A major revamp of the system under which medical cards are granted and processed has been announced by Health Minister Leo Varadkar and his Minister of State Kathleen Lynch.

It was announced today that the HSE is undertaking 10 actions to improve the operation of the medical card system, particularly for people with significant medical needs, in the wake of the recent controversy over the cutting back of discretionary medical cards.

Plans by previous Health Minister James Reilly to allow medical need to be included in the criteria for granting medical cards have now been abandoned due to the complexities involved in listing eligible conditions.

The revamped system continues the practice of granting cards based on means, but is designed to be more sensitive to people's medical needs and individual circumstances in deciding on eligibility.

These reforms to the system are:

· An enhanced assessment process, which will take into account the burden of a person's illness or a condition when applying for a medical card.
· A greater exchange of information between the medical card central assessment office and the local health offices.
· People with a serious illness who hold a discretionary card are being reassured that they will retain their card pending implementation of the actions to improve the operation of the scheme.
· The power of GPs to extend the validity period of medical cards in difficult circumstances will be strengthened.
· A clinical advisory group is being established by the HSE to develop guidance on assessing applications involving serious medical conditions.
· The default position' for medical cards given to people with terminal illnesses is that they will no longer be reviewed.
· The HSE will be empowered to provide people with therapies or appliances if that is what they need, even in the absence of a medical card;
· The HSE will develop a single, integrated process for people to apply for a medical card, a GP visit card, the
Long-Term Illness scheme, and the Drugs Payment Scheme;
· Access points will be established around the country in health offices to support and assist people to make applications.
· The Department and the HSE will consider the best way to make medical aids and appliances available to persons who do not hold a medical card, the provision of services to children with severe disabilities, and to enable people with particular needs to have these met on an individual basis rather than awarding a medical card to all family members.

Announcing the changes, Health Minister Leo Varadkar said Minister Varadkar the medical card controversy of last summer required the Government to reconsider how the whole system works.

"Having done so...we have concluded that a financial means-test remains the fairest way to assess eligibility. But we also need an enhanced assessment process which takes into account the burden of an illness or a condition. From now on, wider discretion and greater humanity will be exercised in such cases," the Minister said.

In the longer term, the Minister indicated that anomalies and difficulties associated with card eligibility will ultimately be removed by free GP care and universal healthcare.

The new measures are based on recommendations set out in two reports which were also published today - the report of the Expert Panel on Medical Need for Medical Card Eligibility, and the external review of the Medical Card Process, undertaken by Prospectus and Deloitte.

After consulting with patient advocacy groups, the Expert Panel recommended that a person's means should remain the main qualifier for a medical card, and concluded it would not feasible, desirable, nor ethically justifiable to list medical conditions in priority order as a means of determining medical card eligibility.

"The more that I have studied the issue of eligibility for medical cards, the more I have become convinced that the only solution is universal health care," Minister Varadkar said.

"No matter what means-test you apply, whether financial or medical, there will always anomalies and there will always be people just above the threshold. However, I am convinced that this new system will be fairer and more humane than the one it is replacing." 

The HSE said it would consult with the IMO to encourage and support the use by GPs of the facility to temporarily extend the validity of discretionary medical cards 'where sensitive renewal is appropriate'.

A clinical advisory group is to be established by the HSE to develop guidance on assessing applications involving significant medical conditions so as to take account of the burden involved and the needs arising from the condition and to ensure that appropriate services are provided to people who need them. 

The IMO gave a 'cautious welcome' to the reforms.  

It said the package announced today accepted the important role of 'discretion' in relation to granting medical cards and this was an acknowledgement by the Government that it had 'got it wrong' when they tried to remove discretion from the process in the first place.

IMO GPO Chairman Dr Ray Walley pointed out the difficulty that would be faced in seeking to withdraw discretionary cards from people who currently have them.

"It is extremely difficult to withdraw a medical benefit that people currently enjoy and I would urge the Government to think very long and hard before they seek to terminate any existing medical card."