A system that allows hospital authorities to automatically know whether a person is entitled to free healthcare is in the pipeline.

This would make collecting dues from these patients more efficient.

As things stand, those without a Maltese ID card have to present documentation to prove their entitlement.

This is already an improvement over the previous practice of ‘no questions asked’ and has helped the hospital increase its revenue from €300,000 to €1.2 million in a few years.

“We have not changed any regulations – only the way we do things,” Mater Dei CEO Ivan Falzon told The Sunday Times of Malta.

Mr Falzon explained that following an exercise in 2015, his team realised that a potential €1.5 to €2 million in services were being given to non-entitled patients every year.

When he first joined in 2014, Mater Dei used to collect between €300,000 and €400,000 from non-entitled patients. The current system started to be enforced gradually and last year the hospital collected up to €1.2 million in healthcare fees.

The funds are invested in the training of staff and hospital infrastructure. Last year, for example, the income helped fund part of Mater Dei’s air conditioning project.

Mr Falzon explained that in the past people would head to hospital with a referral ticket from their GP and given an appointment without any questions asked. It was only when they turned up for their appointment that those not entitled to free healthcare would be asked to pay.

This was a ‘lose-lose’ situation that led to confrontation, ghost invoices with the consequent loss of revenue for the hospital, and in some cases the treatment slot was lost, he explained.

Therefore, to make things easier, a new standard operating procedure started being rolled out in 2017. All new referrals now require documentation – such as payslip or marriage certificate – to be presented before an appointment is set up. Those who are not entitled to free treatment are informed of the fee upfront.

This system is still being rolled out across the different hospital departments, so not all patients are being informed as yet.

Mr Falzon noted that on average, 90 foreigners are seen at the emergency department and another 200 by the outpatients’ services every day. Out of all these, between 60 and 70 people are sent to the billing department to prove their entitlement or otherwise, before they are seen by the professionals.

Foreigners need to present their payslip because so far there is no electronic system in place that checks the NI contributions of patients.

Mr Falzon said that the Health Ministry and the Family Ministry were working together on this issue, which has generated complaints from foreign patients.

“The process we are aiming for is that rather than pushing data into the system, we pull data out of the system – for example we would input an NI number, and the system tells you whether you are entitled or not.

Read: €2 million in unpaid bills fester at Mater Dei

“At the moment we are asking patients to show us their payslip, pulling the information from the patient. It should be the other way round.”

The end result will either be a database with updated information about NI contributions, or an entitlement card issued together with the work permit for those without a Maltese ID card or a Reciprocal Health Agreement card.

Director of the Entitlement Unit Michelle Galea, from the Ministry for Health, noted that the current social security data was around a year old, and that is why people were being asked to present their most recent payslip dating to the previous month.

Following an exercise in 2015, Mater Dei realised that a potential €1.5 to €2 million in services were being given to non-entitled patients every year. Photo: Chris Sant Fournier

So were people expected to carry a payslip with them in case they need urgent care?

“At the emergency department we treat first and ask questions later,” Mr Falzon said.

Emergency cases make up 15 per cent of the hospital’s cases, with the remaining 85 per cent being scheduled, therefore carried out by appointment. In such cases, questions were asked first and people treated once those questions have been answered, he added.

What if you do not want to leave your payslip with the billing department?

Revenue Manager Steve Ellul said patients had a right not to leave the payslip with the clerk because of data protection issues. In such cases, the staff had been instructed to contact him for approval and verify that they have seen the NI contribution document. He admitted the need for more fine-tuning of the system.

The patients’ experience…

▪ A woman with Italian citizenship, dependent on her partner who pays NI in Malta, was rushed to Mater Dei by ambulance, where she was admitted for pneumonia-related complications. At the hospital she was reassured that she was entitled to free healthcare but she then received a €2,500 bill at home.

▪ A Scottish man was asked for his payslip upon being admitted to emergency and asked to send it by e-mail as soon as he could, even though he was in pain. He questioned whether people were expected to carry their payslip around with them.

▪ When a British woman turned up for an appointment, she was asked on the spot to present a payslip. When she did not want to leave her payslip with the billing department because of privacy, she was asked for a marriage certificate and her son’s birth certificate as he was the patient. What if her child is in the care of family friends, and they do not want to leave their payslip with them?

How much does it cost to stay at the hospital overnight?

A general ward bed: €256.23 daily
A high dependency care bed: €489.17 daily
An intensive care bed: €931.75 daily
CT scan: €465.87
MRI: €698.81
Normal pacemaker and leads: €3,494.06

What do you need to take with you to hospital if you don’t have a Maltese ID card?

What documentation do you need?

*Unemployed TCNs or EU nationals married to unemployed Maltese qualify for free health
**Unemployed TCNs or EU nationals, not married to Maltese/NI paying foreigner, do not qualify for free health care