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Dáil

Ceisteanna—Questions. Oral Answers. - Free Medical Service.

asked the Minister for Health the examination, if any, under way of the feasibility of providing health services that are free of charge for everyone; and whether the implementation of the scheme for the extension of the present limited eligibility scheme to the entire population has been decided upon.

Comment on this

The question of providing health services free of charge to all sections of the community has been examined by my Department. I do not think that the considerable cost involved in this extension of entitlement to services would be justified by the need for such a development.

It has been decided to extend to the entire population, with effect from April 1979 the major services which are now available to persons with limited eligibility. The services being made available to persons in the upper income group include: (a) the full range of hospital in-patient services at public ward level, free of charge except for the charges to be made by hospital consultants; (b) subsidies towards the cost of private or semi-private accommodation; (c) specialist diagnostic and treatment services on an out-patient basis in public hospitals, subject to the patients being responsible for payments to the consultants concerned; (d) refund of part of the cost of prescribed medicines.

Comment on this

Is it not a fact that one of the best arguments in favour of the extension of the health service to the entire population is, as the Minister said in his reply to Question No. 21, that where there is a means test, it eventually comes to the stage where it is impossible to exercise it in a just way, because there are unavoidable anomalies in the number and kind of people who become eligible? The eight categories is a typical example of the impossibility of implementing the scheme.

Comment on this

The categories are being reduced to two. They will be very simple categories. In future the two simple straightforward categories will cover all farmers with a valuation of £60 or less, and persons with an income of £5,000.

Comment on this

But there is no general medical practitioner service.

Comment on this

As I said, the general medical practitioner service is administered on the basis of uniform guidelines which are applied throughout the country and there is also the provision that in any case of hardship the chief executive officer has authority to deal with it.

Comment on this

That is the red ticket system.

Comment on this

Is the £60 valuation on a par with £5,000 uniformly throughout the country?

Comment on this

Yes, that is probably the criteria we would adopt, that £60 valuation and £5,000 would be equivalent.

Comment on this

Does the Minister think that £60 valuation is on a par with £5,000, or is uniform; for example, in such areas as Munster would he think a £60 valuation is on a par with £5,000 in Dublin?

Comment on this

That is a question really for the statisticians and economists.

Comment on this

Has the Minister considered having a study carried out into that because the same limit applies for medical cards?

Comment on this

At present the £60 poor law valuation has been settled on for some considerable time——

Comment on this

For many years.

Comment on this

In fact, it was £50 until I increased it when I was Minister for Agriculture some years ago. It has been at £60 for some considerable time now and that has been regarded as the level below which it is reasonable to provide a certain level of services free for farmers.

Comment on this

Would the Minister consider that £60 valuation in Munster is the equivalent of £60 valuation in, say, Connacht or Ulster? There is a case in point. Would he consider £60 in Munster the same as £60 in Connacht?

Comment on this

I am aware of the fact that there are infinite variations between the levels of income which a farmer of £60 valuation will have in different parts of the country.

Comment on this

In view of that great disparity in incomes as a result of the same £60 valuation being applied would the Minister not think it worth while now having a study and perhaps coming up with some more equitable system that would ensure eligibility?

Comment on this

Right through the whole public service that question presents itself and I do not think it has ever been resolved. I think most Ministers who tried to deal with this situation sought around for some alternative system, but in the end they always came back to the PLV which, with all its faults and variations, is at least a readymade and available system.

Comment on this

In view of the fact that eligibility for health services is at stake and that so many people are being deprived of health services in various areas, and others with very considerable income——

Comment on this

I do not think this question will be of all that great significance in the future. As and from April next anybody in the community will have, in effect, all their services free, except the cost of their consultants.

Comment on this

And the general practitioner services.

Comment on this

And the Voluntary Health Insurance Board are going to provide a much improved scheme which will enable even those who will not have limited eligibility in the future to have the services required at very little cost.

Comment on this