Health insurers, hospitals and the government are not doing enough to ensure patients understand hospital bills and know where to turn if they have queries, the national ombudsman said on Friday.

The complicated system for calculating charges, know as the DBC, also means simple treatments can cost hundreds of euros. Sticking a plaster on a head wound can, for example, be classified as a minor surgical intervention.

Patients are also left struggling to deal with hospitals when they dispute a bill, the report says. One man who complained about a €556.60 bill for a 10-minute consultation was referred by his insurance company to the hospital. The hospital, in turn, said it was not required to explain its charging.

‘If people feel the system is not working in their interests and that they are being ripped off this undermines confidence in the health system and the government,’ the ombudsman said.

Health minister Edith Schippers said in a reaction that improving billing transparency is a government priority.

Most people only find out how much their treatment costs when ‘using up’ their own risk element – currently €375 a year – and asked to refund their health insurer.