independent

Monday 21 April 2014

Dr Ray Walley: Prescription charge nothing more than a moneymaker

James Reilly has presided over significant charge increases

'Prescription charges could lead to people, particularly the least well-off in society, not filling necessary prescriptions," said Dr James Reilly (speaking in opposition).

The Health Minister has presided over two very significant increases in prescription charges even though, as the quote above shows, he clearly understands the harm caused by prescription charges. If some previously unknown doubts have emerged in his mind since taking office, he should come to my surgery.

Last Wednesday, I had a consultation with a 74-year-old lady who indicated she would be delaying collection of her tablets till she had some more money. She is a diabetic with hypertension and airways disease. The potential cost of her medication to her with the prescription charge is the maximum €25. Her sole income is her state pension.

On Thursday I had a consultation with a 70-year-old lady who had stopped her calcium supplement and cholesterol lowering tablets. She advised me that the new cost of e2.50 per item per month was the last straw.

These patients only revealed the impact the prescription charge was having on their thinking after close questioning. Like all vulnerable patients, the common approach is stoicism and resignation.

Compliance of medication has always been the holy grail of clinical management. There is no secret that many patients do not take their tablets regularly or correctly and research has proven that prescription charges reduce the use of necessary care as much as unnecessary care.

With this in mind, such credible authorities as the World Health Organisation and the Cochrane database have each published against prescription charges to ensure no disincentives to compliance.

Closer to home, the expert group on resource allocation chaired by the ESRI Director Frances Ruane questioned the wisdom of the imposition of the prescription charge as the "evidence suggests ... possible harmful effects on health".

In 2007 Wales abolished prescription charges. So did Northern Ireland in 2010 and Scotland in 2011. England is the only part of the UK continuing to charge but in that market there is a list of exclusion criteria, which ensures that 90pc of dispensed items are free.

In Ireland, we have the ludicrous situation where the prescription charge will be in excess of the cost of many of the monthly courses for blood pressure, diabetes, psychiatry illness, thyroid disease and contraceptives together with some courses of antibiotics, ensuring the State will make a profit on the patient's illness.

Unsurprisingly there are no exclusion criteria. The Department of Health suggests that this analysis ignores the cost of dispensing medicines (fees paid to pharmacists) but dispensing costs didn't change with the Budget so the impact is still positive for the Exchequer.

When it was first introduced by then Health Minister, Mary Harney, the minister acknowledged (without the Department of Health handlers present), that the measure was to "raise money and discourage both over-prescribing and overuse of medication''.

The Department of Health subsequently tried to correct that impression and stated "it is not envisaged as a revenue-generating measure but its purpose is to influence demand and prescribing patterns".

That lie has now been exposed and it is clear the measure is indeed designed for revenue generation.

Ironically, the increased revenue the State will receive as a result of this increase is close to the Government's suggested cost for the introduction of free GP cards for children under six.

Robin Hood's mantra was that he robbed from the rich to give to the poor. The current Health Minister seems to be taking the opposite approach.

Dr Ray Walley is chairman of the IMO GP Committee

Irish Independent

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