More than 5,100 elderly people have been stripped of their medical cards as part of a bid to save the health service €25m this year.

The extent of the crackdown on full medical cards for the over-70s, who faced tougher income thresholds since the last Budget, are revealed for the first time in briefing documents given to Health Minister Leo Varadkar on his appointment.

Officials told him 60,000 over-70s were contacted and, by the end of May, 4,875 were downgraded to a GP visit card. Another 407 were deemed ineligible for even this card because of their income. Around 20,070 still had time to reply.

The documents also reveal the elderly who need admission to a nursing home face further hardship later this because of the delays in releasing funding under the Fair Deal scheme.

At the end of June, elderly people, who were passed as needing nursing home care, were waiting 10 weeks to get funding but at the end of this year delay will extend to up to four months.

The minister was told that while an average of 729 nursing home applicants were added to the waiting list on average every month from January to April, just 707 beds a month were vacated.

The Department also wants doctors to keep a tight rein on costs when prescribing drugs to patients who need blood-thinning medicines.

Troublesome

Newer, more expensive drugs have become available in recent years as an alternative to Warfarin, which patients find more troublesome.

The officials said however the newer drugs have ingredient costs of between €850 to €950 per patient annually and this medicine bill is expected to reach €20m this year "unless immediate action is taken."

The document says there are currently 35,000 on the cheaper Warfarin and 13,300 on the others.

In order to contain cost there is a need to ensure existing patients on Warfarin remain on this treatment and that less new patients are prescribed newer drugs, it stated.

The documents said making health insurance companies pay if a private patient is placed in a public bed was the "right thing to do" because they had been "heavily subsidised " by the taxpayer.

It expects the charges will bring in €39m for the Exchequer this year. It also revealed:

* Radiotherapy facilities for cancer patients will be at maximum capacity at the end of next year, forcing the installation of two more machines at St Luke's Hospital, Rathgar.

* From this month, living donors who give a patient one of their kidneys will have expenses reimbursed for longer.

* The proposed dismantling of the current health service structure, such as the abolition of the HSE, as part of the plan to bring in universal healthcare insurance, was "unworkable" in is existing format.

Irish Independent