The number of discretionary full medical cards in the system has decreased by one-third since January 2012, new figures have shown.

And around one million people with medical cards will have their entitlement to their cards reviewed this year, according to the HSE.

According to the HSE, there were 74,281 full medical cards issued on a discretionary basis in the system on January 1 2012. However, the number had fallen to only 50,009 by March 1 of this year. A full medical card entitles the holder to free medicines as well as free GP treatment.

However, according to the figures, the number of discretionary GP visit medical cards in the system during the same period increased from 16,251 to 28,301.

There has been much public controversy recently about people with special needs or serious medical conditions having discretionary cards refused, withdrawn or downgraded from full to GP visit status.

In a recent Oireachtas Health Committee response to Fianna Fail Health Spokesperson Billy Kelleher, the HSE stressed that under normal circumstances, qualification for a full card or GP visit card is on the basis of a person's financial means in accordance with the 1970 Health Act.

If an applicant's means are above the set financial limits for a card, the HSE will consider whether the refusal of a card will result in undue financial hardship, and using its discretion the HSE can grant a card in some cases where the applicant circumstances would be such that they could not access GP care without suffering financial hardship.

The HSE has stressed that under the relevant legislation, a medical card cannot be granted purely on the basis of a person's medical condition.

In an interview with irishhealth.com earlier this week, HSE Director General Tony O'Brien said people may have had cards withdrawn or downgraded following reviews as they never did or no longer met the financial hardship test set out in the 1970 legislation.

"I accept that we live in a society that would prefer if we had a medical card system that took medical circumstances into account in a direct way, eg, if you have X or Y medical condition, that will or won't entitle you to a medical card. There is a certain range of medical conditions where there is probably a societal consensus that perhaps that should entitle people to a medical card, but the problem is that is not what the law says."

"The 1970 Act allows me to operate discretion in terms of granting medical cards, but it has to be done on an even-handed, equitable basis so that people in a similar situation are treated in the same way, and for the moment, this financial formulaic approach serves that purpose."

Tony O'Brien admitted this may be a blunderbuss approach, but says the HSE may change how it operates this system to allow it to be more case-sensitive.

He said he had put together a group to examine whether there are methods of exercising discretion which would be equally robust in terms of satisfying the test of good public administration, to see whether he could give directions to enable discretion to be exercised in a different way.

According to the latest HSE figures, the total number of medical cards in the system has increased from 1,694,063  to 1,826, 578 between January 2012 and March 2014.

The HSE says reviews of eligibility status are being conducted on around one million medical card holders this year. It plans to carry out an eligibility review on everyone in the country with a medical card every two years.