Dr Rachel David discusses patients being pressured to use their private health insurance in public hospitals on Radio 5AA

Yesterday morning at this time, we were speaking with Steph McCarthy, who’s an author here in Adelaide. She was admitted to Flinders Hospital. She’s a private patient – wanted to go in as a private patient, has had health insurance for decades. Ended up in a public ward for a couple of days while tests were being conducted. And while she was there, someone has come around in the last couple of hours of her stay, just as she’s been discharged, saying: look, if you sign this, you’re here as a public patient, not as a private patient, but your private funds are going to be wasted. They’re going to be lost, so just sign this. We’ll put the money into the- I think it was called Flinders research, or similar. And so she signed, not really knowing what it was. It seems it’s a regular practice, it’s done often.

The net effect of that, I suppose, just to cut out all the stuff in between, is it doesn’t do anything to keep health insurance premiums low. If you’re staying as a public patient, essentially, in a public hospital, then you decide- you’re convinced to sign over your private benefits to that hospital to help pay for your stay. Or you’ve paid for your stay through your Medicare levy, I’d suggest, not so much through your private health insurance if they can’t put you in a private room. How often is this happening? Is it a regular practice? Well, according to your text message and phone calls yesterday, it certainly does seem to be something that is happening often enough – probably too often.

How do private funds feel about this? Well, let’s ask Dr Rachel David, CEO, Private Healthcare Australia. Rachel, good morning.

Well, look, it’s something that was taking place quite frequently before the pandemic. It then slowed down. It’s now starting to pick up again, so we’ve seen a small amount of growth in this type of claim on the health fund. I’d just take a step back and say it’s not illegal for a private patient to have treatment in a public hospital. In fact, many people choose to have their treatment in a public hospital because that’s where their particular specialist works, and they might have a health condition that’s very difficult to manage in any other setting. So it is perfectly legal. But what I think is at issue here is the behaviour of the clerks or the frontline workers that are going around talking to patients and getting them to sign documents, which, as you mentioned, the lady yesterday said that she didn’t fully understand. And that’s a problem for a couple of reasons. If there’s any coercion at all in that interaction, then that’s not appropriate. Sick people should not be coerced into signing anything under duress. And that includes- some people that we’ve seen have actually had private claims made against their name when they’re a public hospital when they’ve been completely incapacitated. So someone with a stroke, for example, clearly didn’t sign that form. And that is actually a form of fraud which we would be obliged to investigate.

So look, it is- what happens is perfectly legal. But one thing that I do need to be clear about is there needs to be proper consent for that to happen, and that includes proper informed financial consent for any extra fees or charges. The expectation of a private room needs to be discussed with the patient. If they have that expectation, then their hospital needs to be honest about whether or not that can be provided for their treatment. And the final thing is that some of the manipulative statements around, well, this is just a way of helping the public system or helping your local hospital – you know, I understand why they do that. That’s a nudge technique. It’s marketing, but it’s probably not the most honest…

And the second concern is that private hospitals at the moment have struggled because of low occupancy during the pandemic when there were lockdowns. If the public sector is hanging on to private patients and not appropriately referring them to private hospitals, that’s putting unnecessary stress on the private hospital system – just at the very point where both parts of the sector are really struggling after one of the biggest crises that they’ve had in decades.