Health Services: Motion
Dr. Henry: I thank the Minister for an interesting contribution. I am sure he was as disappointed as Members when the other 200,000 medical cards did not materialise after the last election. I take seriously what Senator Feeney said about the improvement in our economic situation. However, Senator Feighan was right when he mentioned the incredibly low cut-off point for medical cards. It is
€138 gross for single people. PRSI contributions may be taken out, but people at that level are still paying tax. The rate for those over 66 years of age is €151.
I welcomed the introduction of medical cards for those over 70 years of age. However, I said at the time that I thought it would be better if a lower income level was expanded to everyone. Why did the Department not realise that there were 30% more people over 70 years of age than it expected? That was extraordinary. I am glad the Minister is working on the GMS lists now because they must be revised. A sum of €20 a day is a terribly low income level. It is about half the cost of a visit to a doctor. As Senator Feighan said, for a married couple with two children it costs €250 which is appalling. One visit to the doctor costs €35 if one member of the family is ill. There is a huge poverty trap here.
The Minister has pointed out that various allowances are not taken into account such as the carer's allowance, child benefit, domiciliary care allowance, child income, family income supplement and foster care allowance and that there are special groups such as Travellers, the homeless, drug misusers, prisoners, asylum seekers and refugees for whom special latitude is given. There is a certain group who must wish they were not leading such upright lives because they cannot afford to take proper care of themselves and they just exceed the income level. The Irish College of General Practitioners has expressed concern to me about this group, who see doctors less frequently than they should. Often they self-diagnose and self-prescribe. Also they present less frequently for routine checks in the event of chronic illness and do not become involved in preventative health care and health advice which, as the Minister has said, is extremely important. They do not present with social and psychological problems. The longer psychiatric problems remain untreated the more likely they are to be serious. In their report on the stark facts the other day, psychiatrists pointed out it was those from the least affluent backgrounds who had the highest level of psychiatric problems and the least psychiatric services. There is a large group who are losing out badly.
The current level of costs definitely affects those who attend accident and emergency services and the College of General Practitioners supports that claim, as do the accident and emergency consultants. It costs €40 to attend accident and emergency departments and it costs probably less to visit GPs, some of whom charge about €25. However, a large proportion of people do not pay in accident and emergency departments. It is much easier to refuse to pay the anonymous receptionist who has the misfortune of trying to collect the money or the strange doctor whom one is unlikely to see again than one's own GP, whose receptionist may be a neighbour. There is also a problem with people giving false names and addresses in accident and emergency departments when they cannot pay so that they cannot be traced. This is a serious issue which needs to be addressed.
I am pleased that so much more money is being spent on the health services. It is important that a huge amount of that money is spent on well-deserved pay increases for the staff working in the health services, but it is not of much benefit to the group being discussed here. The primary care strategy has been an excellent initiative. I agree with Senator Feeney. It is not just WestDOC that is pleased with the situation. I have not heard people from any of the co-operatives say they were displeased and at the same time single handed practitioners appear to be facilitated. All in all it looks good.
A serious problem which all general practitioners encounter is access to diagnostic services in hospitals and access to physiotherapy, occupational therapy and so on. It would be cost effective if it was possible to reduce the number who have to be referred to a consultant before becoming involved in services such as physiotherapy or have much-needed x-rays.
I noticed in the investigation into all the self-regulatory bodies a suggestion that people should be able to refer themselves directly to specialists in hospital rather than go through general practitioners as at present. Direct access to specialists, as in the United States, has led to its being the most expensive and least efficient health service in the world. It spends well over 14%, possibly 18%, of its GNP on a health service which serves only a certain proportion of the population. There are some aspects of our service which are not bad.
That such progress has been made in the health service over the past 30 years is marvellous. I have been in practice long enough to remember the real two-tier system when there were dispensaries and those who could go to their own general practitioner. It is wonderful that everyone is served by the same people now. The extensions provided for in the primary care strategy are well worthwhile and I support what the Minister is doing. General practice is trying to do what it can in the area of preventative medicine but it is very difficult to get through to the general public that it would benefit. I was fascinated recently at the difficulty in getting people to have their children immunised against measles, mumps and rubella, which is a very safe vaccine.
There are demands that the Minister have smallpox vaccination ready for everyone when the bio-terrorism strikes. America has already had one death as a result of it. We know that three in every million die from vaccinia even in the best of circumstances with smallpox. The New England Journal of Medicine has published several excellent articles saying the United States would be better off if it tried to barrier nurse anyone who got smallpox and to vaccinate those who might be dealing with them. Yet there are those here who say we must be ready to vaccinate everyone against smallpox. What would be the cost to the health service?
I have a certain sympathy with the Minister who is trying to control spending in the right direction, but I suggest there is a group who are not getting the services they need.
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