HSE Chief Executive Bernard Gloster has said that he wants to see an end, by next June, to public hospitals getting insource funding from the National Treatment Purchase Fund (NTPF) to cut waiting lists.
He has made the recommendation to Minister for Health Jennifer Carroll MacNeill.
A review of the funding's value over 27 months found that it was worth around €100m.
Mr Gloster told the Oireachtas Committee on Health there is an overreliance on this system by public hospitals to support core care, that the dependency must end and there are risks with the system.
It comes after recent controversies involving funds provided to three public hospitals by the NTPF to cut lists.
A new HSE report revealed that Naas General Hospital is also the subject of an internal audit.
Previously, a Children's Health Ireland hospital and Beaumont Hospital in Dublin had been identified as facilities where internal audits were under way for different reasons.
The insourcing work involves public hospitals engaging external companies or third party suppliers to deliver services, often outside of normal working hours and using HSE-owned equipment facilities and equipment.
In many cases, the outside providers may employ or subcontract staff who are already directly employed by the Health Service Executive, effectively reengaging internal staff through a separate commercial arrangement, typically at premium rates.
The review amounted to over 253,400 instances of care, much of it funded by the NTPF.
Mr Gloster said that what he is referring to as insourcing, is not the use of standard overtime within employment contract arrangements of existing HSE staff.
The 27-month review covered 2023/2023 and the first quarter of this year.
It identified an outsourcing and insourcing spend of €1.1 billion for the period.
Most of this was for outsourcing, ranging from securing private hospital care to private ambulances and laboratory products.
Not all outsourcing was for waiting list management.
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Ms Carroll MacNeill asked Mr Gloster earlier this year to conduct a national review, with a particular focus on insourcing, and the level of activity and dependency on it.
He submitted that report to the minister this week.
Mr Gloster said that insourcing by its nature carries risks, he has agreed with the minister the need to reduce these risks, and increase the safeguards and remove dependency on insourcing.
The NTPF suspended insource funding to Children's Health Ireland in May after a leaked report found that a consultant at one hospital had breached guidelines by referring patients to the doctor's public outpatient weekend clinic.
Funding was later restored after the NTPF secured assurances from CHI.
The NTPF also suspended funding to Beaumont Hospital in April due to a separate issue to what was found in the internal CHI review.
The Beaumont concern did not relate to a consultant-led issue.
In March, Beaumont Hospital had approached the NTPF of its own volition about activity conducted as part of insourcing work under the waiting list initiative. An independent review of the matters is under way by the HSE's Internal Audit Team and the committee heard previously that it involves potential financial irregularities.
83 current, former health service staff acting as company directors
The HSE report found that 83 current, or former health service staff, have been acting as directors in 148 companies, providing insourcing or outsourcing services for public hospitals to cut waiting lists.
The report said that of the 83 individuals, 58 were HSE and 25 were with Section 38 health agencies, funded by the HSE.
Of the HSE individuals, 35 are former employees and 23 are serving.
Mr Gloster noted that there is nothing unlawful in being a company director, and there are equally obligations in respect of Standards in Public Office and or employment contract terms.
However, these issue were not assessed for this preliminary analysis.
"More testing and refinement is needed however this notwithstanding, I am advised than in an audit context this is a higher end level of return on such a search," Mr Gloster stated in the report, published by Minister Carroll MacNeill and provided to health committee members.
The analysis looked at 148 companies covering 365 listed directors and compared names, date of birth and address, against current and former HSE employees. There were 93 matches.
The report said there is a need to put in place more robust safeguards following recent reports and events that have affected public confidence.
