At the time in Ireland (2013), the General Medical Scheme (GMS) was in operation and covered some families and their children. This provided a full medical card or a GP-only card to those who met certain eligibility requirements. The ‘full medical card’ provided access to GP services and associated costs of medicines and prescriptions. The ‘GP only’ card provided access to GP services only. Cover under the scheme (for both the ‘full medical card’ and the ‘GP only’ card) was means-tested at the time of the survey, as the introduction of free GP visits for children under six did not take place until July 2016. In the course of the interview, the Primary Caregiver was asked to indicate whether or not the five-year-old was covered by the General Medical Scheme (GMS). Overall, 40% were covered by a ‘full card’ and just less than 4% were covered by the ‘GP only’ card. Figure 3.12 shows the variations in rates of cover according to the family’s background and circumstances. As would be expected, in view of the medical card being means-tested, rates of cover were significantly higher among the socially disadvantaged groups (as illustrated in the figure by social class). Reflecting the socio-demographic composition of different family types, the percentage of five-year-olds with GMS cover in one-parent families was much higher than in two-parent families.
Figure 3.12: Percentage of 5-year-olds covered by a medical card, classified by family social class, family type and health status of Study Child
The Primary Caregiver was also asked to record how many times in the previous 12 months s/he had seen or spoken via telephone with a general practitioner (GP) about the Study Child’s physical or emotional health. The average number of consultations across all five-year-olds was 2.1. As shown in Figure 3.13, the frequency of GP consultations was closely related to a number of family characteristics, including family income. Families in the higher two income quintiles had a significantly lower average number of consultations than those in the lower three quintiles. Also, the number of GP consultations was significantly higher for families with lower levels of education – 2.6 visits where the Primary Caregiver had left school with Junior Certificate or less, falling to 1.7 in families in which the Primary Caregiver was a graduate. Socio- economic differences in health status as well as differences in the coverage of GP visits by medical cards are both likely to be important in accounting for these GP consultation patterns.
% of 5-year-olds 0 10 20 30 40 50 60 70 80 90 100
Full Card GP Only Not Covered
Professional / Managerial
Non-manual / Skilled
Semi- / UnskilledNever Worked
One parent, one child One parent, two+ childre
n Two parents, one child
Two parents, two+ childre n
Very healthy, no problems Healthy, but a few minor problems
Sometimes quite ill / Almost always unwell
15 51 68 94 79 85 30 33 37 47 64 3 5 5 2 4 2 5 4 4 4 3 82 44 27 5 18 13 65 63 59 49 33
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Figure 3.13: Average number of consultations with a GP, classified by family income quintile, Primary Caregiver education and Study Child’s health status
As one would expect, the average number of consultations was also strongly related to the child’s health status: 1.4 where the child’s mother described the five-year-old as being ‘Very healthy, no problems’, rising to 3.6 where the child was described as ‘Healthy, a few minor problems’ and to 8.9 in cases where the child was described as ‘Sometimes quite ill/Almost always unwell’. This trend has previously been identified in the older Cohort ’98 at nine years of age and also in the younger Cohort ’08 at three years of age (see Williams et al., 2009, 2013).
Therefore, a possible explanation for the greater number of GP consultations among more disadvantaged families is that the health of children in these families is worse. To explore the possible explanations for the observed relationships, Figure 3.14 summarises the average number of consultations by combined GMS cover and health status of the five-year-old. The message from the chart is clear; across all three categories of maternal-assessed health status, children covered by a medical card had a higher number of consultations with their GP in the previous 12 months than those not covered under the GMS. The difference in the average number of consultations among the children in the ‘Sometimes quite ill/Almost always unwell’ group (10 compared with 7) was not significant, however. As Nolan and Layte (2017) note, medical-card entitlement among more disadvantaged families permits greater use of GP services by removing the financial barrier the family might otherwise face. However, as the authors note, even controlling for differences in health status, eligibility for free GP care would be expected to increase the number of consultations, as also shown in Figure 3.14.
1st
(Lowest) Cert or Junior less
Leaving
Cert Certificate / Diploma or more Degree healthy Very Healthy / Minor problem Quite ill / Unwell 5th (Highest) 2nd 3rd 4th Number of GP Consultations 0.0 2.0 4.0 6.0 8.0 10.0 12.0 2.3 2.3 2.2 1.7 1.6 2.6 2.2 2.0 1.7 1.4 3.6 8.9
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Figure 3.14: Average number of GP consultations on the 5-year-old in the last 12 months, classified by health status and whether or not covered by a medical card (‘full’ or ‘GP’ card)