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Prescription charges

The government decision to introduce a 50c charge for a prescription item was sharply criticized in the Dail and Seanad.  The charge was the main provision in the Health (amendment) §2 Bill, 2010.  The maximum to be paid monthly by any family was €10.

In the Seanad, Frances Fitzgerald (FG, labour) explained that whereas the 50c levy per medicine might not appear to be much, that was not the case for many families, especially those on low incomes (Seanad Eireann, Debates, 30th June 2010, 724-784).  The vulnerable in our society were being asked to bear a significant burden of pain, despite not being responsible for the banking crisis and from the point of view of social protection and caring for the most vulnerable, she opposed the Bill.  She pointed out that prescription charges in Northern Ireland had been abolished in April, while significant international research showed that any disincentive effects for people to take the medicines that they needed should be avoided.  Phil Prendergast (Labour, labour) said that the charge meant hardship for people with long-term illnesses.  She understood that we were in difficult times and we must look at everything, but a levy of 50c on end  users was not the right way to go about it.  She acknowledged that it was a small sum, but for some people it was too much and there was scope within the system to influence a change in prescribing practices and the use of generic rather than proprietary drugs.

Geraldine Feeney (FF, labour) criticized what she considered to be opposition for the sake of it.  She did not know what one could buy for 50c now, probably not even a bag of crisps and disbelieved the view that a 50c charge would lead people into letting their health fall into disrepair and that they could die.  ‘If that is what she is worried about, does she advocate the government giving free food to people to ensure that they will live and be able to feed themselves.  It was a good Bill, she said and the start of the minister’s reform of the pharmaceutical sector.  Ivor Callely (FF, Taoiseach nominee) said that there was no magic wand that could resolve these issues, but there was waste and a question of the quantities of medicines found in people’s homes.  He did not wish Ireland to lose the 20 pharmaceutical companies that were creating blue chip employment and investing in research and development. 

Nicky McFadden (FG, labour) expressed the view that 50c might not seem like a lot to senators, but if one’s weekly social welfare payment were €160 a week, then it was considerable.  It could make the difference between food on the table and medicine.  One parent families were seriously threatened by this, especially in the content of other proposals to cut the single parent allowance at 14.  They were in the category of being most at risk of poverty, meaning that they could not obtain basic necessities.  They will forego medicines either for themselves or their children.  Fidelma Healy Eames (FG, labour) quoted Sara Burke’s research which found that although there were charges in most European countries, there were not for the poorest 30% of the population. In England, Scotland and Northern Ireland, certain groups were exempt from charges (e.g. people on low incomes, people with chronic diseases, pensioners, pregnant women, children and cancer patients,) with 85% people exempt in England and charges phasing out in Scotland and Northern Ireland.  The amount to be raised from the charges was €42m this year and €52m next.  Medical card holders were the poorest 30% of the population.  Jerry Buttimer (FG, labour) pointed out that general practitioners were giving out samples of tablets because they could not afford to pay for them and chemists were giving prescription medicine on tick so that people could pay back so much per week.

Niall O Brolchain (GP) asked whether the charge would really stop people from buying medicines.  Some people thought it might stop people seeking unnecessary prescriptions.  There was an overuse of antibiotics and we needed to change our culture.  He would be concerned if the 50c levy meant that people who needed medicine were prevented from getting it, but he did not believe that this would happen.  Perhaps a review mechanism could be built in to the legislation.

Responding to the debate, the Minister for Health and Children, Mary Harney, pointed out that everyone on a long-term illness card would be exempt, as would be people on methadone and children in care.  The situation of homeless people would be discussed later, because of the issue of distinguishing between whether a person with a medical card was homeless or not. On the committee stage, she added that she envisaged that asylum seekers living on €19 a week would be excluded.  Mary Harney pointed out that almost every country in western Europe provides for co-payment, even for very poor people.  This had been contradicted by someone who is supposed to be a health analyst, but she was incorrect.  The minister accepted that if there were no financial pressures, she would probably not be doing this.  It was by no means the first item on her agenda, which was why she addressed the issues of distribution, wholesale margins, retail payments and payments to manufacturers last year.  We were doing this as a contribution to saving money and she hoped that it would make us all think about the medicine we were using and in particular doctors to discuss with their patients whether they needed a prescription just because they visited their doctor.  The Bill passed 29-19.

When the Bill reached the Dail, the Minister for Health & Children, Mary Harney explained that 35% of the population, or 1.55m people, held medical cards.  The cost of medicines to pharmacies rose from €748m in 2004 to €1.129bn in 2008 and €1.179bn in 2009, projected over €2bn in 2010.  James Reilly (FG, Dublin N) expressed ‘vehement opposition’ to an ‘attack’ on the most vulnerable, sickest and weakest in society, while tough decisions on generic prescribing had been long-fingered.  Likewise, Jan O’Sullivan (Lab, Limerick E) objected because it was the poor who would be affected by it.  The Bill copper-fastened inequalities in society, yet we knew that the wealth of the country improved if society were more equal..  The people affected had already seen their incomes reduced in the last budget.

Caomhghin O Caolain (SF, Cavan Monaghan) attacked the charge as ‘pure deception’ because the minister could vary the charges in the future by regulation.  The government deserved no credit for imposing a lower increase than that proposed by McCarthy (€5) – it was still poison.  She was opening the way to higher prescription charges in the future.  Access to essential medicines free of charge had always been the cornerstone of the medical card scheme and had lifted a potentially huge financial burden from people on low incomes.  Instead, the focus of the government should be on generic drugs and controlling gross profiteering.

On the committee stage, Jan O’Sullivan proposed that homeless people be exempt from the charge.  James Reilly raised questions as to how chemists would collect the charge from people who had no money and that they would end up depriving people of their medicine.  The minister explained that she had sympathy with the proposal and people living in hostels or other institutional accommodation would not be obliged to pay as the institution had a generic medical card.  She could not exclude other homeless people who were not identifiable as such.  The Bill was passed on final stage 78-67.