Extension of free medical services
The Minister rejected making all health services free, citing the cost, but said major services would be extended to the whole population from April 1979. Members questioned the fairness of the means test and the equivalence of the £60 farm valuation across regions; the Minister acknowledged disparities but defended the existing measure. General practitioner and consultant services would remain exceptions, with an improved VHI scheme intended to cover costs.
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
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
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
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
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.