One of the main proposals under consideration is to make patients responsible for the initial costs of medical treatment, before charges are then picked up by the health service.

At the present time, the health service meets about 70% of the costs of medical treatment, with the remainder funded through voluntary top-up insurance contributions by patients, or direct payment.

Each time you visit a doctor you are required to pay a €1 excess charge, which is not reimbursable through the voluntary insurance system.

It may well be that this €1 charge will increase to up to €10, and may be extended to include prescriptions, laboratory tests and specialist consultations. Other methods of imposing this ‘health excess’ are also being examined.

It is not yet clear whether the government will allow the new charge to be recovered through voluntary insurance.

If they do, then it is inevitable that insurance premiums will increase, and patients who have not taken out top-up insurance, will pay increased costs each time they seek medical treatment.

Other measures being proposed include a reduction in some of the tariffs paid to certain medical specialists, greater controls on the price of medicines from manufacturers, increased controls on the battle against fraud, the transfer of new responsibilities to reduce the demands on doctors, and greater use of 'generic' over 'branded' medicines.

Not surprisingly, the medical profession is outraged about the proposals, and there is likely to be strong resistance from them to any reduction in their fee tariffs.

There is already loud protests from the health insurers, who consider that their computer systems would not be able to cope with a complex system of excess charges imposed on patients.

Since 2004 the government has pursued a range of measures to try and bring down the level of health spending, but without significant success.