Spending on State-subsidised medical service schemes has nearly trebled over the last six years, according to a consultants' report commissioned by the Department of Health.
The Deloitte & Touche report found the net cost of the General Medical Services (GMS) scheme, which includes payments in respect of medical card holders, has risen from €493 million in 1997 to €1.45 billion in 2003.
The report blamed costs associated with rate of prescribing in the Drug Payment Scheme as well as the introduction of the medical card scheme for over 70s in 2002.
The report which was initiated by the former minister for health, Mr Martin, in 2003 but never published, said the Department of Health and Children seriously underestimated the cost of extending eligibility to older people.
It warned: "Any new schemes or amendments to existing schemes should be subject to vigorous prior planning and negotiation with contractors prior to announcement and implementation."
The report also recommended an evaluation of the cost/benefit of the over-70s eligibility extension be undertaken.
It also urged that one body should be charged with overall governance and management of the General Medical Services system.