The latest report echoes earlier criticisms, writes Dr Muiris Houston, Medical Correspondent
The Deloitte and Touche report echoes many of the issues raised by the Commission on Financial Management and Control Systems in the Health Service, chaired by Prof Niamh Brennan.
Its report, published in June 2003, highlighted serious accountability gaps in the General Medical Services (GMS) scheme.
The function of the General Medical Services (Payments) Board is to make payments to doctors, dentists and other health professionals who provide public health services.
In 2002, the General Medical Service overshot its €739 million budget by 25 per cent. Between 1997 and 2002, the budget for the scheme was consistently underestimated, leading to annual cost overruns. Over the same period, the cost of GP services increased by 101 per cent and the Drugs Payments Scheme (to cover the cost of drugs not covered by the GMS) rose by 217 per cent.
These findings led the Brennan report to state: "We are concerned to learn that the significant cost variations across the various drug schemes and between health board regions and the reasons behind those variations do not appear to be the subject of ongoing systematic analysis and review."
The latest Deloitte and Touche investigation, which was initiated by the former minister for health, Mr Martin, in 2003 but never published, criticises the practice whereby the GMS (Payments) Board starts the year with an in-built budget deficit.
The report recommends that doctors be given a set budget, to include a figure for drug costs, and that they be "accountable for their actions" in spending this budget.
Pharmacists, too, should feel the wind of change, according to the report. The consultants recommend that they forgo the 50 per cent mark-up on the ingredient cost of medicines that they currently enjoy under the drug payment and long-term illness schemes, to bring them into line with reimbursement methods for medical card prescribed drugs.
But the most significant and politically sensitive criticism in the Deloitte and Touche report concerns the granting of medical cards to everyone over the age of 70, regardless of means.
Referring to the role of the Department of Health and Children, which seriously underestimated the cost of extending eligibility to older people, the report says: "Any new schemes or amendments to existing schemes should be subject to vigorous prior planning and negotiation with contractors prior to announcement and implementation."
It also recommended that the Government undertake an evaluation of the cost/benefit of the over-70s eligibility extension "in the light of the significant current and prospective costs associated with this extension".
Although the analysis was written in late 2003, it is remarkably prescient. Before Christmas, the extension of medical cards to the over-70s was highlighted as one of the contributory factors in the row over the deductions of patients' pensions to cover the cost of public nursing home beds.
That decision has also been criticised for introducing inequity into primary care services.
In one go, GPs were paid four times more for looking after a "new" over-70s patient compared with a person of the same age, sex and diagnosis who had been entitled to a means-tested card all their life.
There is anecdotal evidence that this has led to a two-tier system of care for older people, with some even experiencing difficulty accessing GP care as a result.
Deloitte and Touche is yet one more report to criticise the modus operandi of our dysfunctional health service. It will be up to the newly formed Health Service Executive to incorporate its findings in the ongoing restructuring of the health system.