Tens of thousands of patients risk being removed from waiting lists as hospitals have been ordered to implement a 'one strike and you are out' policy to anyone who fails to keep their outpatient appointment.
The new tough policy means that a patient who has received a reminder from the hospital about an appointment they could have waited months, or even years, for will be removed from the list if they do not turn up.
It comes as the HSE revealed it could have a deficit of €105m at the end of the year unless strict measures are taken to rein in spending.
Hospitals, in particular, are in the firing line for curbs on spending and one area of wastage is the numbers of 'no shows' at outpatient clinics.
So far this year, more than 15,000 patients have failed to attend appointments and if this is not tackled it will mean 180,000 slots will have gone to waste by the end of the year.
Exceptions will be made for people with illnesses such as cancer.
But the rule from HSE hospital chief Ian Carter means thousands of others will be put at the bottom of the queue.
He added that hospitals should start a standby list of people who want to see the specialist and can turn up at short notice.
The latest performance report for the HSE, covering August, revealed that it was €93.7m over budget.
At the same time there were 374,104 people waiting to see a specialist for the first time and of these 2,236 have faced delays of four years with 84,000 in the queue for more than a year.
The HSE said it was aiming to have nobody waiting more than a year at the end of 2013. Meanwhile, there are almost 58,649 adults and children on waiting lists for hospital operations and other treatments with 6,666 waiting over eight months.
Some hospitals are seriously in the red including St James's Hospital which has a deficit of €10.3m and University Hospital Galway which has over-spent by €7.2m.
The HSE is also struggling to make up the shortfall of around €60m which was due to be generated in pay savings by the Haddington Road Agreement but will now not materialise.
The figures show the number of people who have lost their GP-visit card so far this year has reached 6,700 while the numbers with a full medical card has risen by only around 9,000.
The figures also confirm a fall in the number of people with discretionary medical cards – with many who had a full card downgraded to a GP- visit card.
The figures show that the numbers on a full card went down from 63,126 at the end of 2012 to just 53,888 at the end of August. During the same time, the number of discretionary GP-visit cards went up from 15,833 to 21,132.
This left many who are on low incomes with significant medicals bills which they have to pay out of their own pocket.