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HSE spent €600,000 last year on debt collectors to chase patients for unpaid bills

The Irish Cancer Society recently called for the government to abolish inpatient charges for cancer patients in the forthcoming Budget.

THE HSE SPENT more than €600,000 on debt collection agencies last year, hired to chase up patients who had not paid their medical bills.

Figures released to TheJournal.ie through a Freedom of Information request show the HSE paid €602,934 in total to debt collection agencies last year. Up until June this year, the health service provider had spent €281,391 on debt collection firms.

Earlier this month the Irish Cancer Society called on the government to abolish inpatient charges for cancer patients in Budget 2019. Patients are required to pay €80 for an inpatient visit, including day cases for cancer treatments such as chemotherapy.

More than 5,000 people have now signed that petition. 

Speaking to TheJournal.ie, Paul Gordon, policy and public affairs manager for the society, said the pursuit of patients for these bills can be a cause of stress for people during their period of treatment and in recovery. 

“It is HSE policy that after seven weeks, if a fee has not been paid, it is either referred to a debt collection agency or to a legal agency.

That can be quite worrying for patients if they are getting a final notice or a letter telling them it has gone to a debt collection agency. This is at a time when they are particularly emotionally and physically vulnerable but also financially vulnerable. It can be an unnecessary worry.

Gordon said the HSE can waive a fee if it is considered undue hardship but many people are not aware of this power of discretion. 

Cost of treatment

The charge for an Emergency Department attendance is €100 and it is €80 for an overnight stay – the latter charge is capped at €800 in any 12-month period.

Cancer patients receiving treatment are considered inpatients and are therefore charged €80 each time. Although there is an €800 cap, Gordon said this can still be a significant burden for a family.

According to research by the Irish Cancer Society, the average cost to a family for treatment is €340 a week – this includes travel to and from the hospital, childcare, GP visits, medication and the hospital charge. 

“That is before factoring in things like more expensive electricity and heating bills, as cancer patients’ needs change in their homes. Also personal care like specialist shampoo or a one-time purchase like a wig if they have lost their hair during treatment. They may also have additional nutritional needs.”

He pointed out that there is often a significant loss of income for patients during treatment and in recovery. 

“If someone is in a single-income family and they are the patient, it could have quite a devastating impact.”

Marie Moran, a breast cancer survivor who was diagnosed when she was 32 weeks pregnant commented recently on the anxiety she experienced in relation to her treatment bills.

I was in the process of applying for a medical card so in the hope that it would come through, I didn’t pay the charges. When the bills turned into final notices it caused me so much stress and worry at an already difficult time. Eventually the hospital agreed to waive the charges, however I still received a couple of chase up letters demanding payment which was really upsetting and stressful.

“I was already fighting cancer with a new baby, I didn’t need the additional fear of debt collectors knocking at my door.”

Spending on debt collection services 

HSE-run hospitals were owed more than €40 million in unpaid fees at the beginning of last year. This did not include the €145 million typically owed by health insurance companies to cover private patient treatment in public hospitals. 

The highest spend on debt collection agencies so far this year of €52,767 has been at Cork University Hospital.

  • Our Lady of Lourdes hospital in Drogheda has spent €27,341
  • University Hospital Limerick has spent 22,057
  • Connolly Hospital has spent 21,658
  • Waterford Regional Hospital has spent 20,074 
  • University Hospital Galway has spent 19,294.

Sligo Regional Hospital has not spent any funds this year on debt collection agencies and only spent €2,999 last year.

Hospitals outside the HSE group also engage the service of debt collectors for unpaid bills. 

In 2017 Beaumont hospital incurred costs of €202,467 in respect of debt collection services and for the period January to June 2018 it paid out €100,675 to companies.

The National Maternity Hospital in 2017 spent €10,650.87 and so far in 2018 it has spent €5,498,21 on debt collection.

The Rotunda Hospital told TheJournal.ie that it paid €7,556 to LCMS and €865 to Ivor Fitzpatrick in last year for debt collection services. The hospital has so far this year paid €2,041 – €110 of this was to Ivor Fitzpatrick and the balance was to LCMS.

A statutory obligation

In a statement, the HSE said it has a statutory obligation to charge and collect these charges. It also said hospitals have the discretion to operate payment plans, where appropriate.

“There are facilities for patients to pay directly, when the patient attends at the emergency department.

“Upon discharge the patient receives an invoice and in some cases a reminder, the follow-up for payment can then be forwarded to specialist debt management services, as outlined in the National Financial Regulation (NFR) 25.

“These contracts, which are based on a national multi supplier framework agreement, are managed locally at individual hospital level and statistics are not held centrally on the collection rates.”

