Report criticises HSE medical card review

The vast majority of medical card holders should have their cards renewed automatically, without the need for a review, according to a report from the Dáil Public Accounts Committee.

The Health Service Executive should rely on risk profiling and random audits, rather than large-scale reviews of all card holders, to detect people who may no longer have an entitlement, it recommends.

The committee complied the report in response to the controversy that arose over the ongoing review of almost 1 million cards by the HSE since 2012.

The Government halted the review of discretionary cards earlier this year after widespread reports this was resulting in the removal of medical cards from seriously ill patients.

The committee says given the anxiety arising from the review process, the HSE should review its communication strategy and engage in a public awareness campaign to coincide with any further reviews.

It should also review its control measures so most resources are devoted to checks during the initial award of a medical card and to “focused” reviews.

Those card holders who have a high risk profile should be priorities for a review, while the 80 per cent plus of card holders whose eligibility is in little doubt because of their low risk profile should have their cards extended automatically.

“More work needs to be done on risk profiling so that compliant card holders are not subject to extensive review, which is a waste of money given the known level of eligibility in the system,” said committee chairman, Fianna Fáil TD John McGuinness.

Risk profiling was now possible, he pointed out, because information can be shared with the Revenue Commissioners and Department of Social Protection and because the HSE has a centralised database with details of almost 2 million card holders.

“The other key issue to be addressed relates to the need for better systems of communication between the HSE and card holders so reviews do not end up frightening people into thinking a review equates to them losing entitlement to a card.”

However, it may be an ineffective use of HSE resources to subject the vast majority of card holders to the rigorous assessment involved in a review.

The report says there is a “material level of excess expenditure” on medical cards that needs to be addressed. In addition, a “culture” has developed where cards are not surrendered after entitlement ends.

This may be because there is no risk of being prosecuted and because the card also gives entitlement to free school transport and other, non-health benefits.

The committee also recommends the HSE review its customer care practices so complex cases are dealt with by a specific team and the card holder can deal with one official as the case manager.