MAINTENANCE FEES of some €164 million owed by private health insurers to the HSE and voluntary hospitals was outstanding at the end of 2008.
The CAG report notes 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”.
About half of private inpatients are not charged for their accommodation, the report states.
According to the figures, 205,203 private patients treated last year in the 24 hospitals reviewed were accommodated in either public beds or “non-designated” beds, which meant the hospital could not charge a maintenance fee.
Based on the HSE’s calculation that it costs on average €1,018 per day to maintain a private inpatient, this means the 24 hospitals effectively had to forgo income of nearly €209 million.
Average daily costs for 2009 for maintaining a private inpatient are €1,018 and €733 for day cases. For semi-private inpatient cases, the average daily maintenance cost is €913, and €885 for day cases.
The report noted, however, that accommodation designated for private patients was used to the extent of 83,541 bed-days to accommodate public patients.
“In these cases, from a financial management viewpoint, the overall effect is that the hospital system has forgone the potential income from private patients in return for the use of these resources to provide services to public patients.”
Some €87 million in total was due to the HSE and €77 million was due to the voluntary hospitals. Many of the fees had been outstanding for “a considerable period of time”.
For the larger HSE hospitals, Waterford regional was owed most in maintenance fees, at €12.2 million from a total annual income of €13.2 million. This represented an average of just over 11 months of income for the hospital.
This was followed by University College Hospital Galway, which was owed €11 million, about six months’ worth of total maintenance income. Of the larger voluntary hospitals, Tallaght was owed some €15.5 million from an annual income of €23.8 million, followed by St James’s Hospital at €13.6 million. Beaumont Hospital was owed €10.1 million, while the Mater was owed €8.7 million or just over 11 months’ worth of income.
Accounting officers for the HSE told the CAG 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 vary considerably between hospitals, “depending on the willingness of individual consultants to sign off their own claim forms promptly”.
The CAG was assured that each of the hospitals was taking action to improve the speed of collection of such fees.
Minister for Health Mary Harney also recently met with the largest insurance provider and the HSE concerning late payments. She 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.