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Shifting patients and costs won't fix hospital waiting lists


If the South Australian Government wants to end long surgery waiting lists, it must work with the Commonwealth and private health funds – or we could end up with a ludicrous and inefficient outcome, writes Rachel David.

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The problem of overcrowding and record non-emergency surgery waiting lists is not unique to South Australia’s public hospital system. It is an issue across the country and one which points to the value of private health insurance.

I spent years as a junior doctor and health administrator working in South Australian public hospitals. One of the hardest things you need to do in that role is to explain to a person with a serious health problem that they won’t get the care they need because of overcrowding in the hospital and long wait times.

With private health insurance, you know when you are going to have your surgery. Under the SA Government’s plan to pay for non-emergency surgery for public patients in private hospitals, consumers still won’t know when they are likely to reach the end of the wait list, where their surgery will take place or who will do it.

More than 80 per cent of consumers with private health insurance – 13.6 million Australians – value it and want to keep it and they cite timing of surgery and choice of specialist among the main reasons.

The SA Government’s proposal does not give consumers control over their health care. Public patients will still be subject to the fluctuating public hospital wait lists. Privately-insured South Australians, however, can be confident this plan will not impact their health care or wait times for surgery in the private sector.

With increasing pressure on the public hospital system, it is time that State Governments reviewed their revenue-raising practice of actively recruiting private patients coming to public hospital emergency departments.

People attending public hospital EDs with non-surgical conditions like breathlessness and chest pains are routinely hassled to use their private health insurance, thereby taking up beds previously reserved for surgery patients. The winter months are typically when public hospitals get overwhelmed, and this is precisely when this practice creates chaos across the system.  National data clearly shows private patients get priority treatment when admitted to public hospitals.

This cost-shifting practice is not exclusive to South Australia but has become a feature of public hospitals across the states and territories and is a major contributor to premium increases for health fund members.

It is therefore ironic that at the same time as public hospital administration staff are coercing private patients to use their health insurance in a public hospital, state health departments are contracting out public patients to private hospitals.

Surely this isn’t an efficient way to run a health system? We have one health system which comprises the mix of public and private sectors and, managed properly, it is among the best in the world. We need to stop this shifting around of dollars and patients for short-term financial or political gain and concentrate on spending the health dollar where it is most efficiently used.

If we don’t act to introduce further sensible reform across the health sector, the logical extension is that we could end up with public hospitals full of private patients, and private hospitals full of public patients.

Governments and health funds as the major payor of elective surgery need to collaborate to ensure care is delivered where it is most needed and the system is better managed.

Dr Rachel David is the chief executive of Private Healthcare Australia – the peak representative body for Australia’s private health insurance industry.

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