Thousands of people turning up at hospital A&E units across the State are failing to pay A&E charges as required, new figures show.
Data obtained by The Irish Timesindicate hospitals are now owed millions in A&E fees by patients.
Figures provided by 34 hospitals show they were owed a total of €8.29 million in A&E fees at various stages during 2006.
One Dublin hospital alone - St James's - had A&E fees outstanding at the end of July last worth a total of €1.62 million.
And a second hospital in Dublin - Tallaght Hospital - is owed €1.19 million.
The fee for attending A&E without a letter of referral from a GP and without a medical card is €60.
It was increased to this amount in the November 2005 Estimates by Minister for Health Mary Harney, who said the increased charge would facilitate more appropriate attendances at A&E units and relieve overcrowding there.
It was believed if the fee was set sufficiently high patients would use their GP, which in most cases would be cheaper, as a first port of call instead.
However, reports commissioned by the Health Service Executive last year showed thousands of patients were bypassing GPs and going directly to A&E for medical help.
The reports by UK healthcare consultancy Tribal Secta indicated that in 2004, over half, or 54 per cent, of people who presented at University College Hospital Galway had not gone to a GP first.
At Cork University Hospital 44 per cent of those attending A&E had not seen a GP and at Wexford General Hospital 41 per cent of people self-referred.
And now the figures for unpaid A&E fees indicate many people who bypass their GPs are getting away with not paying A&E charges either.
While some hospitals have engaged the services of debt collection agencies and solicitors to try and recoup the money owed, the reality is that it could cost more to recoup the €60 than the fee itself would be worth, with the result that charges in some instances are eventually written off as bad debts.
The figures for unpaid A&E fees for each hospital with an A&E department have been obtained from the HSE and in some cases the total amount of money owed goes back a number of years.
The total money owed to 34 of the State's 35 hospitals with A&E units at the end of 2005 stood at €6,639,180.
Only one hospital with an A&E unit, the Mercy Hospital in Cork, could not provide data.
The total owed continued to grow in 2006 and stood at more than €8 million when data was provided by most hospitals in recent weeks.
The HSE said that for those arriving at A&E units the circumstances are often difficult and it recognises the challenges this presents for the enforcement of payment.
"However, all hospitals do seek payment at source initially and all also follow through with internal arrangements to recoup subsequent outstanding debt," the HSE statement said.
"Many also follow through with debt collection agencies, introducing these services after they have initially exhausted internal procedures.
"However, as these agencies usually charge per fee and the number of individual outstanding charges is substantial, the cost of pursuit of all these debts is significant," it added.
Furthermore the HSE said not all hospitals have out-of-hours administrative facilities to collect charges from patients arriving in A&E at night time or at weekends.
These hospitals were "currently exploring the feasibility of increasing their level of administrative cover overnight," the HSE added.