under the initial income guidelines just a fraction of the 200,000 would be eligible.

Harney responded by upping the medical card income guidelines by 25 per cent, which in turn upped the guidelines for the GP visit cards to draw the promised 200,000 into the net. Now the new cards are about to become a reality. The first applications have already been received, and the cards will soon be issued. Now that the political wrangling and positioning has been resolved the focus is switching to more basic issues - what the new card does, who gets it, and how to get one.

What the new card does

When the Department of Health was costing the new benefit they based its €60 million annual price tag on the amount that is actually paid to each GP every year, which is based on about three visits per patient per year (GPs will also get an additional one-off €35 payment for each of the first 200,000 patients signed up). But Browne said there was no limit to the number of consultations a person could have. “It is based on clinical need,” she said.

“If you have a clinical need you will be able to access your doctor free of charge.”

The card also covers the cost of a doctor writing a prescription outside of a visit, as is frequently done for repeat prescriptions such as inhalers for asthma sufferers. But the card does not cover the cost of the drugs or medicines that are prescribed (a separate scheme, the Drugs Payment Scheme, does refund the cost of these drugs above €85 per month for a family).

Browne said that the cards holders are allowed to choose their own doctor, and then register their card there.

But she said that if the chosen family doctor is not available card holders can use the card for free treatment from other GPs.

Who gets it

It is means-tested in the same way as the regular medical cards, the only difference is that income thresholds for the doctor only cards is 25 per cent higher.

Both benefits (medical cards and GP visit cards) now try to take account of both a person's earnings and their outgoings in certain areas. The new guidelines mean that a household can have a relatively high income - €60,000 and higher - and still qualify for a GP visit card under certain circumstances.

The system is particularly favourable to single-parent families, which are assessed under the same income guidelines as two-parent families. Families with children in third-level education who are not receiving a grant also fare well, as their parents benefit from higher income thresholds.

Most of those who will benefit from the scheme will either be in employment or self employed, as most people dependent on social benefits already have medical cards.

In general, when the HSE is assessing a person's income it first looks at the applicants net income, which is their income after PAYE and PRSI have been deducted.

Applications had been previously assessed on gross income, but the Department of Health now believes that net income is a much fairer assessment.

Candidates are also allowed to deduct other “reasonable costs'‘ from their assessed income.

In general these reasonable costs fall into three categories - rent or mortgage payments, costs for travelling to work and childcare costs.

But an official at the Department of Health said that other expenses could also be taken into account in certain circumstances.

“What we are trying to do is look at the overall circumstance of a family,” he said. “So if there are certain social difficulties - such as somebody in the household having a money or household budget management problem - it can be taken into account.”

If a person is paying towards the care of an elderly relative that can also be assessed as a reasonable expense, he said. The HSE can also give medical or GP visit cards to individuals or families who exceed the financial guidelines but have particular medical circumstances.

This can include chronic illness, that mean medical costs would result in financial hardship.

The official said there was no set maximum allowance people could claim under any one category, but the amounts claimed would have to be reasonable. So if a family had high mortgage payments and was experiencing temporary financial difficulties the high mortgage payments would be taken into account.

For childcare and housing expenses the local health office involved will look at the average cost of these services in your local area to see if your claim is “reasonable'‘.

Receipts for childcare and rent are not an absolute requirement, but if the amount you are claiming is considerably higher than these averages then you may be asked to provide them.

How to apply

The HSE has introduced a combined application form, which allows candidates to apply for the full medical card and the GP visit card at the same time. When the HSE processes each application it will first check if the applicant is eligible for a full medical card, and then check if they qualify for a GP visit card. Application forms are available at local health offices, doctors' surgeries and other public offices, and online at www.hse.ie

And HSE staff will be willing to help applicants fill out the application forms. Applicants have to submit documentary evidence on their income - that is a P60 if they are employed, tax assessments/returns if they are self employed or a statement of income from the Department of Social and Family Affairs (if some of the family income is from social welfare).

Browne said the HSE hoped to be able to approve people's applications “within a matter of weeks'‘.

“Anyone who has previously been refused a card should reapply without delay, as should any individual or family who think they may now be eligible,” said Browne.

“We would hope that people on low incomes, in particular parents with young children would benefit from this.” Once a card is issued it is subject to “periodic review'‘, Browne said, so if a person's circumstances change they may lose their card.

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