There's a hole in the bucket: an analysis of the impact of the medical card review process on patient entitlement to free health care.

: In 2001 the frequency of reviewing medical-card eligibility was increased. This study assessed the impact of this policy change on patient entitlement to free health care. Data on reasons for patient removal from a GP's General Medical Services (GMS) list during a two and a half year period was analysed. During this period, 1489 (89% CI 87-91%) patients from the practice list were removed for non-return of review forms. Forty patients randomly selected from patients deleted from the list in 2006 were interviewed. Sixty percent said they had not received a review form and 91% (CI 82-100%) believed they were entitled to a medical card. In the period without medical card cover, cost prevented 11% (CI 1-21%) of those who felt they were eligible from accessing medical care while 26% (CI 12-40%) paid 'out-of-pocket'. This study shows that a bureaucratic policy change has negatively affected access to health care.