It said these charges are separate from the private patient charges which are predominately collected from the health insurance companies.

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37 Comments
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    Mute Paddy Downey
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    Oct 1st 2018, 7:39 AM

    Spending €600k to chase €40m unpaid debts seems pretty reasonable. It’s only 1.5% of the debt.

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    Mute mattoid
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    Oct 1st 2018, 7:55 AM

    @Paddy Downey:
    As a taxpayer I’m delighted they’re pursuing the debt, as long as cases of genuine hardship are treated with sensitivity.

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    Mute Good Early
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    Oct 1st 2018, 9:30 AM

    @mattoid: But theyre not treated sensitively. Time to move to Universal Healthcare for all. Canada, UK, France, Germany, Denmark all have it. This hybrid of two healthcare systems we have here screws it up for everyone bar the very well off.

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    Mute James O'Donovan
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    Oct 1st 2018, 9:40 AM

    @Good Early: Thats a massive generalisation there. How do you know people arent treated sensitively? Not everybody will ring the hospital and discuss their financial situation in detail.

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    Mute Good Early
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    Oct 1st 2018, 9:45 AM

    @James O’Donovan: Because I know enough cancer patients who struggled paying their rising gas electric and rent bills that were hounded by debt collectors while on their deathbeds.

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    Mute Charliegrl80
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    Oct 1st 2018, 9:47 AM

    @Paddy Downey: so is it also reasonable for the HSE paying over 16 million for a unoccupied building and how many unoccupied are around the country.

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    Mute James O'Donovan
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    Oct 1st 2018, 9:57 AM

    @Good Early: And I know enough people in hospitals who will happily come to an agreement with people to make reasonable part payments without putting undue financial pressure on them.

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    Mute Good Early
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    Oct 1st 2018, 10:09 AM

    @James O’Donovan: You have a strange view of the world when an old person with cancer is turning off their gas during winter because they can’t afford it, and you’re happy because they are ‘accommodated’ with part payments on money they dont have.

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    Mute James O'Donovan
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    Oct 1st 2018, 10:15 AM

    @Good Early: Im not happy with your scenario. Im pointing out that your scenario of people being hounded isnt representative of my experiences . Why do you assume that everyone who works in hospitals is obcessed with money ? They are well aware of the financial hardship people are under and will work with them to make things as easy as possible

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    Mute Good Early
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    Oct 1st 2018, 10:21 AM

    @James O’Donovan: I’m not suggesting that at all. My beef is with the Government. We pay via tax and still get charged at the door.
    It has to end now. The sooner we move to a more humane Universal Healthcare model the better.

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    Mute Paddy Downey
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    Oct 1st 2018, 5:42 PM

    @Charliegrl80: and the relevance of that to my comment would be …..

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    Mute mattoid
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    Oct 1st 2018, 5:47 PM

    @Good Early:
    How much are you prepared to pay in increased taxes for universal healthcare, or is it a case of “I don’t pay taxes so it’ll be someone else paying”?

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    Mute Good Early
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    Oct 1st 2018, 7:04 PM

    @mattoid: Up to €1000 more per year. But that’s besides the point. It may not cost us a penny.ore if it’s done right.ill be saving more after giving up my private insurance.
    The biggest defenders of the current system are those who’s company pays their insurance for them.

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    Mute Todd Hebert
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    Oct 1st 2018, 7:58 AM

    Why, with the HSE being a nationalised, socialised, health care system, is anyone going into debt for health care?
    In a country with “socialised medicine” nobody should have any debt to any public hospital, full stop.
    Only private hospitals should have any debt-collection going on relations to patients.

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    Mute Gulliver Foyle
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    Oct 1st 2018, 8:11 AM

    @Todd Hebert: sick of this RTE model being applied to health care, where our per person budget is up there with OECD averages, and we are still expected to top it up at point of delivery, primarily due to competing for beds with a fear driven private system.

    we need to demand to scrap these topups, and while we are at it, so subsidising them with private car park charges on visitors to patients.

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    Mute mattoid
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    Oct 1st 2018, 8:46 AM

    @Todd Hebert:
    How much more tax would you be prepared to pay to eliminate all bills for hospital treatment?

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    Mute Good Early
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    Oct 1st 2018, 9:38 AM

    @mattoid: Who says it need cost more? We have a similar spend to other OECD nations. Any increase would cost less than the price of insurance
    Our problem is we are running two healthcare models from the one small group of hospitals.
    A public one where an appointment is not an appointment if a private patient needs to be bumped up the queue. A private one where those who can afford it are seen in a timely manner. Machines left idle to ensure availability to private patients.

