Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceCHAPTER 6ACCOUNTABILITY – GENERAL MEDICAL SERVICESAND COMMUNITY DRUG SCHEMESIn this Chapter, we examine the accountability issues to be addressed in the General Medical Services (GMS)and the Community Drugs Schemes, particularly the Drugs Payment Scheme.6.1 OVERVIEWPrimary care contractors are a crucial part of the health service infrastructure. In manyinstances, the General Practitioner (GP) and pharmacist link the service user to the healthsystem. A modern, effective health service requires quality standards and value for money in allaspects of primary care.The cost of the GMS has increased rapidly in recent years. In our view, action is required on anumber of fronts. Accountability issues that must be addressed include the services requiredand provided by GPs within the GMS and the publicly funded drugs and medicines schemes asthey currently operate.We believe there is significant room for improvement. The increases in expenditure on theGMS, discussed in Chapter 2, are further examined in this Chapter. The figures make acompelling case for reform.6.2 GENERAL MEDICAL SERVICES (PAYMENTS) BOARDThe function of the General Medical Services (Payments) Board is to make payments due undermedical cards, drug subsidisation, long-term illness and dental treatment service schemes as wellas a range of community-based services. It is the role of the Board to calculate, verify and makepayments under the various schemes and to compile statistical information.The greatest costs covered by the GMS (Payments) Board arise in respect of the medical cardscheme and the Drugs Payment Scheme (Table 6.1). Of the population, 31% are covered bymedical cards and the balance of 69% are eligible for the Drugs Payment Scheme.76
Chapter 6 Accountability – General Medical Services and Community Drug SchemesTable 6.1: Grants to GMS (Payments) Board to cover the Medical Card andCommunity Drug Schemes1997 1998 1999 2000 2001 2002 1 % increase(¤ m) (¤ m) (¤ m) (¤ m) (¤ m) (¤ m) 1997-2002(¤ m)Medical card 361 400 543 551 653 922 155%of which:-Drugs, medicines, appliances 188 202 292 304 375 514 173%-Fees to GPs/pharmacists 149 174 216 211 239 373 150%Drugs Payment Scheme 86 109 142 185 252 276 221%Other drugs refund schemes 2 37 52 50 60 74 76 105%Total 3 483 561 735 795 978 1,274 164%% year-on-year increase 16% 31% 8% 23% 30%Source: Revised Estimates for Public Services, 1998 to 2002; Department of Health and Children6.3 MEDICAL CARD SCHEMEAs shown in Table 6.1, the costs associated with medical cards are the most significant elementof those met by the GMS (Payments) Board. All persons aged 70 years and over, regardless ofmeans, as well as persons under 70 years who are unable without undue hardship to arrangeGP medical and surgical services for themselves and their dependants receive a free generalmedical service. Medical card holders are entitled to free GP medical and surgical services andto free prescription drugs, medicines and appliances through their local participatingpharmacist.Drugs, medicines and appliances supplied under the scheme are provided through retailpharmacies. In most cases, the GP gives a completed prescription form to a person, who takesit to any pharmacy that has an agreement with a health board to dispense GMS prescriptionforms. In rural areas the doctor may dispense for those persons who opt to have theirmedicines dispensed by him/her. This aspect is covered in more detail in the following section.GP Capitation and Other FeesThe arrangements for paying capitation and other fees to GPs in respect of their medical cardpatients are summarised below. Fees and allowances fall into three categories:●●●Standard capitation fee;Additional fees for outside hours work; andAdditional fees for certain services.Under their contract for service, GPs receive a capitation fee in respect of each medicalcardholder registered with their practice. The fee is paid regardless of whether the medical1Figures shown for 2002 are the allocation as per the Revised Estimates for Public Services 2002 plus an additional ¤ 191 millionprovided, by way of supplementary estimate (¤ 183 million in respect of medical card expenditure and ¤ 8 million in respect ofthe Drugs Payment Scheme). 2Includes Long Term Illness Scheme, High Tech Medicines Scheme and Hardship Scheme.3Rounding may affect the totals.77
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Commission onFinancial Managementan
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TABLE OF CONTENTSEXECUTIVE SUMMARY
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6.4 COMMUNITY DRUG SCHEMES 80Medica
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Executive SummaryEXECUTIVE SUMMARYT
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Executive SummaryWe do not underest
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Executive Summary"demand-led" schem
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Terms of ReferenceTERMS OF REFERENC
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GlossaryEstimates for Public Servic
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Chapter 1 Introduction and Backgrou
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Chapter 1 Introduction and Backgrou
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Chapter 2 Overview and Issues2.2 OR
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Chapter 2 Overview and IssuesAppend
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Chapter 2 Overview and IssuesFigure
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Page 41 and 42: Chapter 2 Overview and IssuesProble
Page 43 and 44: Chapter 3 Managing the Health Servi
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Page 65 and 66: Chapter 5 Accountability - Hospital
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Page 81 and 82: Chapter 6 Accountability - General
Page 89 and 90: Chapter 7 Accountability - Employme
Page 101 and 102: Chapter 8 Audit ReformCHAPTER 8AUDI
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Page 107 and 108: Chapter 8 Audit Reformaudit reports
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Page 113 and 114: Chapter 9 External Reporting Proced
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Page 123 and 124: Chapter 11 ImplementationRecommenda
Page 125 and 126: Chapter 11 Implementationbeing brou
Page 127 and 128: Appendix 1Appendix 1COMMISSION MEMB
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Appendix 1He has held this position
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Appendix 2SIPTU*South Eastern Healt
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Appendix 3Name of AgencyBord na Rad
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Appendix 3Name of AgencyIrish Blood
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Appendix 3Name of AgencyWomen’s H
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Appendix 4Department of Health and
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Appendix 4collated and assessed by
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Appendix 4The most detailed element
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Appendix 4Ratifying and Submitting
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Appendix 4changes to the Service Pl
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Appendix 4advised of their existenc
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Appendix 4Approvals Required in lin
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Appendix 5Appendix 5DIAGNOSIS RELAT
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Appendix 5Figure: Ax.1 Casemix Adju
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Appendix 6Appendix 6AUDIT OF STRUCT
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Appendix 7(vii)(viii)(ix)participat
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Appendix 8Appendix 8 - Integrated M
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ADDENDUMNumber Recommendation IT Ti
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Number Recommendation IT TimeframeR
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Brennan Report - Department of Health and Children

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