Unpopular prescription charge is a healthy €120m HSE earner
The so-called "nominal" prescription charge for medical card holders has become a lucrative earner for the health service and will generate €120m this year.
The charge - which is now €2.50 per item, compared to 50c when it started in 2011 - was brought in on the pretext of cutting down on card holders getting needless prescriptions.
It means that medical card holders, who shelled out around €27.6m in the first year it was introduced by the last government, have seen a big rise in payouts.
Pharmacists have warned that it is leading to some medical card holders rationing medicines because they cannot afford the maximum of €25 a month.
It comes as Health Minister Leo Varadkar has indicated that he is looking at introducing a nominal charge for "free" GP visits when they are extended to non means-testing groups after the under-sixes and over-70s.
The GP fee is seen a method of deterring people from abusing free care - but past experience with the prescription charge has shown how this kind of levy can be hiked.
Around €43m of the income from the charge this year is hived out to help offset the savings of €619m which must be made up by the Health Service Executive (HSE).
Dr Varadkar is also expected to face objections from doctors to the introduction of a nominal fee for people who are given free GP visits, outside the normal means-tested benefit.
The Irish Medical Organisation (IMO), which is currently negotiating with the Department of Health on the roll-out of free GP care, may also have to oppose a nominal charge for patients when the scheme is introduced. This is because members voted against this kind of charge at the union's annual meeting when it was proposed for medical card holders as a means of reducing unnecessary visits.
Mayo GP Dr Ken Egan had asked his colleagues to support the introduction of a €5 per visit charge for medical card holders to prevent family doctors being flooded with the "worried well". However, the proposal was rejected by the gathering of doctors who pointed out that it was akin to the prescription charge which the union opposed.
This was adopted as policy and negotiators may find it difficult to sell the concept of a nominal visit fee to its membership as a result.
Such a fee would have to be collected by GPs from a reluctant public and would also mean a lower fee paid per patient by the State.
The original estimate for the extension of free GP care to the entire population was put at €332m, based on the rates which are currently paid to GPs.
However, these capitation fees have already been condemned as inadequate and they will not compensate GPs for the loss of income from private patients who pay around €60 a visit.
The IMO is expected to demand higher State fees for providing free visits to the over-70s, who are guaranteed to make regular use of the benefit.