THE Government during the last fiscal year collected $338 million in claims from health insurance providers, and is looking to recover more by making changes to legislation which will force insurers to pay up, whether or not patients present their benefit cards at hospitals.

A Cabinet submission is being prepared to this effect, the director of planning, policy and development in the ministry, Howard Lynch, told yesterday’s sitting of the Public Administration and Appropriations Committee (PAAC) of Parliament.

He noted that the health ministry has met with insurance companies on the matter in an effort to resolve the issues surrounding claims. “It is difficult 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,” he explained.

Lynch reminded the committee that, as set out in the user fee regulations of 2008, persons with health insurance using a public health facility are required to use their benefit. “What is being contemplated is to get the necessary legislation amended to enforce that collection,” he emphasised.

“Don’t rely on the insurance companies to cooperate with you,” Member of Parliament for St Catherine Fitz Jackson remarked. “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,” said Jackson, suggesting that incentives such as semi-private wards would be given for people who use their insurance benefits.

Director of the Western Regional Health Authority (WRHA), Dr Ken-Garfield Douglas explained that currently when people turn up for treatment during the registration process “ways and means” are employed to ensure access to their health insurance benefits. However, he conceded that hospitals have to depend on patients to offer their health cards, as there are no other means of determining whether individuals have insurance.

“There is great resistance… some people are not saying it…many of the policy holders — even government workers — don’t want to use it, because if they can get it free they have a larger pool to save for other expenses. That is the reality,” Jackson asserted.

Government spends approximately $8 billion on trauma treatment in the public health system. Chief Medical Officer Dr Winston De La Haye noted that for Kingston Public Hospital (KPH) alone 75 per cent are violence related, and 25 per cent related to motor vehicle accidents.

Recent data submitted by interest groups to a joint select committee of Parliament during the review of the Special Zones of Operations Bill revealed that it cost the KPH $400,000 per day to treat trauma victims, a figure which Dr De La Haye confirmed yesterday.

But according to current legislation, only a maximum of $2,000 per day is collectable by hospitals for each motor vehicle trauma victim, which make up 25 per cent of trauma cases at that facility alone, provided that there is an insurance agreement.

The Motor Vehicles Insurance (Third Party Risks) Act says that if an injured person has, to the knowledge of the insurance company received treatment at a hospital, the insurer or policyholder “shall notify the hospital of such payment and there shall also be paid by the insurer or such owner to such hospital, the expenses reasonably incurred by the hospital in affording such treatment, after deducting from such expenses any moneys actually received by the hospital in payment of a specific charge for such treatment: Provided that the amount to be paid by the insurer or such owner shall not exceed two thousand dollars ($2,000) for each person so treated as an inpatient, or five hundred dollars ($5,000) for each person so treated as an outpatient”.