Extension of free GP visit card after Budget 2023

[Passport1]

As part of the budget last Oct it was announced that the free GP card scheme would be extended to cover from April 1, 2023, those with a net median household income of €46,000 or less.

What does net median household income of 46k or less mean ?

What is the process to apply for the free GP card or is it open yet?

Thanks

 

[Purple]

As part of the budget last Oct it was announced that the free GP card scheme would be extended to cover from April 1, 2023, those with a net median household income of €46,000 or less.

What does net median household income of 46k or less mean ?

What is the process to apply for the free GP card or is it open yet?

Thanks

Good question.
This from the CSO outlines what each term means,
Will they use Median household income, Median household disposable income or Median Equivalised household disposable income? The third is the fairest but none of them account for wealth, just income.

If they are taking social transfers into account will they also take HAPS payments into account?

Will the cost of housing betaken into account or will a household paying rent or a mortgage of €2500 a month be treated the same as a household with the same Median Equivalised household disposable income who own their house outright. That's what I mean by taking wealth into account. A family on €60k a year paying rent or a large mortgage needs the support far more than a family on €46k who aren't paying rent or a mortgage.

Then there's the fact that GP's get paid more per consultation for public patients than they get for private patients. They state is paying them a premium for operating in the protected sector.

 

[mct1]

Then there's the fact that GP's get paid more per consultation for public patients than they get for private patients. They state is paying them a premium for operating in the protected sector.

GPs are paid an annual capitation fee per medical/GP cardpatient regardless of the frequency of consultations. Overall those with cards consult more often so unless we can magically appear more GPs from somewhere, it seems inevitable that practices will struggle to see everyone. Most GPs don't want more patients at any price - just ask them.

Doctors critical of extension of free GP care announced in budget

Budget 2023: IMO says free GP care for 400,000 patients will create hospital-like waiting lists at practices

www.irishtimes.com

 

[Purple]

GPs are paid an annual capitation fee per medical/GP cardpatient regardless of the frequency of consultations. Overall those with cards consult more often so unless we can magically appear more GPs from somewhere,

Yes, and when total payments are divided by total consultations they make more money from a public consultation than a private one.
We train more doctors per capita than any other country in the world. The problem isn't a lack of numbers, it's a lack of GP's who want to work fulltime. High marginal tax rates and high childcare costs are key factors in supply side constraints in what is a female dominated industry.

it seems inevitable that practices will struggle to see everyone. Most GPs don't want more patients at any price - just ask them.

Doctors critical of extension of free GP care announced in budget

Budget 2023: IMO says free GP care for 400,000 patients will create hospital-like waiting lists at practices

www.irishtimes.com

Why are we so more inclined to trust everything that's said by organisations and groups we perceive as not having a profit motive and than what is said by organisations we perceive to have a profit motive.
GP's are running a business and are no less motivated by profit and income than a shopkeeper or accountant or builder.

Institutions resist change and people are critical of those who propose changes than don't benefit them materially. That's as true of doctors as it is of taxi drivers.

 

[Early Riser]

when total payments are divided by total consultations they make more money from a public consultation than a private one.

If the public system is so lucrative it seems strange that GPs have been so reluctant about any extension of the public scheme (past and present). Anyway, the capitation amount does not appear exorbitant. I assume the higher amount is for the elderly, who use the GP practice a lot (and not just to see the GP):

"Ireland uses the capitation system by paying GPs sums varying from €52 to €326 depending on the age of the patient."

I think that any system that is totally free will be undervalued and overused - and paralysed by waiting times. I would welcome a public scheme to cover everyone but with some type of payment included. Not necessarily the same as any of these but using the same principle:

"France, where a typical fee is €7.50 and a yearly cap of €50 applies. In Norway, the co-payment is €16-34, with a yearly cap of €233."
(Paul Cullen , IT, https://www.irishtimes.com/health/2...ll-well-and-good-if-there-are-enough-doctors/)

 

[Purple]

If the public system is so lucrative it seems strange that GPs have been so reluctant about any extension of the public scheme (past and present). Anyway, the capitation amount does not appear exorbitant. I assume the higher amount is for the elderly, who use the GP practice a lot (and not just to see the GP):

"Ireland uses the capitation system by paying GPs sums varying from €52 to €326 depending on the age of the patient."

