How State Governments are encouraging public hospitals to bill private health insurers for their members’ treatment

Station: 2GB
Program: Mornings
Date: 4/3/2017
Time: 11:07 AM
Compere: Luke Grant
Interviewee: Dr Rachel David, CEO, Private Healthcare Australia
LUKE GRANT: Now, it’s been revealed today – what do you make of this? It’s been revealed today state governments are encouraging public hospitals to bill private health insurers for their members’ treatment. Now there are concerns this practice is driving up premiums, threatening the stability of the health system and driving public hospitals to prioritise insured patients.

Now, I know this happens because this was put on me a couple of years back at the public hospital. It was that I was out of town and there weren’t many options so I just had to go down that road and they said: Oh, you know if you get your insurer to pay – that slight little encouragement. I did it at the time but now I think back – and I don’t know what your take is on this – but I pay private health insurance premiums, in my case, so I can go to a private hospital and, if I can, jump the queue because I can get a doctor to operate on me earlier if I find myself on a position on the public list to be in a waiting list.

Now, that’s what I expect to get back. I don’t expect to get what I would get for free courtesy of my premium. And has that put pressure on my premium, or health fund, in order to increase it? It’s an interesting question. I have to tell you that privately I had a conversation with the boss of a hospital – a private hospital – on this very topic less than a year ago, and I was told then that this is a very big sleeping issue. Let’s find out more about it.

Joining me on the line, Rachel David, CEO of Private Healthcare Australia. G’day Rachel.

DR RACHEL DAVID: Good morning Luke.
LUKE GRANT: Nice to talk to you. How common is this practice?
DR RACHEL DAVID: Look we’re finding it’s becoming more and more common, particularly in New South Wales and Queensland, the eastern states, but increasingly all over Australia with the kind of naïve belief by a number of public hospital operators and state governments this is a quick way to make some extra money.
LUKE GRANT: Is that basically what it is? Because I’m assuming when I pay my Medicare levy it won’t cover all – but the cost of public hospital admissions and the like, that’s the deal. So they’re getting on top of that what I derive by paying my premium. So they’re milking my insurance to help their budget. Is that too simplistic to look at it?
DR RACHEL DAVID: Well no, it’s not, and I think we’ve got to think of the patient and the health fund’s member here. If you are an Australian citizen and you pay taxes you have paid for treatment for free in a public hospital. It’s called Medicare. So if you go to a public hospital emergency department and you are in distress it is completely up to you whether you choose to use your private health insurance or not and no one should pressure you, particularly if you are unwell, in distress, or a family member is unwell, because you have already paid through your Medicare levy and through the taxes that you’ve paid.

There are some circumstances where people choose – they make a special arrangement with their specialist to be treated in a public hospital. That’s not what we’re talking about here.

DR RACHEL DAVID: This is people going to the emergency department because they’ve had a problem. They are entitled to be treated free at the point of service.
LUKE GRANT: And that was exactly what happened with me in relation to a heart condition. And they put this on me a day or two into the treatment: Oh, you can use- what I actually expected to get, doctor, was perhaps a private room with, you know, someone playing the bagpipes and someone with a hoola hoop performing in the corner. But no, I just got thrown into the ward and they’ve used the private health benefit.

And I did feel, I have to say – and it’s not that I’m weak-kneed necessarily – but I did feel somewhat pressured into doing it. Almost like, you know, you’re doing the right thing by the taxpayer here. Which I have to say was a bit weak, now I think back.

DR RACHEL DAVID: Well no, it’s not weak. I mean, people are under a lot of pressure when they visit a hospital. No one visits an emergency department for fun. But it’s precisely because patients are vulnerable that we need to be careful how we treat them.

Now, if you do choose to use your private health insurance in a public hospital you’ve got some rights, and one right is you need to be fully informed about any out-of-pocket costs that you could have. And we’ve had a number of complaints about people who thought they were being treated for free and got billed – sometimes very large bills later – because they’d signed away for their private health insurer.

The other issue is you need to have your choice of doctor and one person responsible for your care. And you know, if there is- and you need to know, you know, where will I be treated? Are there other options? And these are things that are not being discussed with patients at the time when they’re making these decisions.

LUKE GRANT: So if I can ask you this question: Under what circumstances- let’s say you were me – easy for me to say, but if you were – and you’re in that situation where you’re in a public- you’ve turned up to emergency and a day or two later someone comes up to you, working on behalf of the hospital and says: By the way, I note you’ve got private health insurance, is it possible for us to use that to cover the cost of this? What do you say back to them?
DR RACHEL DAVID: The first thing that people need to understand is that they’re absolutely within their rights to say no, and there should be no further discussion.
DR RACHEL DAVID: If they do decide to say yes, then they need to know what their rights are, and the first thing they need to ask is: Will this mean that I’ll be charged any extra? Because the last thing you want is to be sick and then maybe go home and a few weeks later get bills and charges that you didn’t expect. And then, the implications for any treatment and the choice of doctor need to be made clear.

Now, at the moment the law does not permit someone being treated in a public hospital to jump the queue for treatment. Now, whether that happens or not is very blurred. We hear that it does happen, that people say that they’ve got private insurance and they’re treated more quickly in emergency departments.

LUKE GRANT: [Talks over] Yeah, yeah.
DR RACHEL DAVID: Or they get bumped up the waiting list. Ideally, if they use their private health insurance, they should get that treatment quickly – within a couple of days – but in a private hospital. If they get it in a public hospital a place has been taken for someone who’s less advantaged and that creates a problem for the whole system.
LUKE GRANT: It seems to me, Doctor, without being too simplistic with this, we pay Medicare for what we receive by way of treatment in the public system, public hospital. We pay our private health insurance premium for what we get treated for in the private system. Why should they ever cross over, for God’s sake? It’s almost like we’re double paying, isn’t it?
DR RACHEL DAVID: Well look, they’re crossing over because bureaucrats think that this is a way of shifting money from one part of a system to another to make their own books look good. But the reality is it disadvantages patients and it doesn’t actually help save the health system any money. It’s just shifting one cost from one part to another.

And I think what we need to be clear about here is it’s the patient’s right and the right of the person who’s paid their Medicare levy and who’s paid their private health that needs to be considered here – not whether a bureaucrat has balanced their budget for the next six months.

LUKE GRANT: Great stuff. Good to talk, Rachel. Thank you very much.
DR RACHEL DAVID: Cheers then, Luke.
* * END * *