02 Jul 2022

Column: Outstanding A&E bills derisory but wrong

Darren Hassett writing in this weeks Kilkenny People...

In the grand scheme of things, given that the HSE’s annual budget for this year is close to €14 billion – the amounts outstanding in A&E bills in St Luke’s Hospital is derisory.

But that doesn’t mean the invoices should go unpaid – it’s astonishing that some of the outstanding bills go back as far as 2013.

The number of patients who have payments due after attending St Luke’s Hospital Emergency Department has increased by over 3,000% since 2013 from nine to 312.

The rate of non-compliance is rising year on year with more and more overdue invoices stacking up. Now, the hospital says that can be explained and I’ll get to that later, but it doesn’t make it acceptable.

This week the Kilkenny People revealed that the total amount outstanding in relation to the €100 A&E charge at St Luke’s stands at over €35,000. Right or wrong – that’s the salary of an experienced staff nurse.

The number of people who haven’t paid the fee went from 24 in 2015 - when just over €2,000 was owed - to 312 in 2016 with around €31,000 remaining owed.

The figures going back four years are a good weathervane and they suggest the problem is worsening.

St Luke’s Hospital says it had over 48,105 ED attendances in 2016 with the hospital seeing year on year increases – which they say would account for an upward trend in the amount owed by patients for ED attendances.

That’s a fair point; it’s a statistical probability. But it doesn’t make this behaviour acceptable and rising A&E attendances should not translate into rising unpaid A&E charges.

We’re now a whole nine months into 2017 and 312 invoices from last year are still outstanding - 48 are unpaid from the previous three years. The longer they go unpaid, the more likely they are to stay unpaid.

Large swathes of the general population are not charged the fee for one reason or another –patients who have a GP referral letter and /or medical card holder are not liable and that’s only right.

Yet St Luke’s confirmed there are still 360 patients in total – who were charged - with outstanding A&E bills across the last four years.

As stated already, some 312 of these bills are outstanding since last year – meaning 0.6% of people who attended A&E in the Kilkenny Hospital in 2016 have not yet paid the fee.

So why haven’t people paid?

The hospital says the reasons for unpaid invoices may vary from “incorrect billing address received, persons having difficulty with affording the payment and general delays with people making payments”.

People might criticise the charge and that’s a whole other debate but it’s there and there’s an obligation to pay for most people.

It’s important to note that with all the hits on people’s pockets with austerity budget after austerity budget – at least the €100 A&E charge at St Luke’s was not increased.

I know that might not seem like a lot in the context of the recession - but for the purposes of this column, it’s worth noting the charge has been the same since 2009.

The hospital also says in select cases where people have difficulty paying, the case will be reviewed based on the individual circumstances along with other aspects, and a decision on how much the person can afford will be taken in to account.

There is also a facility for payment by installments for those patients who may have difficulty with the payment and don’t have a medical card/GP referral letter.

While the outstanding bill in St Luke’s might be a minuscule amount with regard to the HSE’s overall budget – the right thing to do is pay the charge in full or in installments. 

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