THE health service must endure €666m in cuts and savings in its €13.6bn budget for next year – so the worst may be yet to come.
Health Service Executive (HSE) chief Tony O'Brien said it will be the most challenging year since it was set up in 2005.
The HSE has yet to draw up its 2014 service plan which will reveal the full extent of where the pain will be felt.
Before that an interdepartmental group from health, public expenditure and the Department of the Taoiseach will for the first time assess the impact of the cuts and verify the figures earmarked for savings.
The HSE is to need a bailout of between €150m to €200m this year.
It was due to make savings of €150m under the Haddington Road agreement but this will now only reach €110m. Health Minister James Reilly also warned it is going to be a "massively challenging year".
"These are the figures we have been given and we have to ensure the budget we have been given ensures a safe service."
The HSE hopes to make around €50m in savings from the greater use of generic drugs and it is to start introducing reference pricing shortly on a phased basis beginning with statins in November.
It is also planned to increase the financial penalties on retailers who sell cigarettes to minors. Currently the one-off fee is €50.