Estonian hospitals see more unpaid patient fees

More people in Estonia are failing to pay hospital fees since patient charges were raised a year and a half ago. Patients with outstanding debts can no longer see a specialist.

The fee for a doctor's visit has gone up from €5 to €20, and the daily hospital bed fee has doubled from €2.50 to €5. At North Estonia Medical Center (PERH), the number of patients who owe money has doubled in that time, while the total amount owed has tripled.

What the debts consist of

Anneli Habicht, PERH's head of customer service, says about 70 percent of the debt is bed fees and 30 percent is visit fees, mainly for emergency department visits. In roughly half of cases patients simply forget to pay, she says, while the other half do not intend to. Before turning to a debt collection agency, the hospital spends a couple of months trying to recover the money itself. Debtors are more often people approaching retirement age and very young adults, as well as men.

Nearly 2,200 people owed money to Narva Hospital last year. The sums are generally small and are usually paid after a reminder. Hospital CEO Üllar Lanno says the number of debtors rose by about 25 percent in the first nine months of this year, but there are no signs of people deliberately avoiding payment or of any need for aggressive collection.

Tartu University Hospital has not had the same problem. Management board member Joel Starkopf says most of its treatment revenue comes from its contract with the Estonian Health Insurance Fund, and patients' own payments make up less than 3 percent of that. The hospital has half a million outpatient visits a year, and perhaps 200 to 400 patients need payment reminders.

The collection agency's view

Debt collection agency Julianus Inkasso says the number of claims from hospitals has risen by a few percentage points, though some institutions have submitted 10 percent more. Its CEO, Merle Laurimäe, says €20 is harder to afford than €5 for households on a tight budget. More than half of debtors settle within a year of receiving a letter from the agency, but they must also pay late-payment interest and collection fees of up to €30. Laurimäe says the total could rise to around €55 at most if people act in time.