Dr. Susan O'Reilly:

Let us think about stretch targets. The reason for having a stretch target is that for the last two years there has been an opportunity to be consistent about requesting people's insurance coverage, as they come in through the accident and emergency department or through any referral or outpatient visit, and not necessarily a private referral. Patients are asked for that information. The reason we are being tasked to do this better is to make sure hospitals have processes in place where they very consistently, and invariably, request this information as they would request medical card information. The information goes in onto the admission form. That is the stretch target. The reality is that if people come in and they do not have insurance or do not give their numbers, there is nothing we can do about that. As a leader and deliverer of health services, to be put in a position that suddenly one should rush and cut back on the acute or elective services because of an estimate - based on gleaning all the information that might be out there about a yield of a certain amount of money - is somewhat difficult to deliver on. This is notwithstanding the fact that in my director's report to Mr. Woods this year I would rather beg for forgiveness than ask for permission to cut back on services.