6PR Mornings program interview with Dr Rachel David regarding the need to change regulations to allow health insurers to fund outpatient programs for mental health treatment

Station: 6PR
Program: Mornings
Date: 19/03/2018
Time: 10:35 AM
Compere: Gareth Parker
Interviewee: Dr Rachel David, CEO, Private Healthcare Australia


GARETH PARKER: The idea of a mental health hospital can be a bit confronting, I wonder, but there’s a cost factor here as well. It’s something that the private health insurance industry is urging us all to take another look at. Now, my guest on the show is the CEO of Private Healthcare Australia; that is the organisation that represents the insurers.

Rachel David, good morning.

RACHEL DAVID: Good morning, Gareth.
GARETH PARKER: Thanks for your time today. Why is this whole issue of the appropriate setting for mental healthcare on the agenda?
RACHEL DAVID: I think the first thing that I’d say is that, from a private health insurance perspective, mental health cover is one of the most important things we do. We fund the majority of admissions for mental health patients in Australia, and with awareness and diagnosis of mental health conditions increasing in importance, it’s something that is a key part of the value proposition of what we offer. So there’s no sense that we want to pull back on funding an appropriate level of mental health care. What we’re suggesting is that in Australia, if you have an acute mental health condition that is exacerbated and you need to be in hospital because you can’t look after yourself, you’re a danger to yourself or other people, the level of access to care is pretty good; whether that’s a public or a private hospital. But for people that are past that acute stage but still need ongoing treatment for their depression, anxiety, maybe they’re on medication, maybe they need some other support in terms of counselling or social support to get them back on their feet. For those people, we have a lack of care in the community that can stop them being admitted to hospital again and again in the future.
GARETH PARKER: Okay. So is there a suggestion that people are spending longer than is strictly necessary in a mental health hospital setting once that crisis has passed?
RACHEL DAVID: Once the crisis has passed and people are in the stage of treatment where they’re not so acutely unwell, one of the problems we face is that if they have to see a psychiatrist or an allied health professional in the community, and sometimes they need multiple visits, this attracts a co-payment under the Medicare system, and if they’re treated as an outpatient, the health funds cannot cover the co-payment. So a lot of patients, a lot of people, struggle with this because it might add up over time to being hundreds of dollars, and if they stop treatment, inevitably they end up back in hospital and cycling through multiple hospital admissions, which seems silly given that it could have been prevented. And one thing that we’re looking at in terms of treating people better is some options for the health fund to cover their treatment while they’re out of hospital to prevent them needing repeated hospital admissions.
GARETH PARKER: So why can’t that happen now, Rachel? Is it a matter of the rules of what is and isn’t rebate-able?
RACHEL DAVID: Yes, that’s right. Private health funds are not permitted under current legislation to fund care that occurs out of hospital, but there are specific circumstances whereby if the right treatment is available, we can apply to make payments for outpatient treatment like this. But one of the problems we’ve had is, because there isn’t a good, good funding for treatment to occur out of hospital, many of these services haven’t been provided. So in a sense, we have to work together with psychiatrists and allied health professionals to develop the kind of services we need to help people who are post that immediate crisis phase.
GARETH PARKER: Okay. So in broad brush terms, Rachel, what- if I could sort of summarise what you’ve described here, is the system that if you are privately insured has pretty good coverage in terms of out-of-pocket expenses under your private health insurance, if you’re in a hospital situation. But there is a lack of flexibility in the rules which means that if you want to receive treatment in another setting, in a home setting or an outside setting in the community, it is much more difficult to get those out of pocket expenses covered by private health insurance?
RACHEL DAVID: That’s spot on, Gareth, and that, unfortunately, that is actually a reason why people end up going back into hospital; because they can’t afford the co-payments to continue to see a psychiatrist or a psychologist in the community, and they end up relapsing or sometimes that’s just the only care that’s on offer. It might be that they have a choice between a psychiatrist with a co-payment or going back into hospital for a day program where there’s no extra costs, and so they end up in a very, very high cost setting when it would have been easier, more convenient, and probably more effective to treat them as an outpatient.
GARETH PARKER: Doesn’t seem to make a lot of sense.
RACHEL DAVID: Well, no. This is one of the issues with the system that we’ve inherited. The system of Medicare and private health insurance that we have now is very effective, but it was designed in the 1970s when a lot of these treatments and up-to-date treatments that are completely appropriate to have in the community weren’t available. So now, we do need to be a little bit more flexible as technology and medical treatments have improved, and the most appropriate setting for patients to receive their mental health care is in the community.
GARETH PARKER: I’d be fascinated to hear from anyone who’s had some experience with this. 92211882 if you’ve been through it. Because, I mean, no one really wants to spend too much time in hospital. I mean, I don’t think that- and that’s true; not just of people with mental health conditions, but any sort of medical condition. The quicker you’re in, the quicker you’re out. Still getting the support that you need. This isn’t about just sort of cutting off treatment, but it’s about being comfortable, about feeling at home, about being at home.

