When examining trends over time, care should be taken in the interpretation of the results in this publication as access to some forms of HSE funded healthcare may have been impacted by the varying levels of COVID-19 restrictions in place over the period 2020/21. The eligibility criteria for the HSE funded schemes can also change over time.
Only those that are eligible for a medical card or GP visit card under the General Medical Services (GMS) scheme are included in this publication. COVID-19 vaccination costs for GPs are not included.
Approximately four in ten patients with a medical card or General Practitioner (GP) visit card who were registered with a GP were aged 24 years and under.
GP payments for patients with a medical card or GP visit card who were aged 75 and over increased by almost 70% between 2017 and 2021.
The cost of HSE funded pharmacy claims remained static between 2017 and 2021, from €964m to €967m.
HSE funded pharmacy claims for persons aged 65 years and over accounted for three in five of all pharmacy claims in 2021.
The total number of HSE funded dental treatments fell from 1.2 million to 0.7 million treatments between 2017 and 2021.
There was an almost 50% decrease in the total cost of HSE funded dental treatments for those aged 34 and under between 2017 and 2021.
Three in five of all HSE funded optical treatments in 2021 were for females.
This publication uses data from Primary Care Reimbursement Service (PCRS) scheme for persons eligible for a medical card or GP visit card under the General Medical Services (GMS) scheme. The PCRS is an agency under the Health Service Executive (HSE).
The GMS scheme provides access to medical services for persons for whom acquiring such services would present undue hardship. GP, pharmacy, optical and dental claims under the GMS scheme only are included in this publication. Claims made under the Drugs Payment Scheme (DPS) are not included in this publication.
Under the GMS, GPs can claim for a range of fees and allowances for services provided to persons eligible for a medical card or GP visit card. This publication includes payments for fees only. Fees for COVID-19 vaccination costs for GPs are not included in this publication as these were managed outside of the GMS scheme. The payments per GP assume that the GP assigned to a person in a reference year is the only GP to receive payments for a patient in that reference year. The publication does not include the number of visits to a GP in a reference year.
Only persons for whom a fully processed and complete claim has been made in a reference year are included in this publication. For the purposes of this publication, the funding of treatments and claims for those eligible for medical cards or GP visit cards is referred to as ‘HSE funded’.
More detail on the GMS scheme and the PCRS can be found on the HSE website.
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Statistician's Comment
The Central Statistics Office (CSO) has today (10 March 2023) published HSE Funded Primary Care Treatments and Claims, 2017-2021.
Commenting on the publication, Sarah Crilly, Statistician in the Health Section said: “The CSO has today published data from the Primary Care Reimbursement Service (PCRS) within the Health Service Executive (HSE) on the funding of General Practitioner (GP), pharmacy, dental, and optical treatments, as well as claims for persons eligible for a medical card or a GP visit card from 2017 to 2021. For the purposes of this publication, the funding of treatments and claims for those eligible for medical cards and GP visit cards is referred to as ‘HSE funded’.
Across all four medical services, the number of treatments and claims was higher for females than males in 2021. Three in five (60%) HSE funded optical claims and almost three in five HSE funded dental claims (57%) were for females in 2021. Three in five (60%) HSE funded pharmacy claims were also for females.
GPs
Between 2017 and 2021, there was an almost 70% increase in the payments to GPs for persons with a medical card or GP visit card who were aged 75 years and over. For the younger cohort, approximately four in ten patients with claims under the GMS scheme were aged 24 years and under.
Pharmacies
Almost €1 billion was reimbursed annually to pharmacies under the GMS scheme between 2017 and 2021, which does not include the Drugs Payment Scheme (DPS). Three in five (60%) claims relate to persons aged 65 years and over with a cost of more than €575 million for this age cohort. The average cost per HSE funded pharmacy claim was highest for those aged 85 years and over, at €72.80 per person, and lowest for those aged 24 years and under, at €30.08.
Dentists
The number of HSE funded dental claims have fallen by more than a third (36%) between 2017 and 2021, from 1.2 million to 0.7 million treatments. The cost of HSE funded claims have fallen by a similar amount (38%), decreasing from €63.3 million in 2017 to €39.2 million in 2021. The number of HSE funded dental treatments dropped by half (50%) for those aged 25 to 34 during this period.
Almost a third (32%) of all HSE funded dental treatments were for oral examinations in 2021.
Optical
There was a 22% decrease in the number of HSE funded optical treatments between 2017 and 2021, from 787,000 treatments to 616,000 treatments. Three in five HSE funded optical treatments were for females in 2021."