James O'Connor (Cork East, Fianna Fail)
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8. To ask the Minister for Health if he will reconsider the eligibility rules for medical cards and GP cards for those with chronic and incurable autoimmune diseases; and if he will make a statement on the matter. [39429/24]

James O'Connor (Cork East, Fianna Fail)
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My question concerns the eligibility rules for medical cards and GP cards in respect of people with chronic and incurable autoimmune diseases. This is an important issue for those it affects. These are difficult healthcare conditions that come with a lot of ramifications for quality of life and in terms of costs. People need access to community healthcare at a fair and affordable price. Will the Minister look at expanding eligibility, acknowledging that this is a huge issue for those it affects?

Stephen Donnelly (Wicklow, Fianna Fail)
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Medical card provision is primarily based on financial assessment. In accordance with the Health Act 1970, eligibility for a medical card is determined by the HSE, which assesses each application on a qualifying financial threshold. The idea of granting medical cards or GP visit cards based on any particular disease or illness has been considered. It is a topic we discuss regularly in the Dáil. There are Deputies, for example, who have made a very reasonable case for cancer care patients. The proposal is that a cancer diagnosis would trigger eligibility for a medical card.

This issue was looked at in detail by an expert group in 2014. The group concluded that it is not possible to list and prioritise conditions for medical card eligibility without creating risks of inequity by diagnosis or condition. As it was explained to me, we cannot create a hierarchy of disease. The expert group could not find a solid ethical approach that would justify saying "Yes" to cancer patients and neurological patients, for instance, and "No" to cardiovascular and diabetes patients. The group said it just cannot be done like that. We cannot create a hierarchy whereby one disease or illness is deemed to be more worthy than another.

While I fully appreciate the Deputy's question, which is one that is discussed quite regularly in the House, the consistent position, which we should maintain, is that eligibility is based on other criteria. There is the financial assessment, as we are aware. There are a lot of discretionary medical cards given out. I might come back to that in my next response.

James O'Connor (Cork East, Fianna Fail)
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I see the point the Minister is making. It does not necessarily mean I wholeheartedly agree with it, but he is right to outline that. We do this best on the basis of age. I acknowledge the Department with its enormous resources has to prioritise what it feels is in the best interests of caring for the needs of our population around this expenditure and providing the best access to healthcare. However, from the perspective of somebody who has come to me and told me their story about suffering from this illness, it brings huge additional costs. I referred to one constituent in the Rathcormack area. They explained to me the flare-ups of their condition and having to travel unexpectedly to and from a healthcare facility in the midlands. It just comes across to me as being unfair and discriminatory that the State healthcare system does not step in and intervene in a case that merits that intervention. The Minister referred to the discretionary medical card. I would be delighted to speak to him individually about the case to which I have just made a brief reference. We do this best on the basis of age. I know we have just come through a budgetary process, but perhaps this is something we could reflect on for the future, broadening it on the criterion of illness as well as on that of age.

Stephen Donnelly (Wicklow, Fianna Fail)
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I will make two points. The first is on the discretionary cards. One in eight medical cards is discretionary, and that is meant to speak to exactly the kinds of cases the Deputy talks about. The discretionary medical card is issued to patients with big medical expenses. They might satisfy the gross income criterion but not the net income criterion. Once they have to pay all these medical expenses, they do not have enough money. That really is the purpose of the discretionary medical card. If the discretionary card is failing some people who really cannot afford their medical care or cannot pay their bills because of their medical care, we may need to review that. As I said, however, nearly 200,000 discretionary medical cards are live at the moment.

Second, the gap between having a medical card and not having one has shrunk, given the number of services we have made free or much more affordable in the past four to five years.

James O'Connor (Cork East, Fianna Fail)
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I know I have raised this with the Minister previously, but in that specific area around Rathcormack and in north Cork generally, people accessing healthcare services has been a huge difficulty and a huge challenge. In particular, I think of the town of Mitchelstown. I have raised here many times cases of a concentration of the healthcare resources in a primary care centre that is privately operated and run. I meet so many people in that constituency who cannot access their local GP. They have a range of different healthcare concerns, whether it is a young person suffering from an autoimmune disease or elderly people who desperately need to get a healthcare checkup. I want to raise this on the floor of the Dáil with the Minister. It may be our final exchange before the general election. This is a huge issue in north Cork for the constituents I represent and it matters to them. The people I have spoken to can be emotive about this, and they are right to be. They are angry. Will the Minister commit the Department to having a look into what is going in north Cork, including day-to-day healthcare services alongside the out-of-hours GP services?

Bernard Durkan (Kildare North, Fine Gael)
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I strongly support the sentiments expressed by the Deputy. This applies not only to north Cork but all over the country and has been raised numerous times in the health committee over recent years. The Minister himself has identified the word "discretion". The request has to be that the criteria need to be broadened to take into account the fact, as described by Deputy O'Connor and as we have described many times at the health committee, that there are people who are really under pressure, who find themselves in panic - very often older people or younger people - and who see themselves being ignored by the system. For instance, in one particular case a procedural error took place and the person is now on expensive medication and so on. That will go to court, but that does not help the person in the meantime, and that is the problem. I ask, like my colleague did, that the discretion be looked at to see if the criteria can be broadened to allow in the people whom we are talking about. The Minister knows about them better than anybody else.

Stephen Donnelly (Wicklow, Fianna Fail)
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Our clear goal is universal healthcare. One of the three pillars of universal healthcare is that it is affordable, so a lot of what we are doing is trying to make sure that people can access care quickly, that it is great care when they get it and that they can afford it. Any debate like this is very important to constantly reviewing and finding those patients who find themselves outside of the various criteria. It is usually by a small amount but it still causes a lot of hardship. The measures we have brought in will help. We have abolished inpatient hospital charges. They were costing families up to €800 a year We have just funded free HRT. One lady yesterday in Wicklow told me she is spending €1,000 a year on HRT. We are funding IVF. Couples were spending €7,000, €8,000, €9,000, €10,000 or €12,000 on IVF. We have brought the drug payments scheme threshold down to €80 a month. We have brought in free contraception. We have rolled out eligibility for another 500,000 people to get free GP care. What we must constantly do is identify the people whose cases the Deputies raise today to ask who are the people who still cannot afford the healthcare they need. We must constantly review our eligibility to support them.