The HSE dismisses allegations that up to €400 million in unpaid hospital charges may be outstanding, but cannot give a definitive figure. Theresa Judgereports.
The Personal Injuries Assessment Board (PIAB) has rejected suggestions from the Health Services Executive (HSE) that the operation of the board could have resulted in hospitals having to wait longer for payment from patients following road-traffic accidents.
The HSE admitted last week that hospitals were owed €152 million at the end of September 2007, and that the total owed at the end of 2006 was €129 million. At the end of 2005, some €118 million was owed.
However, the HSE failed to respond to questions from The Irish Times on the percentage of this debt which was written off in each of these years and the percentage which was carried over.
The HSE issued a statement last week stressing that these yearly debt figures were cumulative amounts and that they could not be added together to give a total figure for the amount of money owed to hospitals. However, it failed to clarify how much was carried over each year.
Fine Gael TD Denis Naughten raised the issue after receiving the figures in response to a parliamentary question. He pointed out that the HSE imposed cutbacks at the end of last year to recoup a €255 million deficit when it was owed €152 million in patient debt.
In a statement to The Irish Times, the PIAB stressed that since it was set up, the average time taken to assess compensation claims following road-traffic accidents has been reduced to nine months from some three years under the litigation system. The PIAB was established in 2003.
Its statement said: "Given that the PIAB has reduced the average timeframe by over two years, both the claimant and third parties (hospitals, doctors, motor repairers) have benefited significantly from the PIAB model."
This was in response to a HSE statement which said that hospital charges arising from road-traffic accidents have "the longest collection period by far, on average three years".
The HSE statement added: "The collection rate has decreased since the introduction of the Personal Injuries Assessment Board, where awards are paid directly to the claimant and the hospital must seek payment from this award subsequently. In the past, awards which were made by the courts were paid via a legal representative, who discharged costs before making a payment of the net award to the claimant." The HSE statement appears to be suggesting that some individuals are withholding payment from the hospital after they receive compensation.
The PIAB stresses that it does not pay out compensation but makes awards and these are then paid by insurance companies to claimants, who must then pay third parties, such as hospitals and garages for car repairs.
The PIAB statement added: "If there are delays in this latter phase, it is a matter between the claimant and any third party due payment for services provided."
In both 2005 and 2006, debts due from road-traffic accidents account for about a quarter of the total amount owed to hospitals by patients.
In each of these years, about 40 per cent of the debt was for what is termed "maintenance" - charges for private and semi-private accommodation in hospitals. This debt was about €54 million at the end of 2006.
While most of this is paid for by insurance companies, some people who do not have private health insurance request private rooms, opting to pay for them out of their own pocket, the HSE said.
According to the HSE, these charges are "on average, settled in full within four to five months of the bills being issued" and that private insurers "generally pay more promptly than individuals".
However, a further comment in the HSE statement that delays "can sometimes be incurred in getting consultant sign-off of the necessary documentation" before a claim can be sent to the insurer has been rejected by the Irish Hospital Consultants Association (IHCA).
IHCA spokesman Dr David O'Keeffe says delays are being caused by a shortage of clerical staff in processing the forms before they are given to consultants to sign. This work was not generally seen as a priority within hospitals and therefore delayed.
The embargo on employment has made the situation worse, O'Keeffe says, and the irony was that hospitals needed the money from health insurers to make up for shortfalls in budget allocations from the Department of Health.
"This is viewed as management and administration and therefore a bad thing, but the work of the clerical staff keep the wheels rolling by keeping the tracks in order," he adds.
O'Keeffe says there are problems retaining clerical staff and that it is "extraordinarily difficult" to replace clerical staff who left.
Denis Naughten says that while there is a lack of clarity about how much debt is being written off by hospitals, it is clear that the amounts owed to hospitals are increasing year on year.
While he believes hospitals should be flexible when dealing with people who have genuine difficulties paying, the level of debt suggests that "there is an awful lot more that could be done to collect fees".
Given that the PIAB has fast-tracked the processing of claims, a system should be devised to ensure hospitals bills are paid as soon as claimants receive their money from insurance companies, Naughten says.