Growth of private care in public hospitals raises equity questions

A new report showing that public patients wait twice as long for elective surgery as private patients do in public hospitals raises serious questions about equity of access to care.

The Australian Institute of Health and Welfare report into statistics on private health insurance patients in Australian hospitals shows that between 2006-07 and 2015-16 the number of privately insured patients treated in public hospitals rose by an average 9.6 per cent a year.  The rate of growth for insured patients treated in private hospitals, 4.9 per cent, was nearly half that rate.

The report also showed that privately insured patients experienced shorter median waiting times for elective surgery 20 days compared with 42 days for public patients.

“We support people being able to use health insurance in public hospitals but these figures raise concerns about the issue of equitable access to public hospital care for the majority of Australians who are not insured,” a spokesman for the Consumers Health Forum, Mark Metherell, said.

“Health insurance subsidies were introduced on the reasoning that higher numbers of people with insurance would result in lowers strains on public hospital.

“The reality of these figures however is that over the past decade the reverse has occurred, with an increasing proportion of insured patients being treated in public hospitals.

“The data shows that public hospitals carry the burden of caring for very sick, young and old.  The private hospitals offer a more limited set of services.

“CHF believes the data need closer examination, particularly around the issues of treatment urgency, health insurance status and waiting time.

“We know from our consumer feedback that one of the motivators for people taking and keeping PHI is to avoid waiting for care – not necessarily queue-jumping. These data showing shorter waiting times would encourage that expectation.

“But when there are dramatic variations in waiting times for common and life-changing procedures such as with knee replacement surgery where insured patients wait 76 days compared with 203 days for public patients, there needs to be a rigorous rethink of why and how these differences occur.

“The growing use of public hospitals by insured patients and their doctors has prompted questions about the practice of public hospitals to prod patients with health insurance to be treated as private patients.

“The public hospitals and state and territory governments are promoting these practices to help meet their costs.

“But this is undermining the universal health care based on clinical need principles of Medicare.  It’s an issue the federal, state and territory governments must address to counter the drift towards two-tiered health care in Australia,” Mr Metherell said.


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Mark Metherell
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