A new study has found that when people are issued with medical cards they tend to up their annual visitation rate to their GP, regardless of their state of health.

The research shows that people over 50 who have a medical card, on average, make two additional visits annually to their GP, even when health status and other factors are taken into account. People in these age
groups typically visit the GP 3.9 times annually, it was found.

The research report, part of the Irish Longitudinal Study on Ageing (TILDA), said this finding has important implications for the cost of introducing GP services which are free at the point of use.

The Government is planning to introduce free GP care for all by 2015, with the first phase of this scheme, providing free care to those in the Long Term Illness Scheme, expected to be introduced by the end of the year.

The report on healthcare usage in Ireland found that a person's age was not strongly associated with use of hospital outpatient services or the likelihood of being admitted to hospital, but older people did have longer hospital stays.

It also found that having a medical card increases the number of days spent in hospital, as does having medical insurance.

The study says usage of GP services and numbers of nights spent in hospital are strongly affected by poor health, as indicated by self-rating, number of reported diseases and measures of disability.

The TILDA study found that people living in Dublin are slightly less likely to visit both primary and secondary care services in comparison to those living in another town or city, or rural area in the Republic of Ireland.

Those with no additional medical care cover utilise health care services much less than those with medical card cover and/or private insurance, with the exception of emergency services. This may represent a sub-group
in society who are not accessing care services due to the costs, the researchers said.

The research also found that those who do not have medical cards are low users of community health and social services, especially those over 70.

The researchers noted that many in this category would be among the wealthiest part of the elderly population, so there may be practical as well as financial barriers in terms of access to these services.

The researchers predicted that social care services were likely to face rapidly growing pressures with an ageing population.

"The rise in the use of hospital and GP care may be relatively modest as the population ages, but the numbers needing home help and other community services are likely to rise more rapidly," they said.

The data used in the report was drawn from the first wave of the TILDA study, which covers a representative sample of 8,175 people aged over 50.

Commenting on the findings, one of the researchers, Prof Charles Normand of TCD, said to a significant extent, the study was encouraging as it shows in many instances services are focused on those most likely to need them, eg. visits frorm public health nurses and home helps are focused on those over 80.

"However, there are some disturbing messages. Recent budget cuts have tended to fall heavily on precisely the services that are likely to be most under pressure, especially those that support people to remain at home or to leave hospital when their treatment is complete."

Prof Normand said it was also diusturbing to see the extent to which thsoe withoutmedical cards were not using important services.