Rationing health care


The announcement by Minister for Health James Reilly that he hopes to introduce free GP care for children under-five is something of a curate’s egg. As part of a phased introduction of free primary care, it is a welcome step; however the Cabinet, which has yet to approve the decision, may wish to reflect on whether the proposal is either a logical or politically sensitive one. Costing €40 million at a time when healthcare rationing is being allowed trump patient need, it is not unreasonable to ask if the announcement of free care to one sector is no more than a political fig leaf designed to paper over the ever-widening gaps in existing services.

In recent months people with cancer heard they could be denied medical cards with one official suggesting a patient’s cancer must have entered the terminal phase before the State would provide the support most people require to remove financial and other social factors as a source of worry when facing a cancer diagnosis. Despite the Taoiseach’s denial of a policy change, ad hoc rationing of free medical care for some cancer patients continues.

Given the target group for Dr Reilly’s announcement last week, it is especially ironic that a similar rationing of medical cards is being inflicted on young children with disabilities. There is anecdotal evidence that children facing lifelong illnesses, for example those with cardiac conditions, infants who require tube-feeding, and children requiring full-time nursing care, are having their medical cards revoked. For patients with illnesses they can never “grow out of”, such rationing is, at the very least, illogical.

At a practical level, not only have the State’s GPs not been consulted about implementing the under fives policy, but as a group they find themselves unable to provide existing services for patients following a series of cutbacks in patient-care grants. And while most will be well disposed towards expanding child development diagnostic services, they must be provided with the resources to provide those services effectively and safely.

Writing in this newspaper in June, Dr Reilly said: “We can and must give the Irish people the kind of patient-centred health service that they both need and deserve.” Acknowledging the reality of rising costs and reduced resources he said there were only two possible responses: “Either large-scale rationing of healthcare, which is socially divisive and economically damaging, or radical reform of the way in which healthcare is delivered.”

Introducing free medical care for children under five may represent the beginning of reform, but both the Minister and the Cabinet must address the socially-divisive rationing by stealth being operated by the Health Service Executive at present. It is a matter that requires the most urgent remedial action.