Some €167 million in maintenance charges owed by private health insurers was outstanding to the HSE and voluntary hospitals at the end of last year, it has emerged.
The figures are published today in the annual report of the Comptroller and Auditor General for 2008.
It says the low rate of income recovery from patients who were treated privately in the 24 hospitals reviewed “would suggest that the State is facilitating private medicine without getting the related income for the service it provides”.
Some 50 per cent of private in-patients are not charged for their accommodation, the C&AG says. Hospitals cannot charge for those patients that have private health insurance and are accommodated in a private bed, but who are treated by a so-called ‘category A’ consultant.
“Overall, a mismatch exists between the number of patients who present as private patients, the number who are treated as private patients and the number of privately treated patients whose accommodation costs are recoverable by hospitals,” the C&AG says.
The report says €87 million in total was due to the HSE and €77 million was due to the voluntary hospitals and that many of the charges had been outstanding for “a considerable period of time”.
Average daily costs for 2009 for maintaining a private in-patient are €1,018 and €733 for day cases. For semi-private in-patient cases, the average daily maintenance cost is €913, and €885 for day cases.
Accounting officers for the HSE told the C&AG the delays were mainly due to the fact that the entire system continues to be paper based, and to delays in getting individual consultants to sign off on their claim forms and paperwork.
The difficulties varied considerably between hospitals, “depending on the willingness of individual consultants to sign off their own claim forms promptly”.
The C&AG was assured that each of the hospitals was taking action to improve the speed of collection of such fees.
According to the report, Minister for Health Mary Harney also recently met with the largest insurance provider and the HSE and secured agreement for an advance payment of €50 million to the HSE for 2009 for work already undertaken, as well as an agreement to work together to improve the processing of private insurance claims generally.
The C&AG said the full economic cost of maintaining private patients is not being levied.
“However, there has been an increase in recent years in the proportion of that cost recovered, and fees have been substantially increased in 2009.
“The Department [of Health] has set up a group to establish the most appropriate way of charging the economic cost of providing services to private patients in public hospitals.”
In November last year, the HSE also set up a working group to liaise directly with the private health insurers in relation to streamlining the transaction processes and exchange of data. It will also examine billing and payment methods, the level of debt outstanding, the implications of recent changes in the consultant contract and the administration of the private insurance claims process.
Labour Party health spokeswoman Jan O'Sullivan said the findings were "proof positive that the system of delivering healthcare in Ireland is broken beyond repair".
"It is high time that we moved away from the dysfunctional, public/private hybrid, two-tier system that we currently have, to one where all patients receive the same high quality treatment," she said.
"At a time when the Government is looking for €800m in health cuts next year - cuts which cannot be delivered without impacting heavily on frontline services - it is absolutely imperative that this money is collected in full."
"The C&AG has once again pointed out that new the consultants contract means that the public system is precluded from recovering the cost of treating of patients treated by consultants who have opted for a Category A (public only) contract. This situation whereby the public patient is effectively subsidising the private patient cannot continue."