Canberra Hospital.

Canberra Hospital. Photo: Rohan Thomson

ACT HEALTH is considering charging foreign nationals a $400 upfront fee when they walk in to local emergency departments for treatment.

The proposal comes after the department was forced to write off almost $2 million of debt with more than $1 million of the unpaid invoice fees incurred by tourists without access to Medicare.

ACT Health chief financial officer Ron Foster said no one would ever be refused healthcare but a conversation about delivery of healthcare services and debt was needed.

Since 2010 the department has written off more than $1.9 million of unpaid invoices, but this figure does not reflect what it actually cost the hospital to provide the services and the costs of trying to chase down payments.

''We are conscious of the number of non-eligibles that access ED that we don't get to collect the $400 charge and we have been looking at switching back to a charge that is collected at the front end of the service,'' Mr Foster said.

He said some NSW hospitals were already charging an upfront fee to those who walk into an emergency department without a Medicare card, and a Victorian paper that looked at the issue of hospital tourism found there was a need to stop growing debt.

‘‘Clearly non-eligibles are an issue - whether it be family members who aren’t covered by Medicare or students and the like,’’ Mr Foster said.

‘‘We have a debt management service and we pursue debts through phone calls and letters to the address provided, but quite often people can’t be found ... and invariably we move them to a write-off situation.’’

Asked if hospital tourism was a factor in the capital, Mr Foster said: ‘‘You might be suspicious of that, but I don’t know.’’

But he said the ACT government could not afford to keep treating overseas patients free, and insurance for travellers should be addressed by the federal government.

'‘Obviously a million dollars is a number of procedures, or a number of staff.’’

The figures also show some Australians are not paying for health services.

In the 2010-11 financial year ACT Health was out of pocket $23,000 for pathology services and in 2011-12 this figure jumped to $70,000. So far this year locals have racked up $23,000 in unpaid blood tests.

Mr Foster said the department was in early discussions to centralise debt collection across a number of ACT government agencies.

‘‘It’s thinking sensibly, if we share a client base. One department might have a debt agreement but we are writing it off ... rather than them being approached by three different areas we would have a consolidated approach to their debt.’’

2010-11 financial year:  $856,000 was written off for around 516 invoices.
2011-12:  $746,800 written off for 1145 invoices,
2012-YTD for 2012-13: the write-off is $358,800 for 202 invoices.