Wednesday, 1 July 2009
Dáil Eireann Debate
Deputy Andrew Doyle: I raised this matter in 2007, when it would probably have been easier to achieve a positive result. Notwithstanding that, I was told it was not envisaged that the 1970 Act that specified the list of illnesses covered by the long-term illness scheme would be added to or reviewed. I have been contacted by a couple of young people who have Crohn’s disease. It is a lifelong illness and has no cure. It can be contained and managed and people can live as ordinary and as normal a life as possible, but it cannot be cured. It is defined as an auto-immune illness, as are arthritis and multiple sclerosis, and yet of the three, only multiple sclerosis is on the list. Given that it has the same long-term consequences, it seems strange that Crohn’s disease is not included.
Last November, the Minister for Health and Children, Deputy Mary Harney, ruled out any chance of Crohn’s disease being included in the long-term illness scheme, claiming sufferers have to pay only €100 per month, so it would be of no benefit to them given the cover available under the drugs payment scheme. Unfortunately, she did not think of the number of GP visits sufferers have, at €50 to €60 each, and the number of routine blood tests they have to undergo to monitor their disease. If it comes to the stage where young people, particularly young women, neglect their visits or blood tests because they cannot afford it, there are consequences down the line.
The Minister is probably correct that this does not affect many people but an alarming number of young people are getting it for some reason which has not been established. Given the fact that it affects so few in the context of the national population its addition should be considered. It would be cost-negative because if people are forced not to look after the illness the consequences are dire by way of long-term medical needs, persistent admissions to hospitals rather than outpatient visits and subsequent operations that will be necessary.
It is manageable, not curable, but needs to be monitored regularly. The amount of money involved in including Crohn’s disease is minimal. There is no point saying that we should give here and there but it is cost-negative. I would appreciate if the Minister would undertake a cost-benefit analysis of it and take medical advice on the long-term consequences of not taking care of it and of the number of people who have the disease but are not attending as they should. The number of visits people should make and the amount of care they should take to monitor this illness are fairly well laid down. If it must be looked at coldly, which, unfortunately, it probably will be, with that in mind it could be possible to include it.
Minister of State at the Department of the Health and Children (Deputy Áine Brady): I will respond to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney, and I thank Deputy Doyle for raising this issue.
The long-term illness scheme arose from a non-statutory scheme, established in 1967, to supply free of charge certain products to persons for the treatment of diabetes. A statutory scheme was introduced in 1971 under section 59(3) of the Health Act 1970. It provides that a health board, now the HSE, may make arrangements for the supply without charge of drugs, medicines or medical and surgical appliances to persons suffering from a prescribed disease or disability of a permanent or long-term nature.
The conditions which have been prescribed are mental handicap, mental illness for people under 16 only, phenylketonuria, cystic fibrosis, spina bifida, hydrocephalus, diabetes mellitus, diabetes insipidus, haemophilia, cerebral palsy, epilepsy, multiple sclerosis, muscular dystrophies, Parkinsonism, conditions arising from thalidomide and acute leukaemia.
From 1971, a separate scheme was introduced to refund the cost of drugs above a certain threshold for non-medical card holders. This evolved into the drugs payment scheme in 1999. Under this scheme, no individual or family unit pays more than €100 per calendar month towards the cost of approved prescribed medicines. The drugs payment scheme is easy to use and significantly reduces the cost burden for families and individuals incurring ongoing expenditure on medicines.
When the drugs payment scheme was introduced, it was decided to continue the long-term illness scheme for the conditions already covered, but it has not been extended and there are no plans to do so. People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. In the assessment process, the Health Service Executive can take into account medical costs incurred by an individual or a family. Those who are not eligible for a medical card may still be able to avail of a GP visit card, which covers the cost of general practice consultations.
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