PUBLIC patients who fail to turn up for a hospital outpatient appointment are facing potential fines of at least €20.
Health Minister James Reilly said he wanted the fee imposed on people who have been reminded of their appointment but fail to attend.
He said they should be charged at least €20 when they eventually attend the clinic.
The minister, who was speaking at the Joint Oireachtas Committee on Health and Children, admitted that some people can be waiting up to four years to see a consultant and may simply forget the date they should attend or seek treatment elsewhere.
Hospitals should text a patient a week in advance of the appointment and also remind them the morning they are due.
He said respect was a two-way process and he believed it was gratuitously insulting for hospitals to call 30 patients for a 9am appointment.
The most recent figures show that 38,108 people failed to keep their outpatient appointment in September even though 385,462 are on a waiting list to see a specialist or have an assessment. Of these, 11,805 are on lists for over two years.
A target has been set that nobody should wait for a first time outpatient appointment for more than a year from November 2013. The target is to decrease to 26 weeks by November 2014 and 13 weeks by November 2015.
Questioned about plans to introduce free GP care for all, Dr Reilly said negotiations had yet to begin with doctors' organisations.
However, he said there is a strong incentive for doctors to be part of state schemes, pointing out a substantial list of medical card holders generates an income of €500,000 for a practice while the equivalent number of private patients would yield just half that sum.
He said he did not yet know how much the health service will need in the form of a supplementary estimate from the Department of Health to allow the HSE to balance its books.
Next year there would be better money management in the HSE that would avoid having to pull the breaks on spending in the latter part of the year, the minister said.
"Nobody wants to be cutting home helps and home care.
"Next year that is not going to happen. The way we have done budgeting in the past means we make hard, snap decisions late in the year which are tantamount to vandalising the system."
Six experts on accountancy were working in different areas of the health service, the minister told the committee.
"We must have more transparency about budgets," he said.
Each area will be responsible for its own budget covering for instance mental health and hospitals. He indicated hospitals may be spared severe cuts next year, saying they had already been cut to the bone.
"We don't want to be cutting services but cutting the cost of service. We want to work in different ways," he added.