The Government's primary care strategy announced yesterday presents an exciting vision of comprehensive health care delivered at community level. This is a radical and ambitious document and offers a picture of what a modern health care system could deliver to the community, in contrast to the "patchy" and "overloaded" system which officials of the Department of Health described to the cabinet at Ballyamscanlon last May.
Progressive health care systems around the world are placing more and more emphasis on primary care because it has become increasingly apparent that it is at the level of prevention in the community that the greatest gains in health can be made.
Investment in primary care could pay dividends in less illness, longer life expectancy and much reduced demands on the acute hospital sector. For all these reasons the Government's new strategy is to be welcomed.
It is all the more disappointing, therefore, that a question mark remains over the Government's commitment to the vision which it paints. It emerged yesterday that the Government does not intend to extend eligibility for medical cards until 2003 at the earliest. In a year which saw the extension of medical cards to all 70-year-olds, whatever their income, this is nothing short of scandalous.
Medical practitioners and the Society of the St Vincent de Paul have testified that people above the income threshold for medical cards are failing to attend their doctor when they need to do so. Even an earlier draft of the Government's own strategy previously reported on in this newspaper makes the same point and argues for universal eligibility for primary care.
The Irish Medical Organisation believes that 250,000 people cannot now afford treatment. The IMO yesterday described any decision to delay the extension of medical card eligibility as unacceptable and suggested this would "undermine the health strategy's guiding principles of equity, access and fairness". It is hard to argue with this assessment. To unveil a multi-billion pound health strategy and, in the same week, implicitly accept that many citizens will face continued financial barriers in getting to the first point of contact with the health service represents an extraordinary ordering of priorities. Since the Government is unwilling to extend access to GP services even on the eve of an election, its belief in the importance of primary care remains questionable.
What political reasoning lies behind this decision? It is tempting to see the hand of the Minister for Finance, Mr McCreevy, but perhaps the motive is electoral. Has the Government taken the view that the length of hospital waiting lists will decide the outcome of the election, whereas if it were to extend eligibility to GP services, it might uncap unmet demand and create GP waiting lists? Scattering hospital beds across constituencies may be a more appealing use of funds.
This Government has little time left to convince that it has any true concern for the poor. After years of tax cuts which have benefited the better off, the Government is by no means guaranteeing that it will remove all minimum wage earners from the tax net in the next Budget, it emerged in an interview with the Tβnaiste this week. It now appears that minimum wage-earners will also continue to pay for their GP visits.