THE HEALTH Service Executive (HSE) wanted the new single capitation rate for general practitioners treating medical card patients over the age of 70 to be set at €158 – nearly half the level subsequently agreed by the Government.
In its submission to the independent fee-setting process, the HSE argued that such a fee rate would generate savings of €68 million.
Following the independent analysis GPs have, since the beginning of the year, been paid a fee of €308 for treating medical card patients over the age of 70. This includes a recent increase under the national pay deal.
The Irish Timesrevealed last week that the Irish Medical Organisation (IMO), which represents GPs, had sought a new single capitation rate of €369 per patient.
The introduction of a new single capitation fee for GPs emerged following the controversy surrounding the Government’s decision in the Budget in October to scrap the automatic entitlement to a medical card for everyone over 70 which had been introduced in 2001.
The new single payment replaces what was effectively two sets of fees paid to doctors for treating patients over 70 with medical cards: an average of €161 paid in respect of those who qualified for the medical card on grounds of low means prior to the 2001 deal; and an average of €640 per annum paid to GPs for medical cards awarded on the grounds of age following the 2001 agreement.
In its submission, the health service contended that the Government’s new single rate for the overall cohort of medical card patients over 70 needed to be nearer to the previous average capitation for those who received their cards on “means” grounds rather than the average paid in respect of those who qualified on age grounds.
“There is no sustainable service argument for a single capitation rate that is significantly above the current average for ‘means’ cards. The need to decide on a rate that will be acceptable to the service providers, under the circumstances, is acknowledged.
“The new single capitation rate needs to return significant savings,” the health service maintained.
The HSE argued that if the former average capitation for “means” cards were to be universally applied to all over-70 medical card patients, the annual cost would be €51 million (323,000 cards at €158.56), generating an annual saving of some €68 million (€119 million less €51 million).
In its submission the HSE also said there were “undoubtedly further efficiencies to be gained from more focused and better structured prescribing in Ireland, both in terms of clinical leadership and frameworks and for greater generic use”.
It maintained that these efficiencies should be pursued.
However, it said it was clear that as a result of the agreement on costs with the pharmaceutical industry in 2006, the premium for proprietary drugs had largely been removed and that the price of these products was now much closer to that of generics.
The HSE said the scope for significant savings through generic prescribing was “more limited in the current market than might be expected”.
“Where there is significant scope for releasing benefit to the patient and the taxpayer is in pricing further along the supply chain.
“While Irish ex-factory prices are moving towards the EU average, retail and reimbursement prices [respectively, what patients and the HSE pay retail pharmacy] remain amongst the highest in Europe. This is a function of the 50 per cent mark-up that patients pay, on top of dispensing fees, and the cost of wholesale services to the customer, which at 17.66 per cent is over twice what the retail sector actually pays for distribution,” it said.
“This allows a very high level of bonusing and discounting between wholesale and retail that the customer pays for, in particular in the generic market, the benefit of which is not released to the HSE or to patients through better retail prices,” it said.