PROVIDING free care to children who tend to be the healthiest in the population in preference to the most vulnerable makes no clinical or economic sense, according to a local doctor.
Dr Michael Harty has questioned a recent government decision, which provides GP care without fees to six and seven year-olds and the basis for further phased extension of GP care without fees to all children 12 years in the coming years.
The new bill also provides for the implementation of an increase in the weekly gross medical card income limits for those aged 70 or older to €550 for individuals and €1,050 for couples.
Dr Harty has pointed out there is no evidence that the general health of patients under six years have had substantial health benefit from being provided with free GP care.
Public health initiatives regarding health diet, exercise and weight control are best delivered through education, public health measures and media campaigns.
The former chairman of the Dáil committee on healthcare recalled Sláintecare proposed that universal care be provided by spending resources for the maximum health benefit for the public good, with the aim of eventually covering the entire population within the constraints of available primary care capacity to deliver this care.
“Providing free care on age grounds makes clinical sense in the older age groups and is being delivered to all patients over 70 years. Patients generally have one or more chronic illnesses in this age group which place higher demands on our health service.
“Investment in primary care in this age group makes perfect clinical sense and will provide substantial savings in managing chronic illness within the community rather than in the far more expensive hospital system.
“Extending free care to those over 65 years of age would bring equal benefit and would continue to make clinical sense and bring maximum benefit.”
He proposed another method of delivering effective free primary care is to provide free care to vulnerable groups with specific needs, illnesses and disabilities, such as those suffering form diabetes, chronic respiratory illness, cardiac failure chronic neurological conditions, and long term disabilities.
These conditions can be adequately managed in the community in the majority of cases preventing unnecessary hospital admissions.
In addition, providing free care to those on limited income makes good economic and clinical sense, thus, lowering the income limits for access to full medical cards and doctor visit cards targets the more financially and medically vulnerable in our society.
“Patients who develop cancer should not have to beg to be provided with free medical care when they are at their lowest ebb, when they are out of work and have financially catastrophic medical expenses. These are the patients who should be prioritised when offering free care.
“It is dishonest, misleading and illusionary to offer increased eligibility and expanded services if the Primary Care Teams and professionals are not in position to deliver on the inevitable increased demand and expectations that free care brings.”
He pointed out general practitioners, primary care teams, public health nurses, community intervention teams, community psychiatric services and home help service are stretched to “breaking point” due to the lack of staff.
“At the moment general practice is facing an obvious manpower crisis that is evident in large urban areas and especially in peripheral towns and villages. Practices lie vacant, never to see a GP again. Others are unable to cope as GPs retire or emigrate. 700 GPs are close to retirement without any hope of replacement.
“Others have so many patients that they are closed to to new applicants. Newly qualified GPs want to work, and work hard. However they do not want to take on the financial and administrative responsibility of owning and running a practice while being expected to provide an increasingly wide range of medical services to a greater number of patients.
“Until there is an increase of numbers of GPs, practice nurses, support staff and other primary care professionals expanding eligibility to any group will destabilise and already unsteady primary care system. This will put increased pressure on out of hours services and eventually on emergency services as patients seek attention where ever it is available,” he stated.
Announcing this decision, former Health Minister Simon Harris described it as an important step on delivering the government’s commitment to ensure affordable access to healthcare for everyone as identified in the Sláintecare Implementation Plan.
He stressed this decision would significantly improve access to GP services for children and provide access to a medical card for an extra 56,000 people over the age of 70.
“Providing a legislative framework to extend free GP care to all primary school children is a significant milestone. It is a key step towards ensuring cost is no longer a barrier to accessing the appropriate healthcare when and where children require it.”
Dan Danaher
East Clare correspondent, Dan Danaher is a journalism graduate of Rathmines and UL. He has won numerous awards for special investigations on health, justice, environment, and reports on news, agriculture, disability, mental health and community.