Rachel, it does seem as though – with everyone of these stories that we sort of look at – there’s a common theme of very prescriptive rule through inflexible systems. Things that need, sort of, legislative change or government sign-off, or so on. When the rules that are set by- well, I’m not sure by who or for whom, but they don’t seem to always support best practice healthcare.

RACHEL DAVID: I think what we’re looking at is some regulation that was set down in the 1970s, and medical treatment and mental health treatment has evolved enormously since that time. There is a government group that- so, a ministerial advisory committee that’s now looking at this very issue. So, we are hoping for some progress. There are expert psychiatrists, hospital people and mental health professionals and consumers involved in that. And hopefully, as a result of that, we’ll be able to see some flexibility in how we’re able to fund mental healthcare. It’s not- so that we’re not locking up people in hospital or- really, providing one inflexible setting of care. We’ve given them the option to be treated closer to home if that’s what’s appropriate and that’s what they want.
GARETH PARKER: Is there- look, let’s not sort of mince words here. There are big cost implications for health insurers as well, aren’t there? I mean, the two modes of care – hospital versus non-hospital – there’s a big difference in cost.
RACHEL DAVID: Well look, for us it’s a secondary consideration, but it is important because the moment you admit somebody to hospital, the costs of care go up dramatically. If we’re covering the cost as an outpatient, we’re thinking it’s about $150 to $300. Well, that goes up to nearly $1000 [indistinct] treatment, even just for a day in a hospital. And if somebody, say, for example, has multiple visits in a year, that can put significant upward pressure on premiums. So, as admissions for mental health are increasing – and they are growing at a rate of 9 per cent per year – we need to be really mindful about whether we’re paying for the right treatment in the right patients in the right setting of care. And part of that is perhaps looking for some alternative options that might be more effective and more desirable for patients who want to be closer to family and friends in their own home.
GARETH PARKER: So- I mean, it’s triple, effectively, it’s triple the cost for each day in hospital as opposed to out of hospital. And I guess, you know, what you want to try and do- this isn’t just about dollars and cents. This can’t just be a cost-saving exercise because, especially, I think, when you’re dealing with mental health issues, there needs to be an imperative to make sure that, first and foremost, the level of medical care is appropriate for the conditions that a person finds themselves in. But, if you can guarantee that in a non-hospital setting, it seems crazy that that shouldn’t be what we try and do.
RACHEL DAVID: Well look, that’s absolutely right and, you know, we’re certainly not stepping back from a major role in funding mental healthcare. But looking at the flexibility on behalf of our members is what we’re aiming for here.
GARETH PARKER: Rachel, appreciate your time this morning.
RACHEL DAVID: Thanks, Gareth.
GARETH PARKER: Rachel David, the CEO of Private Healthcare Australia. It’s always interesting to here how restrictive the rules are. I guess, there’s good reasons for a lot of those rules, but modes of care evolve the way that we treat people with mental health concerns, with problems, with illnesses. It’s evolved and continues to evolve. You don’t necessarily just need to admit someone to a mental hospital where they languish for weeks and weeks at a time. This probably needs to be a more graduated response in terms of a crisis response, perhaps, at hospital, but once that crisis passes, are there better, more comfortable, but also more affordable ways of looking after people? I guess that’s what the private health insurance industry is calling for. That’s what Rachel David wants to see put on the agenda this morning.
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