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    Mute mattoid
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    Oct 2nd 2018, 12:05 AM

    @Good Early:
    But the fees paid by the private patients are essential to subsidise the public patients.

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    Mute Sorcha Ní Shúilleabháin
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    Oct 1st 2018, 8:50 AM

    It would help if people were made aware of the €80 charge while in hospital. My baby spent two and a half months in hospital after being born and upon discharge we got an €800 bill in the post. At no point over 10 weeks did anyone tell us we would owe anything. We were able to refer the charge to our health insurer who took so long to process it that the HSE sent a debt collector after us. It was extremely stressful down on top of bringing a very premature baby home. While bills need to be paid there also needs to be compassion.

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    Mute B9xiRspG
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    Oct 1st 2018, 1:07 PM

    @Sorcha Ní Shúilleabháin: €800 for 10 weeks with a premature baby in fairness is nothing. Other countries you could be looking at more like 80,000. I would question why the bill wasn’t spent directly to your insurer, why your insurer didn’t pay within the agreed time and why the hospital still believed the responsibility was on you.

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    Mute Good Early
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    Oct 1st 2018, 3:24 PM

    @B9xiRspG: In the US maybe. Not Canada or the rest of Europe.

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    Mute Bobby Neary
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    Oct 1st 2018, 7:08 AM

    Sure when you arrive in A&E with your arm hanging off and blood pumping all over the floor,the nice lady behind the counter informs you of the 100euro charge before she takes any on your details…

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    Mute mattoid
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    Oct 1st 2018, 7:53 AM

    @Bobby Neary:
    If I’ve told you once I’ve told you a thousand times, don’t exaggerate!

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    Mute Sean Conway
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    Oct 1st 2018, 11:55 AM

    @Bobby Neary: plus they leave you waiting half the night to get seen to.

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    Mute Finnster
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    Oct 1st 2018, 6:59 AM

    Name and shame the debtors in the national papers .

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    Mute Gulliver Foyle
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    Oct 1st 2018, 8:00 AM

    @Finnster: how would that look?

    Patrick Flynn (deceased) owes €125;
    Mary Power (deceased) owes €80; Michael Walsh (stage IV cancer) owes €240… etc…

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    Mute sequoia
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    Oct 1st 2018, 8:31 AM

    Do people really get “shamed” by having their names in the papers once?

    You’d be mentioned once in a random page in small print & to be honest, I know one person (retired) who buys a paper occasionally when he fancies the crossword.

    Everyone else my age & younger gets their news through other means.

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    Mute Me_a_monkey
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    Oct 1st 2018, 9:09 AM

    @Finnster: do people actually read papers any more? My old dear only buys the mail for the crossword and for something that the dogs can piss on overnight

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    Mute Mark Scott
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    Oct 1st 2018, 7:43 AM

    Is abit naive to waive all fees.
    A single mother with breast cancer and heavy smoker with lung cancer are not in the same category.

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    Mute Gulliver Foyle
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    Oct 1st 2018, 8:06 AM

    @Mark Scott: why? heavy smokers contribute over €1b to the state (where else should that money go to – roads?), compared to the budget of €15b it costs the health service to run.

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    Mute Mark Scott
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    Oct 1st 2018, 8:12 AM

    @Gulliver Foyle: because it’s self inflicted. And if one has money for a frivolity such as cigarettes, then they have money to pay for treatments.

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    Mute Daniel Wilson
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    Oct 1st 2018, 8:24 AM

    @Gulliver Foyle: you can guarantee the burden of heavy smokers on the state is orders of magnitude higher thant tax on cigarettes

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    Mute mattoid
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    Oct 1st 2018, 8:44 AM

    @Daniel Wilson:
    You would think so, but several studies have shown that it’s fairly neutral. One of the reasons for that is that most smokers die younger, which saves the state on various age-related care costs.

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    Mute ⚡ Seánie ⚡
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    Oct 1st 2018, 7:04 AM

    Sound people in Sligo. And poor aoul Ivor isn’t getting a fair crack of the whip!

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    Mute Boyne Sharky
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    Oct 1st 2018, 4:55 PM

    There is some distinction between can’t pay and won’t pay, I imagine being able to differentiate between the two is a remarkable skill in itself. It also needs to be said that cancer isn’t the only serious illness that can enormous hardship to individuals and families, unfortunately there are many.

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    Mute Michael Byrne
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    Oct 2nd 2018, 12:13 AM

    Make RTÉ pay per view and put €30 million into the country…

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    Mute William Rowlands
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    Oct 2nd 2018, 8:05 AM

    Shame on our government I hope they sleep well

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