A major review of the State's health system, due early in the New Year, is expected to propose cuts in the numbers of health boards and stand-alone health agencies.
The examination of the "structures and functions" of the system was begun last June when the Department of Health awarded the contract to Prospectus Strategy Consultants.
Currently, the Republic has 10 health boards - three operating in the Dublin region under the Eastern Regional Health Authority and seven others covering the rest of the State.
The Prospectus review has taken on a particular urgency in the wake of the death of a premature baby in Monaghan, Bronagh Livingstone, whose mother was turned away from Monaghan County Hospital because its maternity ward was closed.
According to sources, the report will recommend a single health authority to cover the greater Dublin region, along with Wicklow and Kildare, and four other authorities for the rest of the State.
The Government's Health Strategy has already proposed the creation of an independent agency which would take all of the State's major hospitals out of health board control.
Equipped with a €5 billion budget, the National Hospitals' Agency would run hospitals such as Beaumont, St James's and the Mater in Dublin, and the University Hospitals in Cork and Galway.
However, there is pressure to create a national agency to take control of some common functions, such as payroll, human resources and information technology.
It is believed that Prospectus will favour limiting the control currently enjoyed by local councillors over health boards.
The Minister for Health, Mr Martin, said recently that Prospectus was "critically examining" the number and configuration of the existing 50 health boards and agencies. "The audit is now well under way and has just entered its consultative phase," he told the leader of the Labour Party, Mr Pat Rabbitte, in the Dáil last month.
The existing health board structure was established in 1970 and, outside Dublin, has largely remained unchanged. The alterations made in Dublin have, according to critics, simply increased the numbers of managers.
Mr Martin is under strong pressure from Cabinet colleagues to impose reforms on the health system, which is now the Government's single biggest spender.
Besides billions to cover current spending, a further €2.6 billion has been promised for capital projects between 2000 and 2006 in spite of the downturn in the Government's finances.
In the first six months of 2002, day-case patient numbers increased from 208,000 to 238,000 compared with the same period in 2001. At the end of September, 6,273 adults had been waiting more than a year for in-patient treatment, while the numbers of children waiting more than six months stood at 1,201.
