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Insurers angry over €150m in HSE bills

Hospitals ‘treat companies as a cash-cow’ via private patient charges, reports Niall Brady

Health insurers have been billed for more than €150m since 2014, when the government changed the rules to let hospitals impose private patient charges on everyone with insurance — even when they end up on trolleys because of overcrowding.

The charges, according to insurance companies, have become a cash cow for cash-strapped hospitals.

The issue will be raised when representatives meet Simon Harris this week in his first formal engagement with the industry since becoming health minister in May.

An analysis of performance data from the HSE, seen by The Sunday Times, shows that income from private patients has increased by €22m at Cork University Hospital since the rule was changed. The big Dublin hospitals — St James’s, Beaumont, St Vincent’s and the Mater — have gained between €12m and €18m each. University Hospital Limerick has received an additional €14m.

The revenue has become a critical earner for the HSE, which has exceeded spending targets in 2016 but is barred under European Union rules from receiving the supplementary budgets from the government that kept it afloat in previous years.

“Large acute hospitals and the consultants working in them are generating significant additional income for providing the same service,” said one insurance source. “Consumers are being charged twice — once through their taxes and a second time through their insurance — to stay on a trolley at a cost of €813 a night.”

Before the rule change, all emergency admissions were treated as public patients and charged at €75 a night, unless they had medical cards.

Now those with insurance are offered the option of going private, even though they are likely to remain on trolleys or public wards with no improvement in the standard of treatment.

Consumers have not resisted the charges because they are picked up by the insurance companies, although they are being hit indirectly through higher premiums.

“All of this additional charging is happening without any additional services for private patients,” said one source.

“It has a direct impact on how health insurers assess claims costs and premiums.”

The state-owned insurer VHI said the move had cost it €40m in the year after the rule was changed.

The British insurer Aviva, which sold its health business to Irish Life earlier this year, also signalled that public hospital charges were hitting the results of its Irish business. Laya Healthcare blamed them for two recent premium hikes.

James Reilly, who introduced the rule change during his time as minister at the Department of Health, had claimed it would cost insurers no more than €30m a year, although this was always disputed by the insurers.

They are expected to question Harris on the extra income that the rule change has generated for consultants in public hospitals.

Under their contracts, private patients are not supposed to exceed 20%-30% of consultants’ workloads.

Insurers claims these limits are being breached, however, because of the increase in patients classified as private since the rule was changed.

“There has never been any reporting by the HSE on how this is monitored or implemented,” one source claimed.