Medical card cutback


Sir, – I had a patient this week whose financial circumstances have recently deteriorated; this month his medical card has been replaced with a doctor visit card, requiring him to pay for all his medication.

This 58-year-old male smoker’s significant medical history includes a diagnosis of long-standing metabolic syndrome: truncal obesity, high blood pressure on 24-hour assessment, borderline diabetes, high bad cholesterol and fats and low good cholesterol (both 24 hour blood pressure assessment and blood testing were performed here at the surgery), mixed alcohol and fatty liver disease and emphysema.

The lifestyle changes I have encouraged him to make along with the medications I have prescribed for his blood pressure and lipid profile alone over the last few years have reduced the absolute risk of him experiencing an adverse cardiovascular event over the next 10 years by 25 per cent relative to pre-intensive monitoring and treatment (risk reduction from 41 per cent to 16 per cent), and reduced his absolute increase risk of death by 8 per cent (change from 11.5 per cent to 3.5 per cent).

I have assessed that his changed medical card status at current rates will cost him €15,840 over the next 10 years, which he cannot afford to pay, therefore he will not take his medication. This non-compliance with medication will expose a risk to the State of potential costs associated with his greatly increased possibility of hospitalisation.

Hospital or nursing home costs will obviously be much greater than having to pay the full costs of his medication and the annual GMS capitation fee of €113.91 plus nominal practice support costs that I receive for looking after him.

This is a classic example of what GPs are confronted with on a daily basis where there has been no cost benefit analysis or systems thinking performed on administrative changes. My patient finds this very stressful and I find it very frustrating, as I send off another letter promoting his case for a full medical card.

The reason for writing to The Irish Times is because I find dealing directly with the HSE is less productive than I would wish it to be. – Yours, etc,


Cromwellsfort Road,

Walkinstown, Dublin 12.