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
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.