Health Minister Simon Harris wants to dismantle the crisis-ridden HSE and replace it with a "slimmed down body".
In a submission made to an Oireachtas committee, Mr Harris has outlined his eight-point vision for the health service based largely on the development of Hospital Groups and Community Health Organisations.
He also argues that new legislation should be introduced in the interim to "improve governance arrangements for the HSE for so long as the HSE continues in its current form".
In 2015, Mr Harris's predecessor Leo Varadkar promised the HSE would be dismantled within five years if Fine Gael was returned to power at last year's election.
And back in 2011 then-minister James Reilly was given approval by Cabinet to draft legislation to allow for the gradual abolition of the HSE structure.
However, after taking over the ministry Mr Harris supported the setting up of an Oireachtas Committee on the Future of Healthcare, which is to devise a 10-year plan for the health service.
A submission by Mr Harris circulated to committee members last night sets out an eight-point plan for reform.
The document, seen by the Irish Independent, states the minister believes there is "a certain amount of reform fatigue" but "this is the last chance for a generation to get this right".
His plan includes devolving greater decision-making and accountability to Hospital Groups and Community Health Organisations.
"Follow this with the provision of a statutory basis for Hospital and Community Health Organisations, operating as integrated delivery systems within defined geographic areas," the submission says.
Mr Harris will tell the committee this approach will bring decision-making "closer to the point of care and deliver a counter-weight to the over-centralisation of decision-making and accountability which impedes service responsiveness".
The minister adds that, subject to the committee's report, he intends to ask the Department of Health to come forward with proposals to improve governance arrangements for the HSE "for so long as the HSE continues in its current form".
"This will include examination of the current vesting of governing authority in the HSE directorate, including the fact that the director general is responsible to the directorate for the performance of his or her functions," his statement says.
Mr Harris says that even after the HSE is abolished, he still sees the need for a body to oversee the coordination of localised hospital groups.
"The national health capability which takes the place of the HSE is likely to be a slimmed down body; one more equipped to lead than to directly control and, accordingly, with less management layers between the top and the front line," he will say.
Such a move is likely to require significant redundancies in the health service.