The health changes in the Budget are not good news for patients and are potentially harmful to older people, writes Dr Muiris HoustonMedical Correspondent
BY ABOLISHING the automatic right to a medical card for people over 70, and moving back to means testing for this age group, the Government can claim they are restoring equity to the GMS system.
However, with just 40 per cent of over 70s likely to retain a full medical card, it means six out of every 10 older people may have difficulty funding the cost of essential medication.
Older people have more illnesses and take more drugs than the rest of the population. Many now face paying €100 every month to ensure a supply of medication for chronic illness. Inevitably, some older people will choose to spend their scarce resources on heat and food and may skimp on their medication. And those who do not qualify for a doctor-only card face the extra cost of paying GP fees for regular check-ups and emergency care.
It has been shown that some patients over the medical card limit avoid attending doctors because of the costs incurred. This non-attendance for regular medical care means that chronic conditions such as heart disease, diabetes and asthma - many complications of which are preventable - are not properly looked after.
The increase in accident and emergency charges to €100 will also impact heavily on those who will now lose their medical cards; calling your GP first in an attempt to avoid the charge may not be an option in an emergency.
Losing a medical card also means you no longer have access to community occupational therapy and physiotherapy, including necessary aids and appliances essential for independence.
While the ringfencing of €15 million for the national cancer control programme is good news, the progress made by Prof Tom Keane in re-establishing trust in our cancer services could now be at risk.
The cancer control programme and the national cancer screening service are to be merged into the Health Service Executive (HSE).
This means that cancer programmes will move from relatively autonomous and well-functioning units to the mire that is the HSE. Decision-making will be slowed significantly by the HSE's over-centralised bureaucracy, with a direct negative effect on cancer patients and their families.
Among other changes, amalgamating the Food Safety Authority of Ireland, the Irish Medicines Board and the
Office of Tobacco Control will only work if the newly created agency has consumer safety, not respective industries, as its priority.
The Government says it will save €100 million following the medical card eligibility changes, but it is likely to cost well in excess of this to treat older people who will become acutely ill because the safety net of chronic care has been taken away from them.
The concept from the 1980s election that health cuts affect the old, the sick and the disabled still applies.
However, this truism seems to have been forgotten under the pressure of financial meltdown.
Changes: how an older person may be affected
A 77-year-old woman, living alone, suffers a stroke, falls and fractures her hip. She is brought straight to the accident and emergency department of her local hospital by a neighbour.
As she no longer has a medical card she is charged the €100 A/E attendance fee.
Following discharge from hospital she must pay €100 per month for regular medication supplied under the drug refund scheme plus the cost of a GP visit.
As she can no longer access community services free of charge, she must pay a physiotherapist to assist her ongoing rehabilitation. For this she will pay in the region of €60 per treatment.
Because of the residual effects of the stroke she also needs to adapt and modify her home. She pays an occupational therapist €200 for this service.
Estimated expenses
A/E charges€100
Drugs Refund Scheme (annual)€1,200
Physiotherapy fee €360
Occupational therapy fee €200
Follow-up GP visit €60
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Total € 1,920
€400 Annual Cash Grant in lieu of medical card
€1,520 = Net cost of healthcare following loss of over-70s medical card.