How does Private Health Insurance affect your treatment.
There has been renewed interest in Private health insurance due to the upcoming increase in premiums as of April 1. Another reason has also been the much criticised changes by BUPA to it’s health cover. But do you actually need to have private health insurance to receive treatment in Australia? The simple answer is, no. And that in itself is something we should all be grateful for.
Our Health system has many flaws but the fact that every Australian has access to free health care for ANY medical condition is its greatest strength. Unfortunately, due to the demands of this system, not every patient can be treated in a timely manner for every problem. This is where our long waiting lists come in. When a patient is booked for surgery through the public health system, we are mandated by NSW Health to tick one of 3 main boxes with regards to clinical priority. The options are 30 days, 90 days or 365 days. This doesn’t leave much room for discussion. Most elective procedures end up having to be booked as a 365 day priority which means the Hospital must schedule the patient for surgery within 1 year of the booking to meet one of its KPI’s (Key performance indicator)
So you may have severe pain from your carpal tunnel syndrome which is stopping you sleeping and working, but due to the nature of the public waiting list you could have to wait up to 12 months for your surgery. However if you are in a health fund, you can opt to be treated in the Private sector and potentially choose your date for surgery. This could be within weeks. But what’s the catch? There is a cost involved and this varies between Funds. As a Surgeon we are obliged to obtain informed financial consent from all our patients prior to surgery. This is just like any other tradesman who gives you a written quote before undertaking a job. One of the problems with the ever increasing premiums is that it is now reaching a level where more and more Australians simply cannot afford to remain in Private health insurance. With some health funds reducing their rebates for surgery, it is leaving their members with a larger “Gap” between the quoted fee and the amount they receive from Medicare and their Fund combined. Naturally this drives more patients into the public system where they can receive their treatment for no charge. But clearly this will also lead to an increase in wait times.
What about patients who have Private health insurance but do not want to pay any out-of-pocket expenses? They can choose to go on the public waiting list to avoid paying a gap. But this just increases the wait times for everyone, especially those in our community who truly cannot afford health insurance.
As a Doctor it is not my role to advise patients on whether or not to have private health insurance, or if they should use their Health insurance. I can only provide the facts and options and it is up to them to decide which way they prefer to go. But as a fellow Australian I do worry that the continued rise in health insurance premiums and shrinking rebates will put extra pressure on our long waiting lists and this will directly impact our most vulnerable who have no choice but to wait for treatment in the public system.
