asked the Minister for Health if he will replace the fee-per-item system of payment for doctors and pharmacists in the general medical services scheme by a capitation system of payment in view of the major contribution it has made to the cost of our health services and of the potential that now exists for over-prescription and over-visiting.
Ceisteanna — Questions. Oral Answers. - Health Services Cost.
I am aware of the evidence suggesting that payment of doctors on the basis of a fee-per-item of service may result in excessive visiting and prescribing. My concern is to ensure that a high quality of general practice continues to be available to the community as a whole, including patients treated under the general medical service. The future method of payment of GPs is one of the matters to be considered by a working party which is currently reviewing the operation of the GMS.
I propose to examine the report of the working party before determining my approach to this question. With regard to pharmacists, the method of payment is not such as to influence the volume of their work.
Is the Minister aware that per head of population there are three times as many pharmacists in this State as there are in Britain and that this would appear to arise directly from the amount of money they are able to collect under the GMS?
There is practically no scope for method of payment of pharmacists to influence their work rates as such since they may dispense only what has been prescribed by doctors. The basic issue relates to the question of fee per patient contact. That would be the main area of concern.
When will the joint committee set up by the Minister's predecessor be in a position to give a report on this matter since it could be very valuable?
I expect to have the report in September and the Government's decisions relating to it incorporated in the 1984 Estimates.
What is the cost of the GMS scheme and the proportion it represents of the total health scheme? Does the Minister consider that the value obtained from that scheme is good, taking into account the cost involved?
That is a separate question.
It is not. If we are to talk about changing the GMS scheme we must know what it costs and the proportion of the total health scheme it represents. Does the Minister have those figures?
I am aware of the figures—£89 million, roughly 10 per cent of total health expenditure.
What proportion of that £89 million is given to doctors?
I do not have the current items for the 1983 Estimates here but I will publish the allocations within two or three days.