Health Minister James Reilly has said only 5% of elderly patients will have their full medical cards taken off them under eligibility changes announced with the 2013 Budget.

However, further as yet unspecified cuts to medical card entitlements for other age groups are also due to take place next year and are to be revealed in the HSE's forthcoming 2013 service plan.

The Department of Health told irishhealth.com there are to be changes to the medical card means test next year, but so far no precise details of this have emerged. These are expected to be outlined in the forthcoming HSE service plan for 2013.

The Government had been under pressure from the Troika to tighten up on medical card eligibility.

Minister, Reilly, having promised on coming to office last year that he would abolish the 50 cent medical card prescription charge, has now trebled it to €1.50 per prescription item, subject to a monthly maximum charge of €19.50 per family. This increase has been 'due to the current financial climate'.

Under the over 70s medical card changes, the Minister said 92% of over 70s will still have medical cards, while 5% will no longer have a full card but will qualify for a GP visit card, while the wealthiest 3% will have neither card, which is the same percentage as at present.

Dr Reilly said single over 70s earning €600 to €700 per week will lose their entitlement to a full medical card, while those earning over €700 per week already do not qualify for a card, following the last review of eligibility in 2009. The new thresholds are double for elderly couples.

Elderly people who will be downgraded to a GP visit card will now have to pay drug costs up to €144 per month, following a new rise in the drug payment scheme threshold.

GPs and other professionals providing services under the medical card and other State schemes are to have their fees cut further.

Dr Reilly told a press conference on the health measures in the Budget that €781 million will have to extracted from the health service in savings next year.

By the end of 2013, this will bring the amount cut from the health service in the previous four years to around €3.3 billion. The service is to get €13.626 billion for everyday expenditure next year.

According to the Department of Public Expenditure, this will be reduced to €13.420 billion in 2014, when further health cuts will be required.

However, Dr Reilly said the lesson over the past year had been that by reforming services, more had been done with fewer resources, with inpatient waiting lists and trolley numbers reduced. He admitted, however, that next year would pose great difficulties.

Dr Reilly stressed the need to promote a greater level of generic prescribing. He said there were some drugs that were of the same class that were one-third the price of the other drugs in that class.

There would be legislation and initiatives to promote more generic prescribing.

The biggest chunk of the €781 million savings total is €323 million in primary care scheme savings - this includes the medical card scheme.

The projected savings of €323 million  in primary care schemes will come from:

* A projected €120 million from agreements with the pharmaceutical industry on drug cost cuts.
* A projected €70m from reductions in fees to primary care health professionals.
* €50m from the increase in prescription charges.
* €20m from changes to medical card means test. These are likely to involve no longer disregarding certain income, grants and allowances when calculating eligibility.
* €12m from replacement of medical cards with GP visit cards for persons over 70 in excess of certain income limits.
* €10m from increasing the threshold in the Drugs Payment Scheme.
* €15m from 'delisting' certain products from the medical card scheme.
* €20m from promotion of more cost-effective prescribing practices by GPs and consultants.
* €5m from a reduction in reimbursement prices of oral nutritional supplements.

The remainder of the total €781 million in health service savings will come mainly from  'pay related savings', as yet unspecified but amounting to €308 million; increased generation of private income from public hospitals - a measure that was promised for 2012; a net saving on the Department's vote, and savings in procurement.

Dr Reilly declined to be drawn specifically on what pay savings in health might arise from an extension to the Croke Park Agreement. However, areas such as rostering were being looked at.

Asked what level of cuts in their allocation hospitals might face next year, Minister Reilly said there would be details of hospital allocations in the HSE's service plan when published.

Minister of State at the Department of Health Alex White indicated that the €20 million planned to be spent on primary care staffing this year but which was reallocated to cover the HSE's deficit would be spent next year. However, there is no specific provision for this expenditure in 2013 in the Book of Estimates.

Funding is to be allocated for the initial phase of the planned free GP care scheme for people with certain long-term conditions, Mr White said.

Minister of State Kathleen Lynch said a further €35 million would be spent on mental health services next year. She said all of the €35 million allocated for development of these services in 2012 was not spent.

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