The ICGP warns of dangerous and unintended consequences of the 2014 health budget

The Irish College of General Practitioners (ICGP) issued a warning today (16 October 2014) that several aspects of yesterday's health budget have the potential to cause significant distress to the most vulnerable patients in our society. The College also stated that if the Government is staying on its promise to provide universal access to GP care for all by 2016, then the 2014 Budget is a retrograde step, if one population group is to benefit at the expense of another group in the patient population.

The ICGP is calling on the Government to provide details of the reports or data that the Department of Health used to measure the health outcomes and benefits that universal medical cover for children aged five and under would deliver, and how that compares with the impact of withdrawing medical cover from the over 70s.

Kieran Ryan, CEO of the ICGP, commented:

"Providing universal GP cover for all children aged five and under may seem laudable and a step towards universal cover. However, the other action of withdrawing an estimated 35,000 medical cards from the over 70s is contrary to the expansion of universal health cover. It is, in effect, a withdrawal of cover from a group in our population who already have universal medical cover."

Commenting on the potential for measures in the Budget to have dangerous and unintended consequences, Dr Darach Ó Ciardha, ICGP Spokesperson, said:

"The Minister of Health has missed opportunities in the 2014 Budget to champion the cause for a healthy nation. He has opted not to introduce measures to combat the sale of cheap alcohol, opting instead for only a nominal increase in the price of alcohol. He ignored the ticking time-bomb that is rising obesity levels and, when we know that the evidence for the beneficial effects of exercise is incontrovertible, allocated no more than 0.03% of what is being spent on the overall health budget to the funding of sport in Ireland." 

According to the ICGP, aspects of the Budget which have the potential to cause most distress include:

• The downgrading of 35,000 over 70s medical cards to GP visit only cards. Expecting patients to pay up to €144 per month for their medications risks reduced compliance and the health effects that may ensue.

• The €113 million targeted from savings in the GMS raises the possibility of vulnerable people, particularly those with complex medical conditions, on the borders of eligibility, losing their medical card entitlements. GPs know that the HSE, through the Primary Care Reimbursement Service (PCRS), has become extremely efficient at identifying medical cards that are no longer valid through a patient passing away or another change in circumstance. This level of error is simply not in the system. GPs also know the difficulties that currently exist for patients with existing health needs when seeking to gain a discretionary medical card. GPs now believe that discretionary medical cards will be a thing of the past if this €113 million correction is pursued.

• General practice in Ireland, properly resourced, can deliver significant savings for the State, by managing chronic disease and facilitating its move from secondary to primary care. The Irish College of General Practitioners has shown through programmes such as Heartwatch and Diabetes Care, that health outcomes and savings are achieved when chronic disease is managed in the community. The Minister is on record, as recently as this morning, re-affirming the important role general practice can play. Unfortunately, we see no moves, apart from support for counselling in primary care, where hospital budgets are reallocated to facilitate this activity in primary care.

• Increasing the prescription charges for medical card holders from €1.50 per item to €2.50 will affect those on the margins and risks serious compliance issues with medicine. It is a very real possibility that because so many medications are preventative in nature patients may choose to stop taking them. This will inevitably lead to a deterioration over time in the health of these patients. 

Returning to the allocation of medical cards, Dr Ó Ciardha said:

"There is a strong evidence base that the provision of medical cards for our over 70s population had a significant impact on maintaining their wellness and managing health issues. The over 70s patient population has, naturally, greater health needs with multiple co-morbidities and chronic illnesses. Ensuring proper medical access and compliance with medication treatments maintains quality of life and minimises the need for acute hospital care. Irrespective of the statements from the Government, it would appear that the Government is funding the universal cover for children aged five and under by making cuts to another group who already have medical cards. This is a retrograde step for the health of the nation."