Why Varadkar should do the right thing and abolish the prescription charge
Leo Varadkar has prioritised getting a realistic budget for health as number one of 10 priorities he wants to achieve within the next 18 months. All 10 priorities make good sense, some of them might even be delivered in the tight timeframe envisaged.
Number two is stabilising the cost of health insurance - easier said than done in the current environment given the age and health status of those covered by private insurance - but essential if the new health minister is to deliver on his overall aim of stabilising the system as it is currently configured. And critically, it is a measure of mega-appeal to core Fine Gael voters, assuming a majority of them have private health insurance.
Number three on his list is reducing the cost of medicines. Again, a no brainer in terms public and political appeal, which also will impact positively on the public and personal purses of the nation.
The other seven priorities are: retaining doctors and nurses; delivering free GP care for children and older people; developing hospital groups, Money Follows the Patient; five major new health facilities; freeing up hospital beds occupied by people who don't need to be there; getting all patients registered with a GP, and implementing Healthy Ireland,the cross sectoral public health policy.
Mr Varadkar presented these ten priorities to a large group of stakeholders gathered in Lansdowne Road last Tuesday, which is just one of many 'listening' events being held by the minister. At this event, the St Vincent de Paul and Irish Medical Organisation specifically requested the abolition of the prescription charges for medical card holders, who by their very nature, are amongst the poorest and sickest in the country.
Charging medical card holders for their prescribed medication was introduced amidst great controversy in 2009, by the then Health Minister Mary Harney, as part of a package of austerity measures in health. From 2009 to 2012, medical card holders were charged 50c per prescription item, capped at €10 per family per month. The charge generated €27m for the HSE in 2010 - the first full year it was collected.
Despite the fact that Fine Gael and Labour campaigned for the last general election promising to abolish the prescription charge, they have increased it 500pc since coming into office. In January 2013, under James Reilly, the charge trebled to €1.50 per item, capped at €19.50 per month. In December 2013, it went up to €2.50 per item per month, capped at €25.
The government broke its pre-election promise out of economic expediency, because the prescription charge is a relatively simple way of raising much needed revenue for the health sector. Last year it brought in €85m and it will be well-over the €100m mark for 2014 when the first full year of the €2.50 rate is counted.
Speaking after the stakeholder event on Tuesday, Mr Varadkar confirmed that the prescription charge for medical card holders would remain in place. He said he was in favour of these co-payments as long as they were kept low as 'they can deter unnecessary use'. The evidence on co-payments or out-of-pocket payments (as they are clumsily known in the academic literature) is black and white - they put off as much necessary as unnecessary use.
International research shows that charging for prescription items stops some people taking essential medicines, especially those drugs that do not have an immediate effect. People with conditions such as blood pressure, diabetes, asthma or psychological conditions may stop taking their prescribed medication because it does not effect them that day or even that week or month. GPs around the country can cite cases of people who are no longer on the drugs they prescribed them as the patients cannot afford the charge.
But the cumulative effect of not taking essential medicines can result in emergency hospital admissions, exacerbated illness and disability and, in very extreme circumstances, death. People particularly sensitive to the charges are those with multiple conditions and those on psychiatric medication. Often these are older women who live longer than their male counterparts.
If Mr Varadkar, a GP as well as a politician, wants to prevent the unnecessary use of medication, then he should start with the prescribing practices of his own medical colleagues. Stream-lining and co-ordinating the prescribing practices of hospital doctors and GPs could also assist patient adherence to drug regimes and bring down the drugs bill.
The prescription charge does raise much needed money in the short term. But it is an extremely short sighted measure that causes financial and physiological harm.
Its introduction is a classic example of bad decision making in times of crisis. Mr Varadkar has an opportunity to do the right thing and reverse the decision by withdrawing the prescription charge for the 1.790,438 people covered by medical cards.
Realising this pre-election promise would be good for the health of democracy, as well as being a very tangible public health gesture for those who have medical cards and for the public health bill.
Sara Burke is a health policy analyst and research fellow in Trinity College Dublin