A confidential consultants' report to Government recommended a review of the controversial decision to provide medical cards to everyone over the age of 70 regardless of means.
The report by Deloitte and Touche, submitted to the Department of Health over a year ago but never published, also urged that one body should be charged with overall governance and management of the General Medical Services system.
It recommended that the Government should carry out an evaluation of the cost/benefit of the extension of the medical card scheme to everyone over 70.
It said that this should be done "in light of the significant current and prospective costs associated with this extension".
The abolition of means tests for medical cards for everyone over 70 was hugely controversial when announced by the Government four years ago. It was criticised strongly by both the opposition and doctors' groups who said it was inequitable.
The number of people potentially eligible to benefit was grossly underestimated, and the overall scheme ended up costing about €30 million more than originally anticipated.
The Deloitte and Touche analysis was commissioned at the end of 2002 by the then minister for health, Mr Martin, and given to Government at the end of 2003.
The report, seen by The Irish Times, also recommended major changes to the way GPs and pharmacists operate and are paid.
The report suggested that there may be more errors in the system of registering patients for free and subsidised treatment and medication similar to the problems which led in recent years to a multi-million euro over-payment to GPs for looking after medical card patients who had died or were otherwise ineligible.
The Deloitte and Touche report also called for the introduction of "budget holding" for GPs working in the medical card scheme. This would be likely to involve doctors being given a set amount annually for their practice to pay for medical treatment and drug costs for patients.
It recommended that there should be protocols established for drug prescribing, as well as the introduction of monitoring of prescription data to ensure appropriate and effective prescribing patterns.
The report also urged that there should be a cap on the amount paid out under an incentive scheme for doctors, which aims to encourage greater use of generic or lower-cost drugs.
The consultants' report also proposed that pharmacists should be paid on a fee for service basis for dispensing medicines under the drug payment schemes and the long-term illness scheme.
It urged the abolition of the controversial system of allowing pharmacists a 50 per cent mark- up on the ingredient cost of the product dispensed under these schemes.
The report maintained that there is an urgent need to establish a central client eligibility index within the GMS system so as to avoid the problems which emerged in recent years with doctors being paid for looking after thousands of patients who were ineligible.
The report has been under consideration by the Department of Health for over a year.
