Minister for Health Leo Varadkar has promised to reform the discretionary medical card system after a report called for greater sensitivity in the way cards are allocated.
Mr Varadkar said he would consult with the HSE, the Department of Public Expenditure and the Attorney General before bringing proposals to Cabinet.
The Government-appointed expert panel said financial hardship or means testing should remain the main way of determining eligibility for medical cards in the vast majority of cases.
The current system of allocating medical cards is "not without its merits for the great majority" given that resources are finite, the panel said in a report sent to the Department of Health this week.
However, the awarding of cards on a discretionary basis needs to be handled “with a greater degree of sensitivity”.
The Irish Times has obtained further details of the unpublished report, which says it is “neither feasible nor desirable” to list medical condition in priority order for medical card eligibility “in the absence of international objective and reproducible methods of measuring burden of disease and illness”. This decision was taken unanimously by the 23 members of the expert panel.
“A listing approach risks inequity by diagnosis and a further fragmentation of services,” the report states.
It says the operational difficulties that currently exist should be addressed using an “ethical principles framework approach”. The general population should be involved in deliberating on the “ethical and social issues arising from access to healthcare in the context of finite resources”.
"Financial hardship or means testing should remain the main discriminator for selecting the large majority of those eligible for a medical card, which is consistent with other health systems in the European Union. "
The group recommends the health service uses its recommendations as a stepping stone to the implementation of the first phase of the Government plan to reform primary care, providing free GP care for all.
Mr Varadkar said he would bring forward proposals to Cabinet to reform the discretionary medical card system “so that sick people are provided for”.
The Irish Cancer Society, which wants all cancer patients receiving treatment to be awarded a medical card, said the report underlined the need to change the 1970 Health Act which governs how applications are assessed. It called for the publication of the report as soon as possible and an indication by the Government of its intentions for reform.
The Irish Medical Organisation said the medical card system should be extended on income grounds with a properly resourced allocation for discretionary cards to take account of medical need.
The Irish Hospice Foundation welcomed the finding, again prioritizing medical conditions when determining a person's eligibility for a medical card. It said this approach would overlook those whose condition may not fit easily into any diagnosis.
Over 2,000 submissions were made to the expert panel, which was announced by former Minister for Health James Reilly earlier this year following months of controversy over the withdrawal of discretionary medical cards. The group also met with over 20 patient groups before completing its report.
