Cabinet agrees measures to tackle medical card controversy

New system envisages greater use of ‘discretion and humanity’ in certain cases

Under new measures, greater account will have to be taken of the medical costs of a person’s condition where medical cards are being assessed.

Under new measures, greater account will have to be taken of the medical costs of a person’s condition where medical cards are being assessed.


The Cabinet has agreed a package of measures designed to put to bed the controversy over discretionary medical cards that dogged the Government parties earlier in the year.

The new approach includes a return to local assessment of some discretionary medical cards, the removal of the requirement for people with terminal illnesses to renew their cards every 12 months and improvements to the way the Health Service Executive processes applications to make the system more humane and compassionate.

Minister for Health Leo Varadkar and Minister of State for Primary Care Kathleen Lynch will publish the full details next week after briefing patient and other health groups. They will also publish the Keane report on awarding medical cards on the basis of medical need and a Prospectus report on the processing of medical cards by the HSE.

They are expected to announce an internal re-organisation of the HSE to separate the Primary Care Reimbursement Service (PCRS) into two sections, one for payments to medical professionals and another for the processing of medical cards.

A person’s financial means will remain as the main criterion for assessing eligibility for a medical card under the “general approach” agreed by Cabinet, but the new system envisages the greater use of “discretion and humanity” in certain cases.

Decisions on awarding cards on a discretionary basis will be on the basis of a person’s medical condition and needs rather than on the basis of a list of specific medical conditions. The latter approach was suggested by former Minister for Health James Reilly but ruled out an unfeasible by the expert advisory group he set up to examine the issue, which was chaired by Prof Frank Keane.

The approach now will be to draw up guidelines for measuring and assessing “medical hardship” and “the burden of a disease” when awarding a medical card to someone with a medical condition or disease. The HSE is currently recruiting members of a clinical advisory group which will be appointed to develop this methodology and relevant guidelines.

Where medical cards are being assessed, even in situations where a person is well above the income threshold, greater account will have to be taken of the medical costs of their condition than up to now.

The processing of medical cards was centralised in 2012 in order, the HSE said, to bring greater uniformity around decisions on the award of cards. However, the new centralised system was criticised for excessive bureaucracy and form-filling and was accused of heartlessness in a number of prominent cases in which families with seriously ill members were refused cards or had them taken away.

It is now envisaged that some element of local assessment of an applicant’s needs will take place in addition to the national system of assessment, possible involving the person’s GP or local HSE office. “While national standards will remain in place, the system will be configured to ensure that exceptions are made where appropriate,” said an informed source.

The controversy over the removal of discretionary medical cards escalated in the run-up to the local elections earlier this spring and was widely blamed within Fine Gael and Labour for the parties’ poor performance. Shortly after the election, the Government rowed back by re-instating up to 15,000 discretionary cards which had been removed during HSE reviews in the preceding years.

These reinstated cards will expire again next spring but Government sources were keen to emphasise card-holders have nothing to fear from the latest set of proposals.

The cost of the package of measure was described by the source as “not significant” and no new legislation will be required.