UHWI’s $16b burden

The University Hospital of the West Indies (UHWI) is grappling with a staggering $16 billion in unpaid debt accumulated over more than a decade from chargeable services provided to hundreds of patients.

The St Andrew-based teaching hospital is not a part of the public health system which provides services without the payment of user fees.

The hospital’s management told The Sunday Gleaner last week that up to the end of its last financial year on July 31, the monies owed by patients now stand at $16.3 billion, more than $5 billion of which has been racked up since the COVID-19 pandemic started in 2020.

The annual debt for the financial year 2020-2021 was $1.92 billion, the highest since the pandemic. The unpaid bills are for a variety of services across a wide spectrum of care, including surgeries, intensive care, and drugs.

An aggressive push to recover payment for services since then resulted in a smaller annual debt burden, although it is still adding more than $1 billion to the uncollected sums each year.

In 2021-2022, patients racked up unpaid bills of $1.315 billion, which fell to $1.174 billion in 2022-2023, before climbing slightly to $1.223 billion for the just-concluded 2023-2024.

Fitzgerald Mitchell, CEO of the type A regional referral hospital, said although the hospital receives a subvention from the Government, it must make money from services offered as it does not fall under the free healthcare programme.

He said that while many patients or their next of kin simply refuse to honour payments to the hospital, some are just unable to pay, resulting in the massive debt which has surged since the pandemic.

“Some can’t afford to pay. Some people will stop paying if there is a negative outcome. Some with insurance won’t use it here, but only where they must pay on demand, such as private hospitals,” he explained last Wednesday.

“At UHWI, our responsibility is to save lives. We are not turning anyone away, and although collecting is important, it is not our first priority. ‘Who is going to pay?’ is not the first question we ask,” he told The Sunday Gleaner.

Mitchell noted, however, that the annual outstanding receivables sum should not be seen as an indication that no payments are being made, as the hospital collects an average of between $3 billion and $4 billion each fiscal year.

Among the high-ticket services for which many patients have not paid are major surgeries for various conditions, including strokes, brain tumours, haemodialysis, and other urgent medical procedures.

The treatment

is not cheap

Mitchell disclosed that the cost for one of the main drugs used in the treatment of strokes costs roughly $600,000 per dose.

“The treatment is not cheap, especially for those needing care in the hospital’s intensive care unit. Cost can range from $500,000 to $1 million, to include staff, equipment, and drugs, and an individual may require that service for several days or even weeks,” the UHWI CEO said.

“Over time, the debt has increased because when we have treated and are ready to discharge, we are often unable to find relatives whose contact we have or the next of kin. Sometimes, after expensive treatment, we end up with some of these patients on a long-term basis as the infirmaries are full and there are costs associated with keeping them here,” he added.

Dr Carl Bruce, medical chief of staff at the UHWI, said the massive debt is impacting several aspects of healthcare delivery.

“The hospital will continue to run a deficit because it still has to try and pay statutory deductions, purchase pharmaceuticals, pay for a number of goods and services, such as cleaning, maintenance and utilities,” he told The Sunday Gleaner.

“Without funds, we can’t purchase disposables, which are so critical to our functions, such as cardiac stents, surgical disposables, tubes, and lines; [or facilitate the] maintenance and replacement of equipment, especially diagnostic equipment. Still, no one will be turned away,” he emphasised.

Bruce recalled one patient last year who had been shot in the head with a five-foot metal spear from a makeshift bow, a foot of which lodged in his skull.

A team of neurosurgeons, assisted by the hospital’s maintenance team, accident and emergency medics, anaesthesiology, ENT nurses, porters, and imagining medics were part of the more-than-five-hour operation which saved the young labourer’s life but cost the hospital $10 million.

“Not a cent was collected from [him]. We are doctors and we do everything to save lives,” Bruce said.

Among the others with uncollectable debts are people brought in by the police from the streets with no known address or relatives.

And as Mitchell pointed out, “Relatives of individuals who have died often do not want to pay.”

Bruce acknowledged, however, that some people have complained that the hospital has been tardy in presenting timely bills, resulting in them leaving without a final bill.

Provide interim bills

Consequently, the hospital has started to provide interim bills throughout a patient’s stay – a move that has been bearing fruits.

Mitchell told The Sunday Gleaner that the hospital’s management has taken a decision to sell $8 billion worth of debt after exhaustive efforts to collect the outstanding payments.

This, he indicated, is crucial to the effort to improve the UHWI’s financial viability and finance plans to improve facilities and provide advanced medical services going forward.

“So the option of selling has been considered and the hospital’s management has pretty much made that decision, but it is subject to the board approval. We will be taking that proposal to the board for approval,” the hospital’s chief executive said.

Last week, The Sunday Gleaner was unable to contact Patrick Hylton, who chairs the hospital’s board.

“The option to sell is what it is, as it continues to grow. We have used debt collectors to go after the monies owed; and our Billing and Collections people have been calling persons to collect with some success. But $8 billion is a massive sum outstanding, and for a long time. Just think of what we could do with half of that money,” Mitchell explained.

A sale of the debt could see the hospital receiving a percentage of every $100 collected.

Health and Wellness Minister Dr Christopher Tufton said the issue is not one for the ministry as the hospital is not part of the Government’s free healthcare system.

“The other hospitals don’t have debts as healthcare there is free and that has always been the case. So they don’t log debts because there is no charge. But UHWI is a paid institution, subsided by the Government, but they (UHWI) would have records of debts outstanding from individuals who should have paid and didn’t,” the minister said.

He told The Sunday Gleaner that the ministry is supportive of the hospital’s efforts as it could make a significant difference in services offered.

Despite the debt collection issues, the UHWI’s planned expansion project is moving ahead, with changes set for the Ring Road access towards the Tony Thwaites Wing.

More than 200 metres of roadway will be rerouted to incorporate a new paid car park to the back of Irvine Hall on the neighbouring University of the West Indies campus. The current car park in front of wards 20 and 21 will be moved to create space for the construction of the first of five new medical towers to be built over time.

Mitchell said the new road and park should be completed by the end of October, and the first tower should be done by the end of 2026. The six-storey tower will feature 10 operating theatres; conference and lecture rooms; a child and adolescent unit; interventional and radiological services; emergency services; and neonatal intensive care.

He said the structure will be eco-friendly and have a green roof terrace.

erica.virtue@gleanerjm.com