Kevin Humphreys (Dublin South East, Labour)
Link to this: Individually | In context | Oireachtas source

I am grateful to the Ceann Comhairle for selecting this topical issue. I mean no disrespect to the Minister of State but I am disappointed that the Minister for Health is not present to take this. Ten months ago, I tabled a parliamentary question about this issue because it was leading to a revenue loss to the health service. According to the reply I received, the loss was estimated at €76 million. My colleague, Deputy Conway, was informed at a meeting of the Joint Committee on Health and Children in September by Mr. Tony O'Brien, director general of the HSE, that the figure owed then was in the region of €60 million while last week, in reply to Deputy Kieran O'Donnell at a meeting of the Committee of Public Accounts, it was indicated that €74 million was outstanding.

I asked the Minister in January, which is ten months ago, what disciplinary action, if any, could be taken and he indicated at the time that he wanted the issue addressed under the Croke Park agreement. The Department indicated there was no contractual requirement that medical consultants should sign off on health insurance claim forms. Is there a contract with bus drivers to make sure bus fares are collected? There seems to be one rule for high paid public sector workers and another for those on more modest incomes. Under the 1999 contract, a consultant must co-operate with his employing authority for the collection and maintenance of fees and, under the 2008 contract, consultants are expected to work within the framework of the hospital, agency and HSE service plan. The delay in claiming the fees due is having a major effect on cash flow in our hospitals. While I acknowledge the Minister managed to secure an agreement recently that will lead to substantial savings in the State's drugs bill and the Bill currently going through the House to deal with generic substitution and reference pricing must be commended, I am disappointed there has been little or no action on this issue.

What action has been taken to ensure claims are paid promptly and signed off by highly paid consultants? Was it part of the recent discussions with the IMO and the Irish Hospital Consultants Association? If so, will it be implemented? It is unclear if the deal will come into force. There was media speculation on when exactly the matter will be before the Labour Court.

Yesterday evening, we had a debate about home help. Today, we are discussing a topic I raised over ten months ago concerning €74 million. Consultants need to get a grip of themselves and carry out the job they are employed to do. It is part of their responsibility to ensure the hospital service in the HSE is properly funded. For them to shrug their shoulders and say they will not sign means hospital beds lie empty, wards close and people in need do not receive hospital treatment they require and deserve. I hope the Minister of State carries this message loud and clear. It is no longer acceptable in this country for highly paid consultants not to sign off on insurance forms.

Ciarán Cannon (Galway East, Fine Gael)
Link to this: Individually | In context | 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.

Kevin Humphreys (Dublin South East, Labour)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for his answer and I hope what he has outlined will happen. Some ten months have passed since I raised the issue and it seems that, from the response of the Minister of State, we are getting some action. Is it not a shame it took so long to get consultants to pull into line? More than 2,200 consultants work in public hospitals. They use beds for private patients and draw down enormous salaries from private practice with questionable practices. Are their incomes subject to PRSI? We must examine the practices and methods of consultants in our public hospitals.

I welcome the payment systems outlined and we must wait and see if they are delivered upon. This is very unfortunate. Shame on the consultants that the Government had to go to such lengths to ensure the income stream and cashflow of our hospitals were guaranteed. These men and women walk the corridors of the hospitals and see the shortfall in income yet they delayed on signing off on significant sums that would make a substantial difference to the hospitals of the State. I welcome the response. I will be monitoring the topic closely and I will check whether the target of 14 days is achieved. I will seek further information on the practices of consultants in the public hospitals service. I want to see this saving and cashflow delivered quickly.

Ciarán Cannon (Galway East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I think Deputy Kevin Humphreys. I agree wholeheartedly that these are significant sums of money that could be expended on front-line services but they are held in abeyance because of a lack of will from certain ranks within the health sector and, perhaps, bureaucratic difficulties associated with the payment process. The Minister for Health, Deputy Reilly, has prioritised the solution to the problem. I referred to the opportunity for a second consultant to sign off on an insurance claim, the electronic claims management system, which will shortly be in place in 11 sites, and the ongoing work with health insurers to set up an accelerated income collection process. One can only conclude from the response that these measures will be put in place quickly and will serve to address the issue. I have a funny feeling that, this time next year, we will not have such a substantial amount of money outstanding.