Major changes to the General Medical Scheme, which provides free GP services and drugs to a third of the population, are to be recommended this week.
A report on the GMS, which suffered a 30 per cent increase in drugs costs last year, is due to be given to the Minister for Health and Children, Mr Martin, by consultants Deloitte & Touche.
In their findings, the consultants are understood to argue that the scheme must impose "a far tighter rein" on drugs and administration costs.
The Government has become increasingly concerned about the escalating cost of the GMS, which this year will be €1.4 billion, up €300 million on 2002.
The GMS finances were particularly strained by the Government's decision to offer medical cards to all over-70s, regardless of income, in July 2001. The Department of Health had believed the change would cost an extra €19 million annually, though the cost had mushroomed to €51 million a year by April 2002. The number of people with a medical card, entitling them to free GP care and medicines, increased from 1,199,454 at the end of 2001 to 1,200,162 by August 2002.
Asked by the Minister to report on the quality of the GMS's administration, and its relationship with health boards, Deloitte & Touche were told to propose "immediate resolutions" for any budgetary "weaknesses and inadequacies".
Under a 1997 review carried out by Prof Michael Murphy, general practitioners were encouraged to prescribe, wherever possible, cheaper generic drugs, though the National Centre for Pharmaeconomics has since shown that generic alternatives can be found for just 18 per cent of the patented drugs prescribed under the Drugs Payment Scheme.
Recently it emerged that GPs had been paid €12 million for patients who had died but who were still on the doctors' books. Doctors have argued they are not paid for the care of babies during the first months of their lives.
Meanwhile, the Department of Health has refused "on a point of principle" to consider Department of Finance demands last September for a €1 charge on all prescriptions, which would have raised €24 million this year if it had been implemented.
Details of the demand appeared in the Sunday Tribune yesterday.
The Department of Health and Children feared that the charge would have marked the end of the GMS, since it would inevitably be increased in future years.
Last night a Department source sought to play down the issue. "It was the normal negotiating process with Finance. You would expect them to say that. It is not going to be taken on board. It is a principle. It would be discriminatory against people with chronic illnesses. Instead, the drug refund limit has been increased on the grounds that most people will only need drugs once a year, or every few years," the source said.
