SPECIAL medical cards are no longer being automatically given to people with cancer on low incomes unless their diagnosis is terminal.
These discretionary cards are given to people who are over the normal financial eligibility limit but face high medical bills due to being diagnosed with some form of illness.
However, Health Minister James Reilly has confirmed the applications and renewals for these cards now face new scrutiny and national eligibility criteria is being applied for the first time.
The minister was rounded on by angry TDs at the Oireachtas Committee on Health and Children who said they were seeing growing numbers of distressed constituents, many elderly or with a disability, losing these cards.
There are now 59,000 people with discretionary medical cards compared to 80,709 in 2010. Another 19,200 more have discretionary GP visit cards.
Dr Reilly told members it was his idea to set up a system where doctors, unrelated to the patients, determine if the cards should be granted or declined.
"In the past it was the decision of the chief executive of a health board. It was his discretion not a doctor's discretion. They were given out for all sorts of reasons.
"In some cases this was because the person had cancer. In the past cancer struck terror into the heart of people and the prognosis was very poor.
"It is now a very different condition and ranges from being a desperate diagnosis to not such a bad diagnosis at all."
Different criteria were used in the past and some people who got the cards did not appreciate them, while others – who desperately needed a card – could not get one.
Senior HSE official Laverne McGuinness said the discretionary card can only be automatically given to someone with cancer if the illness is "life limiting".
They can receive it within 24 hours for six months. This criterion is now applied nationally.
The Committee was told that in the new initiative to monitor those with these cards, the HSE has appointed a doctor nationally to examine trends in applications and renewals.
The senior HSE official said somebody with cancer was not entitled to a discretionary medical card and it would only be given to somebody with a terminal diagnosis.
Deputy Seamus Healy, TD for South Tipperary, said it is outrageous that somebody has to be terminally ill with cancer in order to get a card.
Sinn Fein TD Caoimhghin O Caolain told the minister he knew of one person, confined to a wheelchair since childhood, who has lost their card. Meanwhile, thousands of patients are to feel the impact of protest action by family doctors who are to refuse to take part in a range of services due to cuts in their state fees.
The Irish Medical Organisation (IMO) is calling on its GP members to withdraw from a number of services. This includes community intervention teams, which allow suitable patients to be discharged early from hospital with nursing and medical support.
The doctors are also to step down from chronic disease programmes where they take some of the workload from hospitals to look after patients with long-terms conditions such as diabetes.
And they will also withdraw from primary care teams, which would see them no longer hold face-to-face meetings with other neighbouring health professionals such as public health nurses to discuss a patient.
The cuts in medical card and vaccination fees will see them lose out on over €30m in payments over the course of a year.