Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceTable 6.2: Pharmacy Costs (¤ )Medical CardDrugs Payment SchemeAverage Pharmacy CostNet Pharmacy Costper Cardholder (¤ ) per Claimant (¤ )Source: GMS (Payments) Board, Annual Report 2001Figure 6.2:Average Pharmacy Costs in GMS and DPS SchemesAverage Cost (£ )10005000GMSDPSIt should, however, be noted that there are legitimate reasons for variations across the twoschemes:●●●DPS claimants tend to be, by definition, heavy users of drugs and pharmaceuticals – onlythose using drugs costing in excess of ¤ 70 per month can claim under the scheme.Medical cardholders, on the other hand, are largely determined by reference to meansrather than health status. The medical card population, therefore, will contain bothhealthy and sick people and, as such, can be expected to have a lower average cost.Different cost structures exist; pharmacists receive a 50% mark-up on prescriptionsunder the Drugs Payment Scheme compared to a flat-fee arrangement under the medicalcard scheme.The medical card and Drugs Payment Schemes do not share a common approved drugslist.Nonetheless, we are concerned to learn that the significant cost variations across the variousdrugs schemes and between health board regions (see Figures 6.3 and 6.4 below), and thereasons behind those variations, do not appear to be the subject of ongoing systematic analysisand review.82
Chapter 6 Accountability – General Medical Services and Community Drug SchemesFigure 6.3:Variation in Medical Card Pharmacy Costs (2001) by Health BoardRegionAverage Cost (£ )450400350300396367383 377393353308395371MidlandEasternN. Eastern250S. Eastern200150SouthernWesternN.Western100Mid-WesternNational Average500RegionSource: GMS (Payments) Board,Annual Report 2001Figure 6.4:Variations in DPS Claimant Costs (2001) by Health Board RegionAverage Cost (£ )12001000800864961850810 800880934871 890MidlandEasternN. EasternS. Eastern600Southern400WesternN.Western200Mid-Western0RegionNational AverageSource: GMS (Payments) Board,Annual Report 200183
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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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Chapter 2 Overview and Issuesother
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Chapter 2 Overview and IssuesTable
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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
Page 59 and 60: Chapter 4 Service Planning, Budgeti
Page 65 and 66: Chapter 5 Accountability - Hospital
Page 79 and 80: Chapter 6 Accountability - General
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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 111 and 112: Chapter 8 Audit Reform●●Penalti
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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Page 131 and 132: Appendix 2SIPTU*South Eastern Healt
Page 133 and 134: 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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