A leading consultant in palliative medicine believes patients expected to live for six months or less should be entitled to a medical card.
In a personal submission to the Expert Group on Resource Allocation in the Health Sector, Dr Liam O’Siorain said it seemed short-sighted that this population of patients, who may be very close to the threshold, were disqualified on income grounds.
“At present, there are patients who do not have medical cards entering the terminal phase of their illness who are unable to access simple equipment and supports that would allow them to stay at home,” said Dr O’Siorain, who works at St James’s Hospital and Our Lady’s Hospice.
“Not having a medical card can make the difference between dying at home and dying in an acute setting,” he added.
The bureaucracy involved in getting a medical card could take so long that it was almost worthless by the time it arrived, he said. Furthermore, the process consumed the time of the social worker, hospice unit or hospital.
“Referral to specialist palliative care should trigger an automatic medical card entitlement, which on average will only last for a few months.”
Dr O’Siorain added it was difficult to quantify value for money and health gain within specialist palliative care services. “In palliative care, the value-for-money argument must take into account what value society placed on a ‘good death’.”
However, he said value for money could be shown by improving the cost/utility ratio, where utility was the value placed on the time spent in a particular state of health, such as being pain-free for six months or being at home rather than in hospital.
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