The cash-strapped Health Service Executive (HSE) is owed almost €235 million by patients and insurance companies in respect of unpaid emergency department fees, inpatient charges, and other tariffs.
A quarter of the outstanding fees relate to a single hospital – University Hospital Galway (UHG), which was owed more than €12.6 million by patients and €32.4 million by private health insurers at the end of last year.
The HSE’s own financial regulations require hospitals to refer debts to a debt-collection agency where charges remain unpaid for more than three months.
However, records released under freedom of information laws show that UHG was one of only two hospitals in the country that had no engagement with debt-collection agencies during 2022.
The revelation that the HSE has failed to recoup €234.8 million that it is owed comes after its CEO Bernard Gloster told the Oireachtas Health Committee yesterday that the agency was heading for a budget deficit of around €1.5 billion by the end of this year.
He also warned the committee that there would be a “guaranteed overspend” in 2024 as the HSE continues to run services for which it is not fully funded.
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Internal records show the HSE was owed a total of €51.9 million by patients who failed to pay bills for a range of treatments and services they received at acute hospitals throughout the country.
Some €13.8 million of this related to the €100 charge for attending an emergency department (ED) without a GP referral. The fee does not apply if a patient is subsequently admitted to hospital.
The hospital that was owed the highest amount relating to ED charges was UHG. It was owed €2.95 million under this heading at the end of last year, representing an increase of around €950,000 during 2022.
The next-highest amount owed in respect of ED charges was €1.6 million at General Hospital Portlaoise, which had increased by around €200,000 during the same 12-month period.
A total of €15.6 million was owed to hospitals in respect of inpatient charges. These were abolished in April but previously cost €80 per night up to a maximum of €800 in a single year.
The hospital with the highest amount of outstanding inpatient charges was UHG at almost €4 million. This was followed by Connolly Hospital in Dublin, which was owed a total of €1.2 million under this category.
Charges relating to road traffic accidents (RTAs) accounted for €22.1 million of the fees owed to HSE hospitals at the end of last year. Of this, €5.7 million was owed to UHG, while Cork University Hospital was owed nearly €3 million.
The majority of the €234.8 million owed to hospitals relating to private health insurers. Nearly €183 million remained payable from these companies at the end of 2022, including €32.4 million relating to UHG.
Records released by the HSE show that hospitals spent a total of €514,701 on debt-collection services in 2022 in a bid to recoup outstanding fees.
Cork University Hospital had the highest spend on these agencies at €120,789. Just two of the 29 hospitals spent nothing on debt collection during the same period: UHG and Portiuncula Hospital, which are part of the same hospital group.
“The HSE has a statutory obligation to levy and collect these charges,” said a spokeswoman.
“Debt collection continues to be managed at local hospital level. Hospitals are required, under [national financial regulations], to refer an unpaid debt to a collection agency after a period of time from date of billing.
“If any patient has difficulty paying a hospital bill, the regulations allow for the hospital and the patient to agree an instalment arrangement. We would advise they contact their hospital directly to discuss this on a one-to-one basis,” she added.
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