Health Minister James Reilly has admitted that 2014 will be a 'massively challenging year' for the health service, with €666 million in cuts and savings targeted, particularly at medical card holders.
The savings target is higher than was predicted in recent days - Minister Reilly admitted that 2014 would be the most challenging year yet for the health service.
He said the out-turn for 2013 for the health service had been €14.21 billion, and the budget would be €13.66 billion for 2014.
The targeted €666 million in health savings next year have been broken down into a number of measures, including €341 million in savings on the medical card scheme and drug costs, and €268 million in pay-related savings.
According to the Department of Public Expenditure, the €666 million in savings has to be achieved to meet the overall health expenditure ceiling reduction of €361 million in 2014, Programme for Government Commitments of €57 million and health service pressures of €248 million.
Commenting on the hike in prescription charges to €2.50, Minister Reilly referred to the problem of overprescribing in the elderly, and stressed that sometimes patients did not necessarily need a pill for every illness.
The health Budget savings include separate 'probity measures' on medical card validation, targeting savings of €113 million. The details of this measure are as yet unclear, with the Department of Health stating that this process would 'improve the accuracy of the medical card system'.
Fianna Fail has claimed around 100,000 current medical card holders could be under threat of losing their cards under this measure.
"This new target of saving €113 million will likely see more than a hundred thousand additional people lose their cards working on the basis that the average cost per card is €1,000," the party's health spokesperson Billy Kelleher claimed.
In addition, it has been announced that unemployed people with medical cards who return to work will automatically lose their full cards and will instead get a GP visit card. Until now, they were able to retain full cards for three years - 22,000 people will lose full medical cards under the new measure.
The Minister, addressing a press briefing on the health Budget measures, said free GP care for children five years old and under would be introduced by the middle of next year.
He said parents had in the past found it difficult to pay for GP care for their children and this had been a real barrier to care.
He said legislation would be necessary to introduce this scheme.
Junior health minister Alex White said the Department would be engaging with doctors' representative groups on the free scheme for under fives. However, he stressed that health policy was ultimately made by Government.
Minister Reilly said free GP care for the whole population would be introduced by 2016.
HSE Director General Tony O'Brien, addressing the press briefing on the Budget, said the targeted €150 million savings on the Haddington Road pay deal would not be achieved this year - the final savings were likely to be €110 million.
The health measures in the Budget provide for a cut in health staff numbers of 2,600 in 2014. This, the Department of Health says, will be achieved through natural attrition, retirements and initiatives such as career breaks and targeted voluntary redundancies.
The doctors' union, the IMO, criticised the Budget health measures.
IMO President Dr Matt Sadlier hit out at the decision to remove medical cards from thousands of people and to hike prescription charges again.
On the planned €113 million in probity savings on medical cards, Dr Sadlier said this threatened to be a 'witch hunt' against card holders.
The Irish Hospital Consultants Association expressed concern that the €666 million cuts target would affect services and hit patient safety and patient care.
Minister Reilly revealed that the overrun in this year's health budget was currently projected to be of the order of €150 million, and a supplementary allocation would be needed.
He said €200 million would be provided towards the cost of the new children's hospital from the sale of the National Lottery licence.
Precise details of the impact of next year's cuts will become clearer when the HSE produces its 2014 service plan later this year. Mr O'Brien admitted this service planning process would be very challenging for the HSE.
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