I think that any system that is totally free will be undervalued and overused - and paralysed by waiting times. I would welcome a public scheme to cover everyone but with some type of payment included. Not necessarily the same as any of these but using the same principle:

"France, where a typical fee is €7.50 and a yearly cap of €50 applies. In Norway, the co-payment is €16-34, with a yearly cap of €233."
(Paul Cullen , IT, https://www.irishtimes.com/health/2...ll-well-and-good-if-there-are-enough-doctors/)

The Capitation payment for over 70's GP cards is €403.31. If the patient has a chronic illness there's an extra €300. If they are in a nursing home the basic payment is €644.63.
They also get their Practice Nurse paid for.
They also get their Practice Secretary paid for.
They also get most of the cost of their medical indemnity insurance refunded.
They also get an additional 10% of whatever payments they get put into a pension fund.
They get additional payment of up to €12,500 if they are in a socially deprived area.
When you add all that up and divide it by the number of patient consultations they take there is a 15% premium for operating in the protected sector.

Then there's the Covid Vaccine bonanza. There's isn't a GP in Ireland who didn't make an additional €50k a year off that. any reasonably large practice made well over €100k extra last year.

The problem is that marginal tax rates are high and if a GP has young children the extra cost of childcare as well as a marginal tax rate of over 50% is a disincentive to work.

In the HSE male employees work 50% more hours than female employees. As medicine becomes amore female dominated industry we need to increase the number of training places in order to get the same number of net hours worked. I'm not making a value judgement, just pointing out the facts. People are perfectly entitled to work whatever hours and arrange their lives any way they want.
When a minister tells us that we are increasing training places for we need to factor in the increased demand due to an aging population and increasing levels of obesity as well as the fact that GP's work fewer hours than before. We also need to remember that we have a lucrative industry training doctors from other countries who are often obliged to go home after their training. The medical sector constantly misrepresent this (lies about it) as graduates emigrating after graduation because of the pay and/or conditions in Ireland.

I believe all of those factors need to be taken into account before we give more handouts, in this case paying for their GP visits with other people's money, to people who don't need them.

 

[Protocol]

Here are the capitation rates in 2019:

 

[NoRegretsCoyote]

Everyone should have to pay even €5 to visit a GP.

 

[Purple]

Here are the capitation rates in 2019:

View attachment 7124

​

The rate as of 2022 is €403.31. All information on payments here.
They also get €41.63 for out of hours visits (home visits) for GMS patients. There's no auditing of GP's to confirm that a consultation that they say was out of hours was actually out of hours.

Note that all GP's get payments for vaccines, pre and post natal visits, patients with chronic illness and many other schemes funded by the State.

 

[Early Riser]

We also need to remember that we have a lucrative industry training doctors from other countries who are often obliged to go home after their training. The medical sector constantly misrepresent this (lies about it) as graduates emigrating after graduation because of the pay and/or conditions in Ireland.

You seem to be conflating several different issues.
Medical schools in Ireland rely excessively on extracting funds from non-Irish/EU medical students. (Similar to the the UK reliance in foreign student fees). I seem to recall from the 20-odd year old Indecon report that the cost of educating Irish students in our medical schools is substantially subsidised by the fees from overseas students. In so far as this has changed in the interim I guess it is only to increase the level of cross-subsidisation. If we want to change this there would seem to be a funding issue to be addressed.

Yes, many of these overseas students will leave Ireland after graduation by choice. Until recently, at least, many also left because of the difficulty they had in accessing postgraduate medical training programmes as non-irish nationals. Something which doctors organisations had made representations about for years.

Separately from this many Irish graduates are emigrating after initial internship and many cite pay and conditions.

Your claim that the medical sector is "lying" about this seems well over the top (whichever "motives" you are attributing to them).

The medical sector constantly misrepresent this (lies about it) as graduates emigrating after graduation because of the pay and/or conditions in Ireland.

Do you think we need more GPs working in Ireland or not?

 

[mct1]

We train more doctors per capita than any other country in the world. The problem isn't a lack of numbers, it's a lack of GP's who want to work fulltime.

