Care Agreements

Expenditure management in the health care sector, part 4

We have audited the impact of the Care Agreements on the management of care expenditure between 2012 and 2015. Care costs have increased sharply since the beginning of the century and care expenditure has regularly been higher than the sum agreed in advance. The Care Agreements were made by the Minister of Health, Welfare and Sport between 2010 and 2013 with medical specialists, general practitioners, mental health specialists, patients and insurers in order to reduce the increase in the cost of curative care. We investigated what impact they had had and what the minister had done to ensure they achieved their intended effect.


The Care Agreements include both financial and substantive agreements. The financial agreements have very probably contributed to the lower growth in expenditure between 2012 and 2015. The minister recognised savings of €0.3 billion in 2012, rising to €2.7 billion in 2017, as a result of the Care Agreements. We think it unlikely that the substantive agreements made any meaningful contribution to the lower growth. We looked at the agreements regarding the efficient use of prescriptions, the implementation of the quality and efficiency agenda and the provision of second line care in place of first line care. The impact on expenditure in these areas has so far been limited.


The recommendations we made to the Minister of Health for a future series of care agreements included:

  • Ensure that substantive agreements make a meaningful contribution to the financial goals.
  • Incorporate all agreements with a financial component into the Financial Care Picture.
  • Communicate the actual growth margin for the care providers clearly.
  • Make agreements on salary and price adjustments in the care sector as well as on real growth.
  • Consult the parties on the provision of more assurances on the effectiveness of the agreements.
  • Monitor the substantive and financial relationship of new agreements.
  • To fulfil the substantive agreements, consider embedding the Minister of Health’s involvement in the agreements.


The minister agreed with our conclusion that the Care Agreements had very probably contributed to limiting the growth in curative care expenditure and undertook to improve the provision of information on the agreements. Regarding the recommendations for a new series of care agreements, the minister said she would act cautiously in view of the general election to be held next year. She would investigate whether she could make ‘bridging agreements’ with care providers for 2018 that would incorporate our recommendations. The agreements with the medical specialists and first line care providers end at the end of 2017.