Private Patients in Public Hospitals

Station: 5AA
Program: Mornings
Date: 3/4/2017
Time: 11:06 AM
Compere: Leon Byner
Interviewee: Dr Rachel David, CEO, Private Healthcare Australia
LEON BYNER: When you hear about misleading and deceptive conduct you kind of think in terms of the ACCC taking someone to court for telling you one thing when in fact the one thing they told you was completely incorrect and deliberately so. But this story is pretty amazing where health funds are saying that public hospitals are tricking people into using their private cover by saying it’s a donation that will cost nothing, only for bills of up to a thousand dollars to arrive months later. They also allege emergency department patients who should be treated and sent home free of charge within the benchmark of four hours are instead being admitted, then coerced into invoking their insurance.

Let’s talk to Dr Rachel David from the Private Healthcare Australia organisation. Can you explain what’s actually happening here? And thanks for joining us.

RACHEL DAVID: Thanks Leon. Look, this is a problem that we’ve seen gathering steam over the last two to three years. And it’s really a short term way of balancing the budget for public hospitals but in fact it costs everyone more in the long run.

I’ll explain what happens and why and it’s the practice of chasing people who’ve come in to public hospital emergency departments with a medical condition like chest pain, shortness of breath, or weakness and getting them to use their private health insurance even though they’ve paid already through their taxes and their Medicare levies. What then happens is that often there’s an incentive to avoid the four hour waiting time penalty to admit them to hospital under the care of a private specialist, but the moment that happens a higher cost to the taxpayer and to the health fund is triggered. So it both puts up the cost of Medicare, but also the cost of premiums to help fund members as well.

LEON BYNER: How much?
RACHEL DAVID: Look we estimate that premiums for individuals really are inflated by about $100 to $300 as a result of this. It’s a practice that’s been increasing in New South Wales, Victoria and Queensland, but is increasingly catching on in the western states and places like Adelaide as hospitals are trying to chase every dollar, even if that means patients have to pay twice or even three times for the same service.
LEON BYNER: Alright now the thing for me is that patients are being given wrong information as to what it is. Can you explain that?
RACHEL DAVID: Well that’s right. Sometimes in the course of explaining to patients why they’re being asked for their Health Fund card when they’ve gone into a public hospital they’re given information that is quite manipulative and we’ve had numerous complaints about this that have been made to my organisation and to the Ombudsman. This is saying things like: just think of it as a donation to your public hospital; this will help us buy more equipment; or even – this is one thing that we’ve heard a number of times – is this will help you get treated quicker. Now these things are simply not true. Under the Medicare system, public hospitals get funding from the Commonwealth and the state government. They don’t need patients to pay twice to come into the emergency department – through their taxes and through their Health Fund – and it’s just not appropriate under Medicare, if you’ve come in as a public patient, to be told that you’ll be that you’ll be treated quicker if you use your Health Fund card.
LEON BYNER: Now is it not the case though that in some matters, like there are some surgeries that can only be done, for example, at the Royal Adelaide Hospital if they’re trauma related. So if you were a private patient would it not be legitimate to be admitted as a private patient? Or are we really saying that this whole thing is being abused?
RACHEL DAVID: Look I think traditionally there’s always been some patients who have been treated as private patients in public hospitals and there was always a small number of patients who had basic [indistinct] cover or had a particular specialist that treated their condition or provided a particular kind of surgery that only operated in a public hospital. And that number was stable for about, you know, for as long as we’ve had PHI or private health. It’s been stable for decades. What we’ve seen over the last two to three years is increasingly medical patients who don’t need surgery coming into the emergency department of public hospitals looking for treatment because they’ve got a condition like chest pain or shortness of breath and while they’re in distress being asked to show their Health Fund card so that some Health Fund can be charged as well as Medicare.
LEON BYNER: So basically, you’re saying the public hospitals are extracting a fee to which they’re not entitled.
RACHEL DAVID: Look strictly speaking, in terms of the law, it’s something that they’re getting away with and this is something that’s growing at 12 per cent per annum. But consumers need to understand their rights. They should not be compelled to show their Health Fund card if they’re in a public hospital. And there’s really no reason why they should be told that they need to pay twice to access treatment to which they’re already entitled under Medicare.
LEON BYNER: Now you’ve published figures about what some of the other states are doing, what about South Australia?
RACHEL DAVID: We don’t have specific figures about South Australia but we have been advised by patients that they have encountered consultants when they’ve come into hospital who have tried to encourage them to – and these are admin staff – who have tried to encourage them to use their private health insurance as well. So we think that this is beginning to catch on in South Australia too.
LEON BYNER: And do you think they’re being given the story that it’s a donation?
RACHEL DAVID: Look I think that this has become so common that consumers really need to be aware of their rights if they do hear something like that, if they or a family member have gone into a public hospital emergency department. It might be the right thing for them to choose to see a private specialist but they need to understand what their rights are, they should not be forced to. And they should be given full financial consent about what that will mean for any extra bills or charges they might get.
LEON BYNER: Let’s say you go to a public hospital and you have private insurance and you’re told if you show us your card then you will get much quicker service. Not so?
RACHEL DAVID: Look under the Medicare system if you’ve gone into a public hospital they’re really, strictly speaking, not supposed to do that. You need to- if you’re treated by and you’ve made a conscious decision to see a private specialist they can choose to treat you outside the public system at a time of your choosing, but if you’ve gone in ostensibly as a public patient strictly speaking you should wait, under the Medicare rules, the same time as everyone else.

In an emergency situation if you do have a condition that really needs to be treated then and there if someone asks you to show your Health Fund card you absolutely have the right to say no, and if you do choose to do so you have the right to ask that you’re informed in advance of any bills or charges.

LEON BYNER: Alright. Dr Rachel David, thank you.
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