Medical card allocation never a simple procedure

There is no automatic entitlement to a card in cases of specific illness

People taking part in a protest on medical cards for those aged 70 and over, outside Leinster House, yesterday. Photograph: Eric Luke

People taking part in a protest on medical cards for those aged 70 and over, outside Leinster House, yesterday. Photograph: Eric Luke


Controversy over medical cards has dogged Minister for Health James Reilly, his department and the Health Service Executive over recent months. There have been widespread claims of medical cards being refused, and even taken away, from deserving cases. The Minister and health officials have stressed no regulations have been changed this year, and have pointed out that the number of cards issued continues to rise.

So who is telling the truth? How many medical cards are out there? And what do you get if you have a card?

The first thing to note is the term “medical card” is something of a misnomer because, although it provides the bearer with access to a range of medical services, the card is generally allocated on financial grounds rather than illness.

This was outlined in the Health Act 1970, which says that the assessment for a card is determined by reference to the means, including income and expenditure, of a person and their partner or dependants. There is, as the Minister never tires of repeating, no automatic entitlement to a card in cases of specific illness. (Here, as almost everywhere to do with medical cards, there are exceptions: thalidomide and symphysiotomy victims qualify automatically.)

35-page guideline
The HSE’s guide to medical card entitlement runs to 35 pages, but the core rule is that people must qualify for a card on income grounds. The threshold for a single person under 65 living alone is €184 a week, but all sorts of other factors are then taken into account – savings, mortgage payments, childcare costs, travel-to-work expenses, etc.

The thresholds for people over 65 are higher, and far higher for over-70s, though the latter have been reduced in recent budgets.

The threshold for a GP visit card, which provides for free doctor visits but none of the other benefits, is 50 per cent higher than for full medical cards.

Almost two million people, or 43 per cent of the population, are covered by either a medical card or a GP visit card. The number of cards has increased by 74 per cent since 2005. That sounds impressive but most of the increase is driven by growing unemployment and an ageing society. In fact, the HSE has issued almost 200,000 fewer cards than it anticipated this year.

In 2011, the processing of applications was moved to a central department and away from local health offices. The HSE says discretion is now applied “equitably and consistently” by medical officers, but the question is whether the bar is being set too high for people to qualify, or whether it was set too low previously in some areas.

Cards are normally issued for three years, but some lucky people were given cards for up to 20 years when processing was done locally. Out of two million cardholders, just 22 people contacted the HSE last year to surrender cards because their circumstances had changed.

The rules for qualifying for a card were tightened in last year’s budget, by disallowing the first €50 of travel-to-work costs and the cost of serving home improvement loans when assessing eligibility.

The HSE points out there is only one medical card, which is technically correct. However, there are several routes by which a person who does not qualify on income grounds can acquire a card following undue hardship caused by medical or social circumstances.

A card can be issued on a discretionary basis. A variety of factors are taken into account, including illness resulting in financial hardship; the cost of providing medicines and related items; the cost of treatment; transport costs to hospitals; addictions such as drink, drugs or gambling; and “social deprivation”.

Many individual, hard-luck cases have been raised in recent months where a person has lost a card despite serious adversity. Some can be explained on income grounds, others not. It seems clear from what doctors say that some applicants are being sunk by excessive bureaucracy, while in other cases income assessments are being inflated by, for example, over-calculating the rate of interest on savings.

Terminal illness
Medical cards are also issued in emergency circumstances for six months, on foot of information from a doctor or consultant. Finally, the HSE also issues cards to patients with a terminal illness. No means test applies here.

A medical card also entitles the bearer to other State services, including a small maternity cash grant, exemption from school transport charges and State exam fees, and help with buying schoolbooks.