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

Station: 5AA
Program: Mornings
Date: 4/4/2024
Time: 10:11 AM
Compere: Matthew Pantelis
Interviewee: Dr Rachel David, CEO, Private Healthcare Australia



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.

RACHEL DAVID: Morning, Matthew.
MATTHEW PANTELIS: What’s going on with this practice? Is it common?

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…

RACHEL DAVID: …way to approach it. So I think it’s more the behaviour of these particular clerks who are frontline workers that’s my concern.
MATTHEW PANTELIS: It would have to be sanctioned by SA Health, wouldn’t it, at the end of the day to have some- I mean, they- clearly the person with the clipboard knew who the public- the private patient was in the public ward. They’ve gone right up to her and said: here, signed this You’d be doing that based on knowledge, and that knowledge can only come with the support of SA Health, presumably.
RACHEL DAVID: Well, look, clearly somebody has put in place a program for the hospital to attempt to raise revenue in this way. At the moment that’s not prohibited, but I would encourage SA Health to ensure that the people doing this with the clipboard are meeting their obligations to the patient for informed- fully informed financial and clinical consent. And that means not approaching someone who is in distress or who is sick, and being honest about what they’re doing and whether there’ll be any extra charges.
MATTHEW PANTELIS: You can imagine the State Government not being in a hurry to stamp this out, though. I mean, this is unbudgeted extra money for the health system.
RACHEL DAVID: Well, look, it’s not extra money for a start. It’s coming from the pockets of people with private health insurance who are also paying their taxes, in many cases, if they’re working in Australia. So it’s not extra money, but it is revenue that a public hospital is perfectly entitled to raise. What I would suggest is that that’s done in a way that is appropriate in terms of informed consent, and appropriate in terms of what- not approaching someone who is sick, incapacitated or under duress, or harassing them or their family.
MATTHEW PANTELIS: Rachel, I don’t imagine it’s keeping premiums low, though, is it? If somebody’s in a public hospital as a public patient because they couldn’t get in as a private patient, and then signing over what would have been paid for as a private patient through their fund. I mean, that’s detrimental for price rises, I imagine?
RACHEL DAVID: Well, look, it may or it may not be, because the amount that we pay for someone having treatment in a public hospital is often less than we do if it’s a private hospital. That wouldn’t be the case if we saw a massive uptick in- across Australia…
RACHEL DAVID: …in this type of claim. But at the moment, the growth is pretty modest. I do have a couple of other concerns though…
RACHEL DAVID: …and one of them is that if a hospital is doing this and encouraging people, particularly through the emergency department, to be admitted as private patients rather than sending them to a private hospital that might have capacity. And we know that from recent data that a lot of the private hospitals have capacity, they’re struggling to attract referrals and admissions at the moment after the pandemic. So they’ve had a pretty tough time. But if the hospital is doing that, is that taking away a bed from a public patient…
RACHEL DAVID: …that might not have the money to obtain or get private health insurance or self-fund? So that would be one of my concerns.

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.

MATTHEW PANTELIS: Yeah. That’s interesting, isn’t it? So- and how would you know that? You just wouldn’t. I mean, the hospital might know where capacity lies, but a patient wouldn’t know to be able to say: well, I’d rather go there. I mean, you might say that, but how do you know? They’re just putting you in and you go along with it wherever they put you.
RACHEL DAVID: Well, I think my message to patients would be is don’t let people put you on the spot. It’s your choice, And no is a complete sentence, right? If you’re not comfortable at making this decision and- you’re completely entitled to say no.
RACHEL DAVID: Whether or not the money is going- no matter where they say money’s going, no matter what they say, you’re entitled to say no. If you have private health insurance, it’s up to you when and where you use it. And as I said, you are entitled not to be coerced…
RACHEL DAVID: …if you’re admitted as a public patient.
MATTHEW PANTELIS: All right. Rachel, appreciate your time today. Thank you.
RACHEL DAVID: Thanks, Matthew.
MATTHEW PANTELIS: Dr Rachel David, CEO, Private Healthcare Australia on the issue of people with private healthcare ending up in a public bed and then someone coming around – as a lot of you are telling me it happens not just in Flinders, but in hospitals all over the place. RAH, QEH were mentioned yesterday, and others, too, where somebody says: well, your private health premium’s just not being used, you can donate them to the hospital. In the case of Steph’s incident, I think it was Flinders research was what she quoted.
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