Primary healthcare in Ireland
Primary healthcare has been defined by the WHO as, 'Essential healthcare based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at the cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.'In Ireland approximately 35 per cent of the population is entitled to free primary care. The General Medical Services Scheme provides free general practitioner services and free drugs and medicines to persons with full eligibility. (Those persons covered by medical cards.) The re a re approximately 1.262 million people eligible to use the services under the scheme.Eligible persons are entitled to a choice of general practitioner and can have their prescription medicines dispensed free of charge at a retail pharmacist. Eligibility is decided by the Chief Executive Officer of the Health Board. The criteria are mainly financial (ie, means tested) but heavy expenditure on health services by the applicant will be taken into consideration.There were 1,636 doctor agreements and 1,099 pharmacy agreements i n the GMS Scheme as at 31 December 1992.
Primary healthcare schemes
In addition to the General Medical Services Scheme, the Irish Department of Health also has a number of additional schemes in the primary healthcare area:
The long-term illness scheme
This scheme caters for those individuals who have been diagnosed as suffering from any of 1 5 specified illnesses. The list of specified illnesses has remained unchanged since 1975 and Aquired Immunodeficiency Syndrome (AIDS) is not included. The scheme allows people to obtain, without charge, the drugs and medicines required for treatment of their condition. There are at present 49,000 people covered by this scheme.
Drug cost subsidisation scheme
The scheme was introduced in 1990 and caters for those persons who are certified as having an ongoing medical condition with a continuous requirement for prescribed medication. The individual concerned pays the first £32 in respect of any prescribed medicines and drugs dispensed within a calendar month. The outstanding cost is paid directly to the pharmacisi by the GMS Payments Board. The scheme means that the beneficiary does not have to pay more than £32 in any month for prescribed drugs and medicines. At present, approximately 25,000 people are covered by this scheme.
Refund of drugs scheme
This scheme provides for a refund of any expenditure on prescription drugs and medicines above a specified level over a specified period. The revised arrangements introduced in August 1991 mean that a refund can now be made to any individual in respect of any expenditure above £90 in any calendar quarter.The scheme applies to the population as a whole and in 1990 approximately 225,000 claims were made at a cost of £1 8 million. Costs for 1991, taking into account savings arising from the revised arrangements, were in the order of £15 million.
The Community Core Programme
This scheme embraces all health and personal social services for which the health board is responsible. In addition, in some health board areas, welfare homes and institutions for the aged, the handicapped and other disadvantaged groups have been absorbed into the Community Care Programme.
There are three main Community Care Sub-Programmes providing the following services:
The Community Care Protection Sub-Programme covers:
prevention of infectious diseases;
child health examinations;
other preventive services.
The Community Health Services Sub-Programme covers:
general practitioner services;
drug supply and refund schemes;
home nursing services;
dental, ophthalmic and aural services.
grants to voluntary welfare agencies and personal social services;
services by social workers;
home help and meals on wheels services;
day care services