Over 30% of eligible individuals are failing to avail of a medical card and eligible families who do not take up a card are more likely to have an unmet health need due to financial reasons, new research by the ESRI has shown.

Medical cards are means tested and aimed at those on lower incomes or with long-term health conditions. Those with a card receive free primary, community and hospital care, while prescription medications incur a small fee.

Card holders also receive other benefits, such as a reduced rate of the Universal Social Charge and exemptions from state exam fees.

ESRI researchers investigated the proportion of eligible families who do not take up a medical card, possible reasons for this and the potential financial consequences that this can have.

The researchers used data from the CSO’s Survey on Income and Living Conditions to identify take-up within families. They then examined the characteristics of the families who did not take up their entitlement, and they used data from the Household Budget Survey to estimate the financial impact of not taking up a card.

They estimated that 31% of eligible individuals do not take up a medical card. Families with more children, older individuals and adults who suffered with a chronic condition were more likely to take it up.

Families with a high proportion of income from social welfare benefits were also more likely to have a medical card, which may reflect greater awareness of medical cards, or reduced stigma about the cards, among people already receiving benefits.

The researchers noted that take-up was reduced among households where the head of the household had a higher educational attainment or was self-employed. This may reflect higher stigma, or lower awareness of entitlement, among these groups.

They suggested that the self-employed may also face a higher administrative burden, due to the necessity to submit detailed information on their income.

Meanwhile, the research also found that people use medical cards and private health insurance as substitutes for each other. Private health insurance rates increased significantly among those who were slightly over the medical card income threshold. Similarly, eligible families who do not take up a medical card have high rates of insurance.

The researchers said that while this may reflect a preference for private insurance, it may also indicate a lack of awareness of entitlement, as private insurance coverage does not impact medical card eligibility.

Furthermore, families who were eligible for a medical card, but did not take one up, were significantly more likely to report having an unmet health need due to financial reasons. They were also more likely to spend much more on healthcare per annum.

Such families spend an additional €202 annually on healthcare and €489 annually on private health insurance, compared to families who have the card. This equates to over 3% of their average annual income.

According to the researchers, these findings show that non-take-up of medical cards can have “significant negative financial implications for those affected”.

“Given the scheme is aimed at families on lower incomes, this is particularly worrying. Negative effects of forgoing a medical card are likely to be even higher due to reduced medical care use, which may result in poorer health outcomes. ‘

“This research suggests that, in some groups, there may be a lack of awareness of entitlement, potential stigma, and/or large administrative burdens. The expansion of universal healthcare, as proposed by Sláintecare, may help to solve many of the issues of non-take up found in this research,” the ESRI said.