Public provision of services
The HSE may provide services directly or may make an arrangement with other bodies to provide those services on its behalf. From an eligibility perspective, there is no distinction between publicly funded services provided by the HSE directly or those provided on its behalf.
Free and subsidised services
The legislation that requires the HSE to provide services sometimes sets out that these must be free of charge to some or all recipients. Sometimes, the legislation allows for charges to be made. The fact that you must pay a contribution towards the cost of services does not change your basic entitlement to avail of those services.
Categories of entitlement
The population is divided into two groups for the purposes of eligibility for health services. The legal terms are people with “full eligibility” and people with “limited eligibility”. The usual descriptions for these two groups are medical card holders and non-medical card holders. People with GP Visit cards have limited eligibility for all services except GP services.
Specific groups with entitlements
Two groups have specific entitlements – people who have contracted Hepatitis C directly or indirectly from the use of Human Immunoglobulin-Anti-D or from having received blood products or transfusions in Ireland have specific entitlements under the Health (Amendment) Act 1996 and certain people are entitled to health services because of EU rules.
Review of eligibility for health services
The Department of Health and Children established an Eligibility Review Team in 2005. Its aim is to draw up clear and transparent statutory provisions on eligibility for health and personal social services. The Minister has said that the legislation will define specific health and personal social services more clearly; set out who should be eligible for what services, as well as criteria for eligibility; establish when and in what circumstances charges may be made and provide for an appeals framework.
Entitlement to a medical card
In general, entitlement to a medical card is governed by Section 45 of the Health Act 1970.
Everyone over 70 has full eligibility for health services and is entitled to a standard medical card – there are no conditions attached to this (Section 45 as amended by the Health (Miscellaneous Provisions) Act 2001). In the case of other adults, Section 45 provides that they have full eligibility for the health services if they are considered by the HSE to be “unable without undue hardship to arrange general practitioner medical and surgical services” for themselves and their dependants.
In deciding whether or not you meet this criterion, the Health (Amendment) Act 2005 provides that the HSE must look at your “overall financial situation” (including your own means and those of your spouse) in view of your “reasonable expenditure” in relation to yourself, your spouse and your dependants.
The legislation seems to provide that an individual assessment should be made in the case of each person who applies for a medical card. In practice, entitlement