Ciarán Cannon (Galway East, Fine Gael) | Oireachtas source

I am responding on behalf of the Minister for Health, Deputy James Reilly. I thank Deputy Humphreys for raising this important issue.

The HSE and voluntary hospitals recoup a considerable amount from private health insurance companies in return for private and semi-private treatment services provided to patients with private health insurance cover. However, lengthy delays can often occur between the discharge of patients and the receipt of payment from health insurance companies. This has led to an unacceptably high level of debtor days and months with a significant amount in fees outstanding. As of the end of September 2012, €204 million was due to the HSE from private health insurance companies in respect of treatment provided to private patients. Of the €204 million, €100 million relates to claims under preparation in hospitals, and €104 million relates to claims submitted to insurers which are either being processed or are pending.

Delays in consultants signing off on health insurance forms is one of the issues affecting the claims collation process in public hospitals. Of the €100 million under preparation in hospitals, €73 million relates to delays in consultant sign-off. The Minister has instructed the HSE to address the issue as a matter of urgency and the HSE has directed hospitals to bring down the value of claims awaiting consultant action. Hospitals are also targeting the highest value claims.

The issue was also addressed by health service employers and the two consultant representative bodies at the Labour Relations Commission. An important feature of the proposals agreed between the parties was a commitment on the part of all consultants to expeditious processing and signing of claims for submission to private health insurers. Consultants will be required to complete and sign private insurance forms within 14 days of receipt of all the relevant documentation and to co-operate with the secondary consultant scheme, whereby a secondary consultant involved in a case can sign the claim form if the primary consultant has not signed it within a reasonable timeframe. They will also be required to support the implementation of electronic claim preparation.

Health service management is proceeding with implementation of this and other measures in the coming weeks, having regard to the relevant provisions in the public sector agreement. In addition to addressing delays in consultant sign-off, the HSE has also awarded a contract for the phased roll-out of an electronic claims management system in 11 HSE sites. The system will address the many deficiencies of the current paper-based process, will streamline the claims collection process and will ensure standardised work practices are implemented across hospitals. The system is live in six hospital sites with a further three to come on board by mid-November.

It is also worth reflecting on the intensive work that has been ongoing between my Department and the main private health insurers to reach an agreement in principle on an accelerated income collection process, which will generate an additional once-off cashflow benefit in the region of €125 million in 2012. The accelerated payment arrangements are at an advanced stage, with the detail of the legal agreements between the HSE and insurers expected to be finalised very shortly.

The Minister has emphasised to the HSE the importance of addressing the issue of income collection, in conjunction with the insurers, in order that the maximum resources possible are available to the health system. He believes the range of measures I have outlined will contribute to improving the collection of income outstanding to the public hospital system.

See this speech in context