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The journal of developments in social services, policy - page 6 / 11





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to a standard medical card is generally based on the income guidelines which are set annually in general, but last increased in 2005. However, these guidelines are not absolute and individual circumstances must be taken into account.

Certain groups retain entitlement to medical cards when they return to work or education/training. There is no legislative basis for this.

GP Visit Cards

GP Visit Cards or “doctor-only” cards are provided for in Section 58 of the Health Act 1970 (as amended by the Health (Amendment) Act 2005). This states that the HSE “shall make available without charge” GP services for people who have full eligibility (standard medical card holders) and people with limited eligibility for whom it would be “unduly burdensome” to arrange such services for themselves and their dependants. People with full eligibility get the standard medical card and those with limited eligibility who meet this criterion get the GP Visit Card.

The legal difference between the “undue hardship” criterion for qualifying for a standard medical card and the “unduly burdensome” criterion for the GP Visit Card is not clear. The income guidelines for the GP Visit Card are 50% higher than those for the standard medical card.

Review of medical card eligibility

There is no statutory requirement that the medical card guidelines be changed from time to time. The last change to the income guidelines was introduced in 2005. The

2007 Programme for Government includes a number of commitments on medical cards including:

Indexing the income thresholds for medical cards to increases in the average industrial wage

Implementation of an annual publicity campaign and making applications easier so as to increase uptake amongst those who are eligible for medical cards and GP Visit Cards

Doubling of the income limits for eligibility of parents of all children under 6 years of age, and trebling them for parents of children under 18 years of age with an intellectual disability

The social partnership agreement Towards 2016 includes a commitment to review the eligibility criteria for assessment of medical cards in the context of medical, social and economic/financial need, with a view to clarifying entitlement to a medical card. This review is being conducted as part of the general review of eligibility for health services.

A Steering Group has been established which is expected to complete this work in autumn 2008.


Hospital care is provided in public and private hospitals. There is no legal definition of public or private hospitals in the Health Acts.

Broadly speaking, there are three different types of hospital but there is very little difference in practice between the first two types:

Hospitals owned and funded by the HSE.

Voluntary hospitals, most of whose income comes directly from the State – generally, they have agreements with the HSE under Section 38 of the Health Act 2004. This section allows the HSE to enter into an arrangement with a person for the provision of a health and personal social service by that person on behalf of the HSE. Some voluntary hospitals are owned by private bodies

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