This article was originally published by Dana Daniel in the Sydney Morning Herald, on October 22, 2021.
Health funds are being hit with refund requests from members fed up with being unable to access elective surgery, while doctors are demanding state governments boost hospital funding to reduce their waitlists.
The Australian Medical Association has asked the competition watchdog to scrutinise state and territory arrangements with private hospitals after The Age revealed Victorian private patients were having their surgeries cancelled to make way for public patients.
As Victoria’s elective surgery freeze drags on and NSW hospitals are preparing to restart non-essential surgeries at 75 per cent of usual capacity on Monday, health insurers are contemplating another round of refunds after handing back more than $100 million to members in August.
AMA President Omar Khorshid said he was concerned state governments could be misusing special pandemic arrangements with private hospitals – under which the Commonwealth pays an uncapped 50 per cent of the costs of treating a public patient in a private hospital – by encouraging the prioritisation of public patients to avoid properly funding public hospitals to catch up on elective surgery.
Dr Khorshid said this risked “reducing the value proposition of private health insurance”.
“There are people who are doing the right thing by putting their hands into their own pockets to pay for private health insurance,” Dr Khorshid said, warning that frustrated members who ditched their health cover would put further pressure onto the public system.
“Our health system works because of this delicate balance between public and private,” he said.
The Australian Competition and Consumer Commission is considering applications by Victoria and NSW – along with Queensland, Tasmania and the ACT – to renew a previous determination allowing them to enter agreements with private hospitals to provide public healthcare.
In a letter to the ACCC, seen by the Sydney Morning Herald and The Age, Dr Khorshid called on the watchdog to ensure the states “are committed to building overall system capacity”.
A Victorian health department spokesperson said the state’s partnership with private hospitals “is helping to manage demand and prepare for an increase in COVID patients”.
A NSW government spokesperson said the health department “rejects any suggestion that the current arrangements and future arrangements between NSW Health and private hospitals to provide support in response to COVID are based on anything other than the safety of our communities, staff and patients”.
They noted the NSW government provided an extra $458.5 million to fast-track elective surgeries cancelled last year under federal government rules, with $80 million allocated in 2021-22.
The elective surgery bans have left private patients facing wait times normally only encountered in the public system, despite paying health insurance premiums that are supposed to guarantee faster access to care, along with the choice of a doctor.
Medibank member Robert, who asked for his surname not to be used, is still waiting for a colonoscopy that was due last year but has been cancelled under successive Victorian elective surgery bans.
“I took out health insurance in 1987, we’ve been insured for decades,” the Melbourne grandfather, aged in his mid-60s, said.
He said he phoned Medibank to complain about the lack of value in his policy and was offered a five-day discount on his next premium instalment.
Private Healthcare Australia chief executive Rachel David said it was unfortunate private patients were having their surgeries cancelled and urged patience as hospitals caught up.
“If this was to continue for a long time, we’d have to reconsider the situation for members in Victoria,” she said.
Dr David said having private health insurance was still the fastest way to access elective surgery and mental health treatment.
NiB Managing Director Mark Fitzgibbon said while it was appropriate for private hospitals to help out in a crisis, “you have to make sure people are treated based on need”.
The industry has set aside funds to eventually pay for catch-up elective surgeries in the private system.
A federal Health Department spokesperson said public patients waiting for non-urgent elective surgery should not be referred to private hospitals.
“Patients requiring elective surgery will continue to be prioritised based on clinical need and cases are not to be reclassified unless clinically indicated,” the spokesperson said.
Source: Dana Daniels, The Sydney Morning Herald, October 22, 2021 – Read the article on the Sydney Morning Herald’s website here.