Actually, someone is to blame for the €125m in insurance claims written off by hospitals: consultants

The news that public hospitals wrote off €125 million in unpaid debts from private health insurance companies over the last four years speaks to pretty much everything that is wrong with the health service. For a bit of context, €125 million would get 25,000 hip replacements, or pay the wages of about 2,000 nurses. It would only get you 5 per cent of a national children’s hospital.

First and foremost, it highlights the extent to which the public system is the loser in the incestuous relationship between public hospitals and private medicine, which has developed over the years, allowing publicly employed consultants to see private patients in public hospitals and avail of facilities funded by the State.

It has proved lucrative for the medical profession, which is not without influence. Thus the arrangement is very hard to dismantle – as demonstrated by the recent row over public consultants continuing to carry out private work in Dublin’s Rotunda Hospital. Somehow, this privilege has come to be seen as a sort of birthright for aspiring Irish consultant doctors.

The fact that this practice continues at Irish hospitals is hard enough to understand, but the idea that the hospitals in question are not billing the health insurance companies that make the whole thing supposedly viable is beyond comprehension.

The precise reason for public hospitals’ failure to collect the €125 million they are owed has not been elucidated. But the public accounts committee says that, according to the HSE, the number one reason is: “Consultants not completing the claim form on a timely basis, and [the] insurer refuses to process the claim as it has exceeded their allowable time for claim submission.”

According to Minister for Health Jennifer Carroll MacNeill, no one in particular is to blame. “The consultant has to make sure to sign it [the claim] within a year. It has to be processed by the hospital and the HSE, and the insurance company has to pay it,” she has said.

Her insouciance about the failure of consultants to facilitate their hospital to collect bills incurred on their behalf at the cost of taxpayers is somewhat at odds with the vigour with which the Minister pursued the issue of public-only consultants carrying out private work in public hospitals earlier this year.

[ Consultants’ private healthcare in public settings has ‘ceased’, HSE review findsOpens in new window ]

Carroll MacNeill said she did not want to “ascribe fault” in the case of unclaimed insurance payments. “It’s everybody’s responsibility. But if there’s anybody there who hasn’t discharged their responsibility on that today, well, they really should because they really must.”

The health service is not noted for its efficiency, but when the minister of the day is reduced to asking people who work for her – consultants and others – to please do their job out of some sort of sense of duty or personal responsibility, you really have to wonder what is going on.

It’s unclear how much, if any, of the €125 million relates to VHI, but a failure to pay public hospitals on its part would be unsporting, to put it mildly

It is very hard to imagine the boss of a private sector company not wanting to apportion responsibility for a failure to collect €125 million, and instead just asking everybody involved to try a little harder in future.

The private health insurers are not exactly blameless either. Health insurance is big business in Ireland. Almost one in every two people has a policy, which is well above European norms. In Europe, the model tends towards State funding or mandatory public health insurance. In many ways, the Irish private health insurance industry is the yin to the yang of the tradition of allowing private medicine to be carried out in public hospitals.

[ Rotunda Hospital’s clash with Coalition over private maternity care deepensOpens in new window ]

The largest player in the market, with an almost 50 per cent share of it, is the VHI, which is owned by the State. A commercial body, it operates at arm’s length from the Government, and competes with privately owned insurers. Unlike other State companies, it does not pay a dividend, and retains any surplus that it makes.

It’s unclear how much, if any, of the €125 million relates to VHI, but a failure to pay public hospitals on its part would be unsporting, to put it mildly. It would also find themselves on common ground with all the other vested interests who seem to take the view that the taxpayer-funded health service is some sort of fatted calf.

[ ‘I felt nobody had my back’: What the Rotunda row says about public v private maternity careOpens in new window ]

Something will have gone seriously wrong if VHI seems happy to go along with unnecessary losses being foisted on taxpayers because consultants – whose fees it also pays – appear to be unbothered about doing paperwork.

One useful exercise VHI and its peers could carry out – and perhaps share the results of with the Public Accounts Committee – is whether consultants adopt an equally dilettantish approach to putting in the paperwork to ensure their own fees are paid.

Linking the two might solve the problem.