5AA Mornings program interview with Dr Rachel David on proposals for health funds to cover some specialist care out of hospitals

Station: 5AA
Program: Mornings
Date: 26/11/2019
Time: 11:08 AM
Compere: Leon Byner
Interviewee: Dr Rachel David, CEO, Private Healthcare Australia


LEON BYNER: If you’re privately insured and you’ve got an emergency and you need to go to a hospital quickly you might go to a public ED but if you’ve got insurance, that’s private health, you’ll probably go to one of the private ones. The only thing is if you do that, even if you get admitted, there can be a charge 3, 4, $500 and this is something which, under the law at the moment, even if the private funds wanted to cover they’re not allowed to. Now, as I think I told you a while ago there’s been some active discussions between Health Minister Hunt and the industry about whether we can make this a much better user-friendly system.

So let’s talk to the CEO of Private Healthcare, Rachel David. Rachel, what is the progress of these talks?

RACHEL DAVID: Well look we saw in the press this morning that Greg Hunt was flagging that he had asked the industry for proposals to bring forward our ability to be able to fund some specialist care out of hospitals.

Now, you correctly identified that one of people’s main gripes with private health insurance is that it only covers them for hospital care and the funds actually aren’t allowed to cover their specialist treatment out of hospital. This is a system that’s been, the rules that are governing this system have been around since the 1970’s but back in the 1970’s we didn’t even have the same diseases that we have now as we have a number of frail aged people and people with chronic illnesses who could be actually treated better in the community so they don’t have to go into hospital in the first place.

LEON BYNER: Got a question and that is that let’s suppose the government decided that okay, they’re going to let you cover some of these out of pockets, well particularly ED’s at private hospitals. Won’t that necessarily increase people’s premiums, because it’s going to introduce a cost that you never had before, isn’t it?
RACHEL DAVID: Well look, if we did it badly that’s actually a possibility. But I think the idea is that by co-funding with the government some services in the community you can actually prevent people from going into hospital in the first place. And secondly you might be able to prevent them being readmitted to hospital if you give them more intensive care in the community after they’ve been discharged.

So by saving on an overnight hospital admission you actually save a lot more money than you would spend simply by funding a visit to the doctor.

LEON BYNER: Yeah. What do you think of the idea, the Grattan Institute – we’ve had Stephen Duckett on this show quite a bit as you know – but he’s put out a report where partly in this document patients undergoing surgery would no longer receive multiple bills from specialists, anaesthetists, assistant surgeons, pathologists, that private hospitals would be in charge of negotiating with providers and have to bundle the bills together. How practical a wish is that?
RACHEL DAVID: Look, I am really concerned from the patient’s perspective and from a patients perspective this is absolutely what we need and should be doing in private health. Firstly providing people with a reasonable quote for their hospital stay or surgical procedure up-front. And secondly, one bill when they finish with everything itemised including what the health fund paid and any gaps that’s payable. That’s what’s fair and with modern technology it should be much easier than people are letting on.

Now, one of the traditional barriers to this has been that the Australian constitution defines private doctors as being self-employed and that creates complication in terms of a private, in fact because a private hospital can’t actually employ them in the traditional way. But that doesn’t mean that no one can take responsibility for this and for too long no one has.

I’d like to think that private medical specialists are of a mind to keep private health viable and would sign up to this, but someone needs to take the lea. And if private hospitals, I’d like to think that private hospitals would be in a good position to do so, they already have strong relationships with the doctors that use them…

LEON BYNER: Alright.
RACHEL DAVID: …and there’s strong documentation already available about what the doctors do in private hospitals. But we’re happy to help from a private health fund perspective in getting this right.
LEON BYNER: Now, just to get the record clear, what is the percentage increase that the private funds are seeking for the next round of increases? How many per cent is it?
RACHEL DAVID: As low as possible.
LEON BYNER: Well that’s a, I’d like number though. Can you give me a number?
RACHEL DAVID: Look I, yeah I could probably give you a number in about a week or two but right now Private Health Australia as an industry organisation doesn’t have a line of sight into the documentation that every fund puts into the government that wouldn’t be legal or appropriate but I do have an idea from the data and the conversations that I’ve had, that we are supporting the government in keeping premium rises as low as possible. There is nothing worse for a health fund than having to issue a big premium increase unless it’s necessary.
LEON BYNER: I’ve got one other question and I did ask you this before but gee we’ve had dozens of emails on it and that’s this, that patients who seek to not be covered for let’s say, maternity issues, and there is advertising out there, we’ve spoken of this before but it’s still a huge issue so I’m raising it again. So a lot of advertising is leading people to think that if you contact your fund, tell them that you don’t want the pregnancy cover and you’re going to save on your premium. Well, having done this – and this is from people who’ve done it – they can’t get the maternity or pregnancy cover off because it’s bundled up with a whole lot of other stuff that they want.

So, my question is: what do we do about such a situation, and why would any fund be leading people to a belief that just can’t that you can’t actually fulfil?

RACHEL DAVID: Look, I agree that this is a problem because to be perfectly honest if you do need access to expensive procedures like joint replacement, cataract surgery and cardiac, which we all do…
RACHEL DAVID: …as we get older. That’s why – I’m over 50 and that’s why I have my private health insurance is to get access to those things. Quite frankly if you need access to those things you will be paying top hospital cover regardless of whether pregnancy is covered or not. And you’re not going to make a great saving as a result of exploiting pregnancy. Where you can make a saving is by comparing products from different funds and I would urge people to go to the privatehealth.gov.au website, which is an independent website, to be able to do that. And in the meantime I will give your feedback to the funds and also to the aggregator and intermediary companies like – some of the compare the market and I select and so forth.
RACHEL DAVID: I’ll give the feedback to them that this is very confusing advertising because if you do need access to those expensive planned surgery procedures, it is an expense- it is a more expensive product.
LEON BYNER: Alright. Rachel, please keep us in the loop. That’s Dr Rachel David, the CEO of the Private Health Funds. Just getting some answers.
* * END * *