The number of medical cards registered in Northern Ireland exceeds the total population by up to 80,000 – raising questions about whether our free healthcare system is being abused by people in the Republic.
The Belfast Telegraph has learned that there are significantly more people registered to avail of healthcare, such as GP services and accident and emergency, than there are people actually living in Northern Ireland.
According to the 2011 census, the population currently stands at 1.8 million. But it is understood the number of medical cards registered to addresses here is up to 80,000 higher than this figure. And 20,000 of these are believed to be in the Londonderry area alone.
While there may be some discrepancy in numbers because of deaths, students from Northern Ireland living elsewhere and people moving away, it is feared the number is largely inflated by people who live in the Republic – where healthcare is not free – but who have managed to secure a medical card through an address in the north.
While the Department of Health did not have official figures on how many medical cards are currently registered, a well-placed source confirmed the figure is as high as 80,000 over the population.
Information shown to the Belfast Telegraph reveals that houses here are showing multiple occupancy in terms of people on the medical register, particularly along the border areas.
One house in south Armagh has 16 people registered to it despite the premises only having two bedrooms.
In some cases the register shows three or four generations still living at one address.
Another indication of the fraud is premises with higher than usual occupancy where the people concerned may all have different surnames.
Insiders are privately pointing the finger towards the Republic for the ongoing upsurge in numbers registering here illegally. In particular, the decision in Dublin to introduce charges for a visit to a GP or to attend an Accident & Emergency Unit without a referral letter from a GP.
Fraud on such a scale would equate to the loss of tens of millions of pounds from Northern Ireland's hard-pressed health service every year. It means people paying tax to a different country are draining resources away from frontline services.
The news comes after Health Minister Edwin Poots announced the service is launching a major counter-fraud campaign.
The minister said the crackdown will deal with a range of offences from people obtaining fraudulent prescriptions to consultants claiming unworked hours.
The Department of Health stated that the £250m figure they released as an overall loss figure due to fraud is the worst-case scenario.
The minimum amount of taxpayers' money being drained from the service due to fraudulent registration is in the region of £48m and could be as high as £100m a year. Those figures – coupled with other types of fraud highlighted by the health service – indicate the £250m figure may well be conservative.
Health tourism is the root cause of the problem, particularly in border counties where this has become something of a growth industry over the last two years.
The official amount for primary care per head of population is calculated to be £600 which with 80,000 extra people registered comes to £48m a year. If those on the list needed secondary care – calculated at £10,000 – the figure soars to £100m a year.
The Department of Health does have an anti-fraud unit but sources have indicated it simply does not have the manpower to be as effective as it could be.
Alliance MLA and member of the Stormont health committee, Kieran McCarthy, described the figures as concerning. "There is certainly cause for concern," he said. "We would want to know why and where these people are coming from. Is it further afield?
"It is certainly a very large number of people and it will obviously put extreme pressure on the health service to deliver. I would expect some sort of inquiry."
Deputy chairman of the Stormont health committee, Jim Wells, said action should be taken to ensure medical cards are held legally.
"There needs to be a check on medical cards in border areas just to make certain that people are UK residents and that they are legally entitled to hold a medical card," he said.
Mr Wells added: "I suspect some of this will be explained by people who are resident in the Irish Republic obtaining medical cards in Northern Ireland by using the address across the border.
"People from the Irish Republic are perfectly entitled to come across the border and obtain medical treatment. Then the Department of Health would bill the Irish Republic the full economic cost of that.
"I suspect one of the things we need to look at is if there are any element of people obtaining medical cards who are not entitled to free treatment.
"Of course, in the Republic you have to pay for visits to the GP and prescriptions and therefore there would be an incentive to register north of the border to do that."
Mr Wells added: "We need to dig down a bit deeper to identify this.
"I think it is a mixture of factors of people who have passed on, emigrated and who have not notified the Health and Social Care Board plus some people who are availing of medical treatment in Northern Ireland.
"The fact that it is more prevalent in the border areas would indicate that perhaps there are people who are getting free treatment who shouldn't be entitled to it.
"Well it is free to them but we should be getting the money back from the Republic.
"One thing that should be checked is when people go to register a death with a local council; does that information automatically go through to the Health and Social Care Board so that person is taken off the register?" asked Mr Wells.
Comparing costs: A tale of two hospitals
- If you attend the out-patient department or emergency department (A&E) of a public hospital in the Republic of Ireland without being referred by your GP or family doctor, you may be charged a standard fee. The charge is €100 (£84)
- In-patients are charged a standard fee of €75 (£63) per night, up to a maximum of €750 (£630) in one year
- For long-stay patients receiving in-patient services in premises where nursing care is provided on a 24-hour basis, the maximum weekly charge for the maintenance element of care is €175 (£147)
- Medical card holders pay a €1.50 (£1.26) charge per prescription item, subject to a monthly ceiling of €19.50 (£16.40) per family
- GP visit: Between €40-€60. (£33-£50)
- Cost of attending A&E: Free
- Cost of prescription: Free
- Cost of maternity services: Free
- Cost of in-patient stay per night: Free
- Cost of GP visit: Free
The differences in entitlement north and south
By Victoria O'Hara
To register with a doctor or a dentist in Northern Ireland you need a medical card.
This is done by filling in the HS22X form which is found in surgeries and online.
After filling it in, a card will be issued.
This contains an NHS number and other information such as your name, address, date of birth, and details of your registered practice or individual doctor.
It allows you to get certain health services free of charge.
So, once registered, what health services are available free of charge to someone issued with a medical card to an address in Northern Ireland?
e GP service;
e Routine (non emergency) treatments;
e Subsidised dental care;
e Pharmaceutical services/free prescriptions;
e Emergency services/A&E services;
e Subsidised optician services;
e Family planning clinic services.
People living in the Republic are not entitled to free healthcare north of the border.
If someone from the south needs treatment while in the UK, for example on holiday, they will receive this free of charge but their country will be billed.
The situation is the same for someone from the UK visiting the Republic.
Someone who lives in the south but who works in Northern Ireland is also entitled to an NHS medical card.
Dental treatment is subsidised and generally not free. They are entitled to GP services but that does not usually extend to their family either.
A NI (UK) medical card is entirely different to a medical card in the Republic. It is not means-tested and is not linked to social welfare payments.
Provided a couple from the south but working in Northern Ireland have no other income sourced in Ireland, they are also entitled to Irish medical cards which would enable them and any dependent children, to access free public healthcare in the south.
A recent review in the Republic revealed that just 68% of medical cardholders were deemed as eligible to hold the cards in 2012.
After 109,000 reviews were carried out, 74,900 cardholders had their eligibility confirmed.
A death notice was received in respect of 1,300 cardholders, 4,600 had their eligibility downgraded to a GP visit card and 9,000 were found to be ineligible because of a change in financial circumstances.
Around 19,200 people did not respond.
In Northern Ireland if you lose your NHS medical card a replacement can be provided either by visiting the GP or by contacting the health authority.