We train more doctors per capita than any other OECD country (not "in the world"). And we have one of the lowest per capita number of doctors. Even then most doctors do not wish to train as GPs. One factor identified in a recent study is that medical students often have relatively little exposure to general practice during their course. And then of those who do complete their 4 year post-grad GP work-training many soon leave the country. So lack of numbers would in fact seem to be a significant contributor to the problem.

As to the "lack of GPs who want to work full-time" many of these are opting for less money in exchange for a better work-life balance. I see that as a positive thing, and hardly the act of someone largely "motivated by profit and income".

We train plenty of doctors but we need to make GP a more attractive (not more lucrative) profession than it currently is or the drain will continue. Overloading GPs with more patients and more consultations before sorting out the groundwork is not the way to go.

 

[Purple]

You seem to be conflating several different issues.

No, I'm not.

Medical schools in Ireland rely excessively on extracting funds from non-Irish/EU medical students. (Similar to the the UK reliance in foreign student fees). I seem to recall from the 20-odd year old Indecon report that the cost of educating Irish students in our medical schools is substantially subsidised by the fees from overseas students. In so far as this has changed in the interim I guess it is only to increase the level of cross-subsidisation. If we want to change this there would seem to be a funding issue to be addressed.

I want the ICGP to acknowledge it and stop misrepresenting the data to suggest that every graduate doctor that leaves is doing so because of the shortcomings of the system.

Yes, many of these overseas students will leave Ireland after graduation by choice. Until recently, at least, many also left because of the difficulty they had in accessing postgraduate medical training programmes as non-irish nationals. Something which doctors organisations had made representations about for years.

Separately from this many Irish graduates are emigrating after initial internship and many cite pay and conditions.

Exactly. But that's not how the medical sector present it.

Your claim that the medical sector is "lying" about this seems well over the top (whichever "motives" you are attributing to them).

What would you call it?

Do you think we need more GPs working in Ireland or not?

Of course we do. More specifically we need more of the GP's we have working in General Practice and working full time. I think that lower marginal tax rates and lower childcare costs would be a big help, as they would be for most female dominated sectors as women still shoulder the greater proportion of the work involved in rearing children.

 

[Early Riser]

Exactly. But that's not how the medical sector present it.

Then we have been hearing different reports. Or selectively listening.

What would you call it?

I would say it is a lie to claim this. Or maybe that is a gross exaggeration?

 

[Purple]

We train more doctors per capita than any other OECD country (not "in the world"). And we have one of the lowest per capita number of doctors. Even then most doctors do not wish to train as GPs. One factor identified in a recent study is that medical students often have relatively little exposure to general practice during their course. And then of those who do complete their 4 year post-grad GP work-training many soon leave the country. So lack of numbers would in fact seem to be a significant contributor to the problem.

Do we need to improve the training of doctors so that they have more exposure to General Practice?
What proportion of the doctors who complete their 4 year post-grad GP work-training are foreign students/graduates who were never going to stay here in the first place?
Do we need to separate out the numbers between the two groups to get a better picture of the real numbers of doctors which we can realistically expect to remain within the Irish healthcare sector?

As to the "lack of GPs who want to work full-time" many of these are opting for less money in exchange for a better work-life balance. I see that as a positive thing, and hardly the act of someone largely "motivated by profit and income".

Income is part of the equation in any work-life balance.
Working twice as many hours so that over 50% of the extra income goes in tax and half of what's left goes on childcare is not a good use of anyone's time. Profit and income is absolutely a big part of the decision to work or not work those extra hours. There's absolutely nothing wrong with being motivated by profit and income, as long as you aren't doing harm to others in the pursuit of those goals.

We train plenty of doctors but we need to make GP a more attractive (not more lucrative) profession than it currently is or the drain will continue.

Making it more attractive does make it more lucrative or are you suggesting that Doctors are somehow not subject to the same human weaknesses as the rest of us?

Overloading GPs with more patients and more consultations before sorting out the groundwork is not the way to go.

I agree 100%.
I also think that people who can afford to pay for services should have to pay for them. I'm not a fan of universal benefits.

 

[Purple]

Then we have been hearing different reports. Or selectively listening.

