The American comedian Jackie Mason was once noted to remark, “I have enough money to last me the rest of my life, unless I buy something.” Mason was not alone in valuing his financial security. In the “current economic climate” (to use the much-hackneyed phrase), we have all become more aware of counting the pennies when it matters. But not all penny-pinching is necessarily cost-effective.

For example, if I were to announce to readers that I plan to park on Blackrock Main Street every lunchtime from now on without feeding the parking meter, I might elicit sombre nods of encouragement from readers over my parsimonious display of modest rebellion. After all, who among us is not irritated by having to search our pockets, bags and car ashtrays for spare coins to spend on “pay and display” stickers? More importantly, why should we be expected to shell out our hard-earned cash when we receive nothing in return other than the privilege of being left alone?

Alas, readers familiar with Blackrock village will know that traffic wardens tend to patrol the Main Street parking zones like the Russian security regiment patrols the Kremlin, possibly in similar numbers and all keenly on the lookout for dissenters who refuse to obey the rules. To park one’s car each day without forking out a few loose coins leaves one liable to inevitable fines of E80 or more. It simply isn’t cost-effective. Yet this is precisely what the Department of Health decided to do.

No, they didn’t decide to park their cars on Blackrock Main Street without paying. Instead, they made the decision to begin charging Medical Card holders for their prescriptions from late 2010. This affects many of our most vulnerable psychiatric patients. They now pay 50 cent per prescription item, per month, per person (or per family if they are organised enough to acquire a “family certificate”), up to a maximum of E10 per month or E120 per year. Admittedly, not many people are prescribed 20 items, but it is easy to see how a family with hereditary psychiatric illness might collectively reach this number.

There is comprehensive and widespread research evidence to suggest that medication adherence among psychiatric patients is poor. This is largely due to a combination of poor insight, negative attitudes to treatment and side-effects of the medications themselves. The outcome of such non-adherence is all too frequently relapse yet, until recently, a vital and mitigating incentive for our patients to take their medication was that at least it didn’t cost them anything. Our new prescription charge now represents a further disincentive to patients who are already acquiescent at best.  

The Department of Health would, no doubt, argue that earning up to E120 per patient or family contributes significantly to the cost of delivering healthcare at a time when our health budget is under considerable strain. But is this really true? Admittedly, I have scribbled my calculations on the back of an envelope but, as far as I can see, the health service budget is enhanced to the tune of just E12,000 for every 100 psychiatric patients with medical cards who pay the maximum annual charge of E120. Presumably most pay less than this amount and thus the net yield falls considerably short of this sum. Yet it still represents a lot of money to the impecunious and vulnerable in society. 

More important is the presumed effect of this charge on adherence. Is it just me or are we – nearly two years down the road – experiencing a surge in public psychiatric admissions? For the sake of argument, let’s say one night in hospital costs E500, give or take the small change. The average length of stay, meanwhile, is 26 days, according to a 2010 report by the Health Research Board. Simple arithmetic (again, on the back of an envelope) reveals that each relapse costs the state E13,000, which means that, even if only one per 100 patients stops taking his or her medication and thus relapses as a result of the prescription charge, the state stands to make a E1,000 loss per 100 patients who fall under the new scheme.

Let’s ignore, for a moment, the terrible human cost of relapse. Instead let us ask, how would a financial loss of E1,000 per 100 patients to be covered by the health service? Would it be taken from other patient services? Or would the health service simply refuse to admit acutely unwell patients beyond an agreed cap? We might sigh out loud at the repercussions of an ill-conceived charge but at least there is one consolation: I now know I should simply inform my local traffic warden that I have a fixed budget for parking fines.