here you go guys..
American patient dies before paying $642,000 N.S. health bill
Wed Dec 15, 2:30 PM ET
STEVE MACLEOD
HALIFAX (CP) - Nova Scotia taxpayers are on the hook for $642,000 charged to an American patient who spent 183 days in a Halifax hospital before dying without paying.
The revelation was outlined in the annual report of Nova Scotia Auditor General Roy Salmon, who is critical of how Canadian hospitals keep track of patient expenses. "They have no costing systems," Salmon said after releasing his report Wednesday. "They don't know what it costs to maintain a patient in the hospital, either for a short stay or a long stay.
"The rates they set are arbitrary."
The Capital District Health Authority said the patient, whose name, gender or illness were not disclosed, was gravely ill on admission to the Queen Elizabeth II (news - web sites) Health Sciences Centre in Halifax in 2003. The patient died this fall.
Salmon said patient stays at U.S. hospitals are "costed down to the last Band-Aid." But Canadian hospitals use a per diem rate that doesn't accurately reflect the actual cost of treatment.
An examination of hospital records by the attorney general revealed that the patient was undercharged by at least $451,000 for the stay, including a 94-day stint of which only 62 days were actually billed.
The health authority, in a response printed within Salmon's report, said it initially charged the U.S. patient an out-of-country per diem of $3,200 a day, but decided "that would lead to an overstatement of revenues."
It adjusted the per diem to the $1,173 charged to patients from other provinces, but Salmon said there is no record of the actual final cost of treating the unnamed American.
He said his staff came up with the $642,000 figure based solely on the per diem.
Capital District said hospital officials initially believed the patient's insurance would cover the cost of treatment, but the insurer, after paying just $53,000, has refused to cover the rest.
"Under both Canadian and U.S. laws, a hospital cannot refuse emergency services to a patient when required, even if they do not have the ability to pay for those services," the authority said in Salmon's report.
Salmon recommended that the health authority's monitoring of accounts and each patient's ability to pay must be significantly improved.
"They were caught between a rock and a hard place once that patient was admitted," he said.
Angus MacIsaac, Nova Scotia's health minister, didn't know if the province would pursue payment of the dead patient's bill.
"Obviously what I want to do is learn from his report and ensure that we improve our system so we don't face such a situation again," he said.
Diane Whalen, the Liberal's finance critic, called the case "a red flag" that exposes weaknesses in the way non-residents are billed.
"You can't just allow patients to be there with no effort at collection," she told reporters.
The annual report also called for improvements to the province's costly prescription drug program.
Salmon called for the Health Department to develop a long-term strategy for the program, which have seen costs increase 21 per cent over the last three years to $108 million in 2002-2003.
He said the province's contract with Atlantic Blue Cross Care to administer the program is inadequate.
The Health Department should bring in a performance-based, third-party provider that would have clearly defined roles and expectations, the report said.
"We noted the contract is not current and lacks appropriate accountability requirements . . . and performance standards," Salmon said in his 167-page report.
Salmon also urged the Health Department to find ways to reduce drug prices.
"Although we acknowledge that pharmaceutical companies ultimately control the price of drugs . . . the potential savings to the program of even modest price reductions could be significant and warrants further study."
The annual report was Salmon's 13th since becoming auditor general in 1992. He told reporters he will table one more report before retiring and praised the province for improving the way it accounts for its spending.
"There has been an amazing amount of improvement in government management, in financial reporting in terms of completeness, accuracy and timeliness," Salmon said.
"Comparing '92 to 2004 is like comparing night to day."