Non-residents skip on unpaid health bills
Over the past five years, B.C. taxpayers on hook for $75 million for patients’ hospital and ambulance costs
Non-resident patients have stuck B.C. health authorities with $75 million in unpaid hospital and ambulance bills over the last five years, according to figures given to Postmedia News by the authorities.
On an annual basis, unpaid bills have varied, from a high of $16.6 million written off by health authorities in 2012-13, to a low of $13.3 million in 2011-12.
The amount is dwarfed by the $334 million health authorities collected from non-resident patients, either through insurance or direct payments, but represents a cost taxpayers wind up having to absorb.
It’s an issue that has been on the radar of provincial health officials before.
In 2006, then-Health Minister George Abbott encouraged health authorities to find ways to collect for services delivered, because B.C. “is not in the habit of providing free health care for the rest of the world.” That’s when the amount owed was around $10 million per year.
More recently, a ministry official wasn’t made available to comment on the current numbers, citing rules preventing civil servants from speaking to the media during election periods.
Postmedia put the question of how big a concern the unpaid medical bills should be to the B.C. Liberal and NDP campaigns.
Liberal communications staffer Alexis Pavelich emailed an unattributed comment noting that all health authorities have policies with respect to the collection of bills and that writeoffs are “fortunately rare,” amounting to less than one-10th of one per cent of health funding.
Health authorities do, however, work hard at collecting fees, said Vancouver Coastal Health spokeswoman Anna Marie D’Angelo, because “it is important for healthcare sustainability.”
“We never deny urgent and emergent health care based on someone’s ability to pay,” D’Angelo said in an emailed response, “but we do expect to be compensated as our health care is not free, it is paid for by the taxpayers of B.C. and is intended for their use.”
Of the health authorities, Vancouver Coastal, the biggest patient-receiving jurisdiction, had the biggest outstanding bill at $40 million over five years. (It also collected the most at $133 million.)
D’Angelo said they collect 65 to 75 per cent of bills to non-resident patients. And while VCH’s uncollected billings are larger than other authorities, it’s also the authority that sees more tourist patients and provides the most specialized care.
It’s also difficult to tell whether patients come to Canada specifically for health care. D’Angelo said the information that the health authority collects doesn’t capture the reasons non-patients are in Canada.
“To put things in perspective, VCH has an annual budget of $3.2 billion, which is spent on acute and community health-care services for more than one million people in the province,” D’Angelo said.
The figures don’t separate-out patients by nationality, and include anyone not covered by the Canadian medical insurance system.
The Lower Mainland’s Fraser Health Authority had the second-highest amount of bills owing at $15.4 million over five years, which spokeswoman Tasleem Juma said “has remained fairly consistent,” at between $2.4 million and $3.3 million per year.
All the authorities reported their finance departments keep track of billings to non-resident patients and are making efforts to collect payments for unpaid amounts.
“Our finance department makes every effort to work with the patient, family or insurance companies to obtain payment,” said Andrea Palmer, spokeswoman for the Northern Health Authority, before accounts are sent to a collection agency.
Northern Health, which covers most of the province north of Quesnel, had the smallest amount of unpaid bills at $348,960 over four years. (The agency was unable to provide earlier years of figures due to a change in technology.)
At Island Health, which covers all of Vancouver Island and part of the Central Coast, “billing and collection work is strongly, but compassionately, engaged right from the patient’s initial presentation,” said spokeswoman Meribeth Burton in an email.
Island Health had the third-highest amount of non-resident bills left owing at $5.6 million over the past five years, and fourth-highest amount collected at $34.3 million over five years.
Burton said Island Health makes personal contact with patients owing $100 or more and sends out invoices for four consecutive months for accounts under $2,500 before turning them over to a collection agency. Accounts over $2,500 are only turned over after considering possible legal action.
Interior Health, which covers the south Cariboo, Okanagan and Kootenays, saw $4.6 million in unpaid bills over five years, while collecting on $46.6 million.
“Any unresolved accounts without a payment plan are outsourced to a third-party collection agency,” said spokeswoman Darshan Lindsay in an email.
The Provincial Health Services Authority, which takes in Children’s Hospital and B.C. Women’s Hospital, saw the second-lowest amount of unpaid bills at $1.5 million over five years, while collecting $14.4 million.
B.C. Emergency Health Services, which operates the B.C. Ambulance Service, wrote off $7.8 million from non-resident patients over five years, but collected $36 million.