The harsh reality for some non-medical card holders is that GP fees are beyond their means, writes Éibhir Mulqueen
The Irish Medical Organisation (IMO) has accused the Government of engaging in "smokescreen PR" by compelling GPs to display their consultation prices in their surgeries.
The Tánaiste, Ms Mary Harney, is expected to sign an order later this month requiring GPs and dentists to display their consultation charges. "The Tánaiste is in discussions with the doctors and dentists' groups with a view to finalising something in the next few weeks," a spokeswoman said.
Dr James Reilly, vice-president of the IMO, which represents GP interests, said the organisation had no problem with the issue of displaying prices.
"We think it is a good idea. It may focus people on what it costs to do x, y and z. There is no way an exhaustive list can be put up."
But there was a concern, he said, that Government ministers, particularly Ms Harney and the Minister for Justice, Mr McDowell, had no expertise in the area of primary care.
"Instead of delivering on election promises to provide 200,000 medical cards on a means-tested basis, they are pursuing this smokescreen PR."
He said the Government had reneged on its promise to make primary healthcare more accessible through the medical card scheme. "The reality is there are many people out there who cannot afford to go to their GP."
This belief is repeated by many GPs throughout the State. Dr Anne Lynott works at the Ballymun Health Centre in Dublin where a consultation fee is €30.
"We are coming across people more and more who cannot afford healthcare. We feel it has got worse. It seems to me that people are getting penalised. They are trying, they are getting jobs, then they are just over the limit and their medical cards are taken from them. They cannot afford to pay GP and prescription charges."
Dr Lynott is a member of Doctors in Support of their Communities (DISC), which is fighting for primary healthcare improvements. "People are losing their medical cards because the threshold is too low, and people trying to get back into the workplace are being penalised," she said.
Dr Brian Coffey, a GP in Cathedral Road, Cork, where the consultation fee is €35, says about 50 per cent of that fee goes on expenses. "Those fees we feel are uneconomical but because of the area we feel it is unfair to charge much more.
"At the moment, it is definitely iniquitous. We are very aware that people marginally above the medical card limit find the fees quite high.
"If you have to see patients for follow-up, my own policy is to charge a much reduced fee. Occasionally we waive the fee."
Dr Gerald Wheeler, a Co Clare GP based in Ennistymon, charges €28, the lowest consultation chargeencountered during an informal telephone survey carried out by The Irish Times. He says prices are a guideline rather than something to be rigorously enforced.
"Sometimes people fall on hard times and you think they should have a medical card. But they do not and you might reduce the charge.
"There is a huge body of people just over the limit of the medical card who are not terribly well off, for whom a major output to the doctor or the pharmacist is a significant part of their weekly income. I think they are the ones who are vulnerable to doctors' fees."
Dr Wheeler gave a hypothetical example of a patient with a badly paid job and four children. If one of the family becomes ill and has to see a doctor four times in three weeks, he said, the fee - plus prescription - are expenses that would have to be considered.
Mr Stephen McMahon, of the Irish Patients' Association, says families on €300 a week would find a doctor's bill of €40 and a medicine charge of €30 "a huge hit".
"This problem has to be addressed. It is a false economy if patients put off a visit because they cannot afford it. When they are really ill, they will cost the system a lot more than the few hundred euro capitation that is paid on behalf as a medical card holder."
GP costs vary in Dublin and around the State, and many practitioners believe a system for displaying prices will not be a major issue. However, many GPs vary their charges, depending on the length of time of the consultation or whether it is a repeat visit. If a mother has sick children, GPs will sometimes waive the charge for the extra heads.
One mother in Limerick told The Irish Times she immediately changed her GP - whom she had attended for 10 years - when, having brought her two children to the surgery with the same illness, she was charged for the second child.
"I felt it was disgraceful that I could go in there with two children, that a consultation should last seven or eight minutes and that he should charge me time and a half because there were two children that needed to see him," she said.
A spokesman for Ms Harney has said the IMO comments, accusing her of smokescreen PR, appeared ironic given that the purpose of the measure was to introduce more transparency into GP fees. "It is about transparency and it is a long, long way from smokescreen PR," he added.