Insurers to be forced to pay for patients’ hospital stays
The Government is looking to recover more than the $338 million it collected from health insurers over the last fiscal year, through legislative changes to force the insurers to pay up whether or not the patients present their insurance cards at public hospitals.
The disclosure came from Howard Lynch, Director of Planning, Policy and Development in the Health Ministry, during Wednesday’s sitting of the Public Administration and Appropriations Committee (PAAC) of Parliament.
Lynch advised that a Cabinet submission is being prepared to lay the foundation for the necessary legislative changes to be made.
He said the ministry has met with insurance companies on the matter, in a bid to resolve the issues that will likely arise.
“It is difficult (now) even if you have knowledge of persons' health insurance status. Without the card itself, you can't access the benefit. The insurance company would not, in essence, make the payment. However, an alternative is being explored at the policy level to make legislative changes to enforce collection if you have knowledge, even without the card,” Lynch outlined.
He said the user-fee regulations of 2008 require that persons with health insurance who use a public health facility are required to use their health benefits.
“What is being contemplated is to get the necessary legislation amended to enforce that collection,” he explained.
The outline earned the support of committee member and Member of Parliament (MP) for South St Catherine, Fitz Jackson.
“Don't rely on the insurance companies to co-operate with you,” said Jackson. “They have a vested interest in persons not claiming on the policies. You will want to legislate that it becomes an offence to tell a lie, so that it gives you more teeth,” he recommended.
At the same sitting, Director of the Western Regional Health Authority (WRHA), Dr Ken-Garfield Douglas, said at present, when people turn up for treatment at public hospitals, “ways and means” are employed during the registration process, to ensure access to their health insurance benefits. But he acknowledged that hospitals have to depend on the patients to offer their health cards, as there are no other means of determining whether individuals have health insurance.
“There is great resistance… some people are not saying it…many of the policyholders — even Government workers — don't want to use it, because if they can get it (the service) free, they have a larger pool to save for other expenses. That is the reality,” Jackson suggested in response to Douglas’ outline.
Only recently, the administration of the Kingston Public Hospital, the island’s main trauma centre, expressed the desire to force collection from patients with health insurance who are treated at the facility for injuries like gunshot and stab wounds, along with injuries from motor vehicle crashes.
The KPH perspectives were expressed in view of the sharp increase in its patient load from violence over recent weeks as a consequence of an intense flare-up in criminal activities mainly across the Corporate Area.