DOCTORS are reportedly considering asking patients on the Government's Hospital Insurance Plan (HIP) to pay for medical services in full ? a move that would leave policyholders to claim back what they are due from their insurers afterwards.

The idea could lead to some of those least able to pay in the community being asked to fork out thousands of dollars up front for essential and possibly life-saving medical procedures.

Widespread frustration among the medical profession with documentation and accounting related to HIP have led doctors to consider extreme measures to bring about improvements, a well-placed source told this newspaper.

The fund behind HIP health coverage is the Hospital Insurance Fund (HIF), which came in for strong criticism in Auditor General Larry Dennis' annual report on Government finances, presented to the House of Assembly last Friday.

The understands that the Bermuda Medical Society (BMS) wrote to the HIF managers earlier this year, asking to see improvements, otherwise BMS members would consider billing HIP patients directly.

According to one source, the Fund, which is managed by the Department of Social Insurance, has been paying out lump sums to doctors making claims for services rendered to HIP policyholders without specifying what the payments actually relate to.

This has caused physicians great difficulties in compiling and reconciling their own accounts and ensuring that the accounts of patients are credited accordingly.

BMS president Dr. John Gaugain said he could not comment until he had read Mr. Dennis's report.

Payments from the Fund for treatments at King Edward VII Memorial Hospital are also reportedly often up to a year late, causing problems with the BHB's cash flow and accounting.

Financial reporting of the Fund is seriously in arrears, the Auditor's report stated, and the last audited financial statements referred to the year ended March 2001.

Mr. Dennis wrote: "The breakdown in accounting systems has now begun to affect the operations of local businesses and this will soon have a negative impact on members of the Fund.

"Medical service providers are not receiving itemised breakdowns when being reimbursed. Besides failing to support significant cash disbursements out of the Fund, the lack of a breakdown prevents the service provider from allocating funds received against amount due from patients. The alternative will be for service providers to bill patients directly ? an unnecessary inconvenience to members of the fund, all because management is not maintaining an appropriate accounting system."

In the section of his report dealing with the Bermuda Hospitals Board (BHB), the shortcomings of the HIF are once more highlighted.

"... the Department of Social Insurance (which administers the Fund) seems incapable of processing and paying claims within a reasonable timeframe, or providing patient details when claims are paid," Mr. Dennis wrote.

"Claims are routinely paid up to one year after they are submitted. This impacts negatively on the Board's cash-flows and renders its billings receivable records almost useless for the purposes of identifying and investigating billing errors and disputes promptly."

The report added that BHB management acknowledged this was an ongoing problem.

We asked whether the BHB would ever consider asking HIP patients to pay up front because of the Fund's slow repayments.

Delia Basden, the BHB's chief financial officer, responded: "Bermuda Hospitals Board has a positive working relationship with the Department of Social Insurance. We continue to manage our HIF receivables successfully."

The Mutual Re-insurance Fund provides back-up for the Government health insurance programmes and settles claims for items such as long-stay hospital care and kidney transplants. The Auditor reported that this fund, also maintained by the Department of Social Insurance, was also in arrears with its reporting.

We were unable to speak with Karen Daniels, the director of Social Insurance, as she was engaged in meetings throughout most of yesterday.