I've never heard a GP representative highlight the number of overseas doctors we train and how that impacts on the number of graduates who leave.
This is the sort of nonsense that it trotted out by the medical industry. In this care the RCSI, the guys who have the highest number of foreign students of any Medical School.
From the link "Niamh Humphries, a senior lecturer at the RCSI Graduate School of Healthcare Management, told The Journal that around 725 doctors graduate each year, meaning that a “significant” number of newly-qualified doctors are choosing to go abroad". Do you think that's an accurate representation of the full picture?
The OECD has extensive data on the subject. Much as with the rest of the Healthcare Industry until we actually look at the facts on a granular level we won't fix anything.

I would say it is a lie to claim this. Or maybe that is a gross exaggeration?

Okay, so you would say that it's a lie. Maybe misrepresenting the truth for their own gain would be a better way of putting it.

As things currently stand only 50% of any extra training places we create will result in a extra doctor in Ireland since 50% of our trainees are not from here and won't be staying here.

 

[mct1]

Do we need to improve the training of doctors so that they have more exposure to General Practice?

Yes.

 

[Early Riser]

As things currently stand only 50% of any extra training places we create will result in a extra doctor in Ireland since 50% of our trainees are not from here and won't be staying here.

Are you talking about undergraduate training? If so, if we want more Irish undergradutes then we have to address the funding. We are already relying on foreign student fees to subsidise medical college costs. We do not have to double the number or foreign high fee-paying students to do this.

Okay, so you would say that it's a lie. Maybe misrepresenting the truth for their own gain would be a better way of putting it.

No, I am suggesting this was a lie (or maybe just a misrepresentation of the truth would be a better way of putting it?):

The medical sector constantly misrepresent this (lies about it)

 

[mct1]

Do we need to improve the training of doctors so that they have more exposure to General Practice?
What proportion of the doctors who complete their 4 year post-grad GP work-training are foreign students/graduates who were never going to stay here in the first place?

I think you may be mixing up the foreign (non EU) doctors who graduate then leave the country, with those who apply, are accepted for, and complete the ICGP 4 year GP scheme. The latter are almost without exception undertaking this with the intention of eventually going into practice in this country. One reason they might have left after completing it would be if they were unable to secure a practice to work in. It's their Irish colleagues who head off to Australia and Canada where jobs and the whole work-life balance are more attractive. You can't blame them either.

 

[Purple]

Are you talking about undergraduate training?

Yes.

If so, if we want more Irish undergradutes then we have to address the funding. We are already relying on foreign student fees to subsidise medical college costs. We do not have to double the number or foreign high fee-paying students to do this.

I agree. I'm in favour of higher college and university fees. The old system where those who could afford to pay did so and those who couldn't afford to pay didn't was much more equitable. I'm not in favour of the taxes paid by poor people being spent educating rich people.

No, I am suggesting this was a lie (or maybe just a misrepresentation of the truth would be a better way of putting it?):

Oh, okay. I asked you what you would call the misrepresentation of the facts by the doctors unions and you seem to have done what they do and answered a different question.

 

[Purple]

I think you may be mixing up the foreign (non EU) doctors who graduate then leave the country, with those who apply, are accepted for, and complete the ICGP 4 year GP scheme.

I wasn't but I certainly could have been cleared.

The latter are almost without exception undertaking this with the intention of eventually going into practice in this country.

Is there data to back that up? I'm not saying you're wrong but the whole discussion around our health service is lacking data on the "why" while we are great at counting the "What"; trolleys, waiting lists etc (though I don't believe the numbers for waiting lists are anywhere close to accurate as one on every 7 people in the country isn't waiting for an appointment).

One reason they might have left after completing it would be if they were unable to secure a practice to work in.

So there's a massive shortage of GP's but the newly qualified ones can't get a job? That sounds hard to believe.

It's their Irish colleagues who head off to Australia and Canada where jobs and the whole work-life balance are more attractive. You can't blame them either.

Yea, where taxes are lower and house are cheaper. They are left with more income after expenses. It comes down to money in the end and no, I certainly don't blame them... though when the people of Ireland just spent hundreds of thousands educating you some would say you should have to pay back the cost of your training before you bugger off.