med cards
It's not philanthropy on the part of the govt. Basically, they'll give you a medical card if it works out cheaper for them than not giving you one.
The price paid to pharmacies for prescriptions for non-medical card holders is cost price + a % mark-up + a dipensing fee (i.e. the profit to the pharmacy is the % mark-up + the fee). The first €78 in any month is paid by the patient, and the excess over that is paid by the govt.
In contrast, the price paid to pharmacies for medical card prescriptions is cost price + a dispensing fee (i.e. the pharmacy receives no profit on the goods, just a fee per item dispensed). This is all paid by the govt.
Now, consider a case where a patient is on expensive medication - say €500 cost, or €750 with a 50% mark-up. If the patient has no medical card, they will have to pay the pharmacy €78 and the govt will pay the remaining €672 to the pharmacy. If the patient has a medical card, they pay nothing and the govt only pays €502-€503 to the pharmacy (cost price + fee). It's win/win for the patient and govt (though the pharmacist loses out). The higher the medication cost - particularly if it's a condition the patient is likely to have for some time - the more money the govt saves by giving them a medical card. Of course, if the patient's medication is only cheap, then it's cheaper for the govt not to give them a medical card and then they have to pay the first €78 themselves.
That's the main criterion the govt will use for deciding whether to award a medical card or not - it's not a caring sharing thing.
(Note, there is a separate long-term illness (LTI) scheme for a very limited list of medical conditions that operates differently - patients with these conditions are automatically entitled to free medication for that specific condition only - not any other illnesses they may also have - and the pharmacy gets cost + mark-up + fee in payment.
LTI conditions are:
Diabetes mellitus
Multiple sclerosis
Hydrocephalus
Diabetes insipidus
Muscular dystrophies
Spina bifida
Epilepsy
Acute leukaemia
Cerebral palsy
Haemophilia
Phenylketonuria
Mental illness (<16 yrs only)
Parkinsonism
Cystic fibrosis
Mental handicap