Despite the Committee’s 2002 recommendation to introduce a common waiting list for public and private patients this has not yet happened. As a consequence of significant cuts made to the overall health budget, health care costs have increasingly transferred onto patients through user charges including the prescription charge, increases in the charges for hospital treatment and increases in the threshold for the Drug Payment Scheme. The net result is that people are on average paying about €100 in additional costs for accessing care and prescribed drugs.1 Such user charges are a significant deterrent to people on low incomes from accessing necessary treatment.
The cost for a General Practitioner (GP) consultation may also act as a barrier for low-income individuals who do not qualify for a medical card. A 2014 report looking at the cost of a GP visit across 650 clinics found a great disparity in prices right across the country: the cheapest consultation in Galway cost €30, rising to €65 in Dublin.2 Medical professionals have expressed concern that people are not accessing or delaying necessary medical care due to the high cost.3
In May 2014, almost 1.8 million people (39 per cent of the population) held a full medical card; some 52,232 of these were granted on discretionary grounds. While the Health Act 1970 (as amended) sets out that access to a medical card is dependent on whether a person can afford medical services ‘without undue hardship’, this assessment relies on non-statutory income guidelines to determine eligibility.4 In some cases where a person does not satisfy the strict means-test, a card for doctor’s visits may be issued (known as a GP visit card). In May 2014, 134,130 people had a GP visit card of which a quarter were discretionary.5
Between January and April 2014, a planned review of one million medical cards assessed whether the holder continued to fulfil the necessary qualifying criteria.6 This resulted in the withdrawal of 97,000 cards; 1190 of these had been granted on a discretionary basis while 49,184 new cards were added in the same period, of which 5478 were granted on a discretionary basis.7 The removal of discretionary medical cards from people with chronic illnesses, in particular from children and persons with disabilities, received widespread criticism.8 In response to the public outcry, the Government announced in May 2014 that the review would be suspended9 and medical and GP visit discretionary cards were returned to an estimated 15,000 people.10 An Expert Panel has been convened to examine eligibility for medical cards based on medical rather than financial need. The report is expected in September 2014.11
Government spending on pharmaceutical drugs has reduced since the beginning of the crisis through the negotiation of price cuts with pharmaceutical companies, cuts to pharmacy fees and by increasing prescription charges.12 However, since 2010 prescription charges for medical card holders have been introduced13 and were further increased in 2014 to €2.50 per item with a monthly ceiling of €25 per family.14 The projected revenue in 2014 from prescription charges is €120 million, an increase of 40 per cent since 2013.15 This figure indicates the scale of the measure which will particularly impact on low-income families16 and older people who are more likely to take multiple medicines.17 For people not in possession of a medical card, the Government has committed to reduce the high cost of medicines in Ireland which is much higher than in other countries.18 It plans to do this through reducing the maximum price of generic drugs and by encouraging the use of generic medicines over branded medicines.19 Even at national level prices vary widely with an average difference of 56 per cent across all individual prescription products.20
The right to sexual and reproductive health services includes the right to access and afford contraception.21 While a variety of contraceptive methods are widely available in Ireland, the cost of accessing both prescription and non-prescription items can sometimes lead to people on low incomes, particularly young adults under 25,22 having unprotected sex or not taking steps to avoid unplanned pregnancies. In a 2010 survey conducted by the Crisis Pregnancy Agency, the vast majority of respondents did not find it difficult to access contraception but a significant number cited ‘access/locality, embarrassment and cost’ as the three main barriers they faced.23 In particular, the high cost of condoms not available under the medical card,24 as well the high cost of GP visits to renew a prescription for the contraceptive pill, discouraged respondents from accessing and using contraception.25
The survey found that while an overall 18 per cent of respondents reported that the cost of a GP visit was a ‘frequent barrier’ to accessing medical services, the cost was much more likely to deter those from a lower socio-economic background.26 The high cost of contraception also impacts on women’s contraceptive choices, as women continue to use less reliable and more expensive forms of contraception such as the oral contraceptive pill because they cannot afford the upfront fee for more effective long-term contraception such as the implant or coil.27
Access to quality, affordable reproductive health information, services, treatment and supplies is of particular concern in relation to people living in disadvantaged communities28 including young women, people living in direct provision centres (asylum seekers) and other marginalised groups.
FLAC urges the Committee to recommend that the State:
Set out how it intends to progress its plans for universal health care and prioritise funding to implement the system. In the meantime, ensure that no further measures are introduced to impact on the affordability of private health insurance for those on low or moderate incomes who do not qualify for a medical card.
Ensure anyone in need of financial assistance to access medical services has access to a medical card based on their medical need.
Conduct a review of the impact of prescription charges on low-income individuals and families, in particular for older people.
