A leaked document from the health service hierarchy confirmed hospitals brought in €381 million in fines, private bed costs and other extra payments from patients and insurance firms during 2010.
The figure is just 41% of the €642m level HSE chiefs had set for the period.
An internal health service management report obtained by the Irish Medical Times (IMT) said while the use of private beds by hospitals for infection control and the terminally ill did occur, these were not the only reasons for the below-target total.
It said the majority of hospitals were falling far below a minimum target of 73% of their potential private income.
And as a result, the document noted that the costs may have to be passed on to the general public in order to balance the HSE books.
“It is recognised that hospitals use private beds for infection control and patients who are terminally ill. These issues are being managed in St James’s Hospital and still a usage level of 89% is being achieved,” the Update on Income Value for Money Initiatives 2011 report stated.
“Achievement of this target will not change the volume of private work undertaken in public hospitals.
“It will allow for the charging of a greater number, but not all of the people will elect to be private.”
The below-target figures emerged just weeks after HSE finance director, Liam Woods, informed the then-HSE board he had recommended a change to the current extra fee-charging regime.
Mr Woods is understood to have informed Health Minister James Reilly that he would prefer a more straightforward system that cuts down on red-tape.
“One element of this could be to allow hospitals to charge up to the maximum number of designated beds, so long as there are sufficient patients electing to be private on a daily basis,” the senior HSE official proposed.
The below-target private income level will add further difficulties for the HSE, which the Irish Examiner reported in March is also owed more than €266m in outstanding patient charges. Some €54m has been owed to the HSE for between 12 and 36 months, with €39m outstanding for more than three years and unlikely to ever be repaid.