Report finds medical card system restricts competition

THE MEDICAL card contract system operating for general practitioners protects them from competition and restricts new entrants, the Competition Authority said yesterday.

In a report on competition among GP practices, the authority said some features of the medical card or General Medical Services (GMS) system have resulted in restricted competition between GP practices.

The report is the third in a three-part series on GPs undertaken by the authority.

Parts one and two, published last year, examined the supply of and demand for GP services in Ireland. Under the system, which is based on a series of agreements between the Department of Health and the Irish Medical Organisation (IMO), qualified GPs have no automatic right to obtain a medical card contract.

Before a decision is made to award a contract in an area “due regard” must be given to the viability of existing GP practices. And the marking system used for selecting who will get a contract gives more points to GPs who already hold contracts.

The report found that the system limits the number of GP practices; it encourages new GPs to operate within existing practices instead of setting up in competition; and reduces competition for both public and private patients.

“The GMS system favours existing GP practices and protects them from competition from newly qualified GPs. This limits the number of GP practices in Ireland,” it said.

It made five recommendations, including that access to medical card contracts should be opened up to all qualified GPs.

It also said that GPs in possession of such contracts should be free to set up in, or move to, the location of their choice.

And decisions to award a contract in a particular area should not have to take account of the viability of GPs already practising in that area.

The report said payments to GPs should not be decided on the basis of agreement with the IMO, which was against competition law.

Such decisions should be taken by the Minister for Health, following consultation with GPs and the IMO, if desired.

The proposed changes to the medical card system would lead to improved choice and quality of service for both private and public patients, as well as helping the State to secure value for money, the report found.

Chairman of the authority Declan Purcell said the proposals represented a “win-win-win” situation.

“Patients, newly qualified GPs and the State can benefit from these changes,” he said.

The IMO broadly welcomed the report. It said many of the changes and recommendations had either begun or were in progress.

But IMO vice-president and GP chairman Dr Ronan Boland said criticism of the decisions on payment agreements for GPs was “no longer valid”.

He said as part of the Croke Park deal, the most recent public service agreement, the Government said discussions would take place with the IMO regarding commitments to make appropriate changes to the Competition Act 2002 to enable the IMO to represent its members in negotiations.