Over-fifties’ GP visits affected by medical card entitlement

Posted on: 27 October 2016

A new report launched today by The Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin, details the impact that changes to an older person’s entitlement to a medical card has on their use of health services, such as GP visits, flu vaccines, medications and hospital care. The report authors found that changes in people’s entitlement to medical cards are associated with changes in their use of GP services and level of medications dispensed.

Uses data from two waves of TILDA in 2010 and 2012 they found that in the over 50s:

• Gaining a full medical or GP visit card is associated with 1.3 extra GP visits per annum. Compared to the level of GP visiting for this group in 2010, which was 3 visits, this represents an increase of approximately 43 per cent.
• For those who lose a full medical or GP visit card, the number of GP visits falls by 1.2 visits per annum. This is equivalent to a fall of approximately 29 per cent from the 2010 level which was 4 annual visits.
• Gaining a full medical card was associated with a significant increase in the numbers of medications taken regularly.
• Getting a medical card was not, however, associated with any significant changes in the probability of a flu vaccine, the number of emergency department visits, outpatient visits or inpatient nights.
• 12.6 per cent of the over 50s who did not have a full medical or GP visit card in 2010, gained one by 2012.
• For those with a full medical or GP visit card in 2010, just 3.5 per cent had lost their full medical or GP visit card by 2012.

The researchers found that in 2012, 39% of the over 50s had a full medical or GP visit card and no private health insurance (PHI); 18% had dual cover, i.e. a full medical or GP visit card and PHI; 33% had PHI only; and 10% had neither a full medical/GP visit card nor PHI ‘no cover’.

In summer 2015, however, free GP care for all children aged under 6 years of age, and all adults aged 70+ years was introduced. In May 2016, the new Government announced a commitment to an extension of free GP care to all those under 18 years of age.

Dr Anne Nolan, one of the authors of the report, commented: “These findings have important implications for the Irish healthcare system as free GP care is extended to all under 6s and over 70s and as we move towards universal healthcare. In the context of extensions in free GP care, it is crucial to understand current patterns of healthcare utilisation, not only for highlighting the extent to which the current system leads to financial barriers to accessing healthcare services, but also for forecasting the likely demand implications of reform proposals so that policymakers can cost the proposals and plan effectively.”

Dr Nolan continued: “One of the key questions is whether the increase in the use of GP services and medications that we observe upon receipt of a full medical/GP visit card reflects an increase in beneficial care and/or whether those who lose a full medical/GP visit card are foregoing necessary care. This would require more detailed research on diagnoses, length of consultation, health outcomes etc.”

Professor Rose Anne Kenny, Principal Investigator of TILDA noted “Data from TILDA provide a unique opportunity to explore how changes in access to healthcare services impact on the use of healthcare in Ireland. As further waves of TILDA data become available, the impact of public healthcare entitlements on health outcomes can be investigated”.

The full report is available here: http://tilda.tcd.ie/publications/reports/