Continue the implement of measures to ensure greater use of generic drugs and reduce the high cost of medication in Ireland.
1 S. Thomas, S. Burke and S. Barry, ‘The Irish health-care system and austerity: sharing the pain’, The Lancet, 383 (3), 3 May 2014, p.1546.
2 E. O’Regan, ‘GP fees vary wildly from county to county’, Irish Independent, 10 July 2014.
3 Irish Medical Organisation (2013) IMO Budget Submission 2014, Dublin: IMO, pp.6-7.
4 Department of Health (2014) Background Policy Paper on Designing the Future Health Basket.
5 Health Service Executive (2014), Health Service Performance Assurance Report: May 2014, Dublin, HSE, p.7.
6 Health Service Executive (2013), National Service Plan 2014, Dublin, Health Service Executive, p.39.
7 Joint Oireachtas Committee of Public Accounts, Debate on Eligibility for Medical Cards, 12 June 2014, http://bit.ly/MedicalCardsPAC [accessed 22 July 2014].
8 A petition to reinstate medical cards based on medical need received more than 60,000 signatures. The campaign website is available at: http://bit.ly/OurChildrensHealth [accessed 22 July 2014].
9 Department of Health, ‘Suspension of Medical Card Reviews’ [press release], 29 May 2014..
10 Department of Health, ‘Government approves method for the return of medical cards lost in discretionary review’, [press release], 17 June 2014.
11 Health Service Executive, ‘HSE Appoints Expert Panel on Medical Need for Medical Card Eligibility’ [press release], June 2014.
12 Organisation for Co-operation and Economic Development (2014) OECD Health Statistics 2014: How does Ireland compare? Paris: OECD, p.2.
13 The Health (Amendment) No. 2 Bill 2010.
14 For information see: http://bit.ly/PrescriptionCharges [accessed 7 August 2014].
15 Minister for State with responsibility for Disability, Older People, Equality & Mental Health, Kathleen Lynch TD, Parliamentary Question: Written Answers [32202/14] and [32555/14], 17 July 2014.
16 Society of St Vincent de Paul (2013) Analysis of Budget 2014, Dublin: Society of St Vincent de Paul, p.6.
17 The Irish Longitudinal Study on Ageing 2011 (2012) Polypharmacy in adults over 50 in Ireland: Opportunities for cost saving and improved healthcare, Dublin: Trinity College Dublin, pp. 1-2.
18 A. Brick, P. Gorecki and A. Nolan (2013) Ireland: Pharmaceutical Prices, Prescribing Practices and Usage of Generics in a Comparative Context, Dublin: Economic and Social Research Institute, p.70.
19 Minister for State with responsibility for Primary Care, Alex White TD, Parliamentary Questions: Written Answers [30459/14] and [30464/14], 10 July 2014.
20 National Consumer Agency, ‘National Consumer Agency Publishes Results of National Study of Prescription Medicines’, [press release], 25 March 2013.
21 J. Westeson (2012) Sexual Health and Human Rights in the European Region, Geneva: International Council on Human Rights Policy, p. 155.
22 O. McBride, K. Morgan and H. McGee (2012) Irish Contraception and Crisis Pregnancy Study 2010 (ICCP-2010), Dublin: Crisis Pregnancy Agency and Health Service Executive, p.73.
23 O. McBride, K. Morgan and H. McGee (2012) Irish Contraception and Crisis Pregnancy Study 2010 (ICCP-2010), Dublin: Crisis Pregnancy Agency and Health Service Executive, pp.71-72.
24 In 2008, the Government cut VAT on condoms from 21 to 13.5 per cent which reduced the price to €12.40 for a box of twelve which was still much higher than the estimated cost of €3.50 in Germany. O. McBride, K. Morgan and H. McGee (2012) Irish Contraception and Crisis Pregnancy Study 2010 (ICCP-2010), Dublin: Crisis Pregnancy Agency and Health Service Executive, p.73.
25 O. McBride, K. Morgan and H. McGee (2012) Irish Contraception and Crisis Pregnancy Study 2010 (ICCP-2010), Dublin: Crisis Pregnancy Agency and Health Service Executive, pp.74-74
26 O. McBride, K. Morgan and H. McGee (2012) Irish Contraception and Crisis Pregnancy Study 2010 (ICCP-2010), Dublin: Crisis Pregnancy Agency and Health Service Executive, pp.77-78.
27 Irish Family Planning Association (2010) Annual Report, Dublin: IFPA, p.4.
28 Center for Economic and Social Rights (2012) Mauled by the Celtic Tiger: Human Rights in Ireland’s Economic Meltdown, Rights in Crisis Briefing Paper, Madrid: CESR, p.22.
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