Medical card theory clashes with reality

Analysis: HSE says allocation has not changed but many on the ground disagree

Karl Hughes, who has Motor Neurone Disease: “I can’t understand how they would hit the most vulnerable.” Photograph: Aidan Crawley

Karl Hughes, who has Motor Neurone Disease: “I can’t understand how they would hit the most vulnerable.” Photograph: Aidan Crawley


For months now the air in radio phone-in shows and in politicians’ constituency offices has been thickening with claims by people that they can’t get a medical card in spite of serious, even terminal, illness.

Some even say they have had their cards taken away, or can’t get them renewed, despite suffering degenerative conditions.

These claims have been met with flat denials by the Government and health bosses, who say that there has been no change to the guidelines for the allocation of medical cards.

Not for the first time in the health sector, the gap between the reality on the ground, and what those running the service have to say, appears enormous. As with other controversies in health, it is difficult to get to the bottom of the welter of allegation and counter-allegation.

Medical cards have always been allocated on the basis of means, not medical need, which might surprise many people. The overall number of cards continues to rise due to greater unemployment.

The total is set to reach almost two million by the end of the year.

Where people’s income is too high, the Health Service Executive must consider whether refusing a card would result in undue hardship, and has discretion to grant one.

Issues such as medical circumstances, transport costs to hospital, addictions and “poor money management” are taken into account, and a variety of people are consulted, including doctors and social workers.

For patients with terminal conditions, the HSE says emergency cards are issued on foot of a diagnosis within 24 hours.

Patients are supposed to apply for full cards within weeks of getting an emergency card, which is valid for six months.

That’s the theory. What actually happens depends on who you talk to.

The Irish Motor Neurone Disease Association says discretionary and emergency cards are not being given to members with the condition, which is terminal.

Chief executive Aisling Farrell says it has tried many avenues to get answers but the HSE medical card department is “not contactable”.

Neurologist Orla Hardiman, who deals with most motor neurone patients in the country, has rubbished the HSE’s claim that it provides emergency cards to terminally ill patients within 24 hours as “simply untrue”.

Backbench Fianna Fáil TD Niall Collins says he deals weekly with constituents who have been refused cards, or who have lost them in a review process.

“It seems like everyone is going through a review now and you almost have to be terminal to get a card.”

He has also noted an increase in the amount of documentation required to get a card.

Before, a GP’s note might have sufficed but now a letter from a consultant is required, and this can lead to long delays in completing applications from those in the public system.

In contrast, the Irish Cancer Society says it is satisfied with the assurances given by Dr James Reilly and the HSE on the issue.

“We’re sought assurances and for now we’re happy with what the Minister is saying,” says a spokeswoman.

She attributes a rise in calls to the society’s helpline to a misunderstanding by some cancer patients in relation their entitlement. “There is no automatic entitlement to a card if you have cancer, and there never was,” she says.

Under the old health system, discretionary cards were decided by the chief executive of the local health board, but Reilly says he has asked the HSE to tackle the problem by establishing “an architecture to make certain that discretionary cards are properly and effectively handled”.

A panel of doctors is involved in making decisions to ensure medical needs are fully understood, he says.

Curiously, while the overall number of medical cards is rising, the number of discretionary cards has fallen, from 74,000 in 2011 to 63,000 last year and 56,000 this year.

The Government announced in last December’s budget that it was taking medical cards from 40,000 people.

Half of this was accounted for by changes in the income thresholds for over-70s, but it hasn’t explained where the rest of the savings were to come from.

The figures would appear to point to a squeeze on the number of discretionary cards, but just how this squeeze is being applied remains unclear.

Case history: Karl Hughes
Karl Hughes, from Sandyford in south Co Dublin, was diagnosed with motor neuron disease in February 2010, a month before the late RTÉ broadcaster Colm Murray was diagnosed with the condition.

He was granted an emergency medical card last year, which was invaluable, not just for his medical needs but also for other services such as occupational therapy, the adaptation of his house to his reduced mobility and the supply of equipment such as the breathing apparatus he uses at night.

However, last December he found the card had expired when he went to a local pharmacist for his medicine supplies. Since then he has had to pay for his own medicine, up to a maximum of €144 a month.

“I can’t understand how they would hit the most vulnerable,” he said, referring to the loss of his medical card. “It’s terrible when something like this happens and you don’t expect it.”

He asked the HSE why it hadn’t informed him in advance that the card was going to expire. It replied that a letter was sent to him; but it appears to have gone astray. He says he will apply again for a card, though he’ll have to pay for his medical needs until one is issued.

In the three years since his diagnosis, his condition has deteriorated and his speech is now slurred. Ironically, he may qualify for a medical card in the normal way, on income grounds alone. He used to work in IT but now passes the time at home, where he lives alone.

Like many people in his situation, he spent much of the time after receiving his diagnosis coming to terms with the shock involved in learning he was seriously ill, rather than attending to the niceties of medical card application.