Putting our public patients last
If you have a first consultation with a specialist in their private rooms, you have skipped the hidden waiting list most endure, and it costs public hospitals millions, says Martyn Goddard
THERE was a time when public hospitals were for public patients — people who did not have to pay and who were treated on the basis of need, not wealth. But no more. More than 22 per cent of admitted patients in Tasmania’s public hospitals are fee-paying private patients. At the Royal Hobart Hospital, the figure is more than 25 per cent.
Our public hospitals are being privatised and we haven’t even noticed. The main beneficiaries are a group of wealthy senior doctors.
And the people who suffer the most are public patients, whom we always thought the system was designed to benefit. The Private Patients Scheme is open to fully qualified specialists but the benefits are largely restricted to a relative few. The main areas concerned are pathology, imaging, elective surgery and cardiology.
By no means all senior doctors are involved. Some refuse to join for ethical reasons. Other have few or no private patients.
When a public hospital patient agrees to be treated as private, the money coming for that person — from private health insurance and from Medicare — is paid into a pool.
From there some 95 per cent goes to those senior surgeons, anaesthetists and physicians who are members of the scheme. Five per cent is put into a research fund.
The people who do most of the work — nurses and junior doctors — get nothing. The public hospital has to go on paying their salaries and to foot the bill for other staff, equipment, administration, drugs, supplies, catering and all the rest.
To make it much worse, the hospital gets no federal funding for those private patients.
The commonwealth says it’s already paying for Medicare and the subsidy of health insurance premiums. But that money has already gone to the top doctors.
On average, every private patient costs the public hospital system about $1800 more than treating the same person as a public patient. That translates into an annual loss to Tasmania’s hospitals of at least $43 million.
If that was used for public patients, who would attract federal money in the usual way, an extra 11,600 inpatients could be treated.
If those senior doctors in the scheme were to rely on their public salaries, they would earn up to $300,000 a year. Most of us could get by on that. But these greedy doctors want more.
Many patients, already in hospital, are asked to allow their private insurer to be billed because they are told this will benefit the hospital. The reverse is the truth. And if you’re already in hospital when you switch from public to private, you will get little or no benefit from it.
In other cases a wide gulf has opened up between the two groups.
If you have your first consultation with a specialist in his or her private rooms, you will already have skipped the “hidden” waiting list that most people endure.
People who can’t afford to pay wait for many months or years just to get that first consultation and to be entered on the official waiting list.
If you need elective surgery, the surgeon can put you on one of two waiting lists.
One is for private patients; the other is for everyone else. The private list is short and the public list is very long indeed. Some public patients may never get the operation they need.
The surgeon can, and sometimes does, manipulate urgency ratings, putting favoured paying customers into an artificially high category so they will further jump the queue.
In Tasmania, even after being put on the official list, a public elective surgery patient can expect to wait almost three times as long for an operation as someone who can afford to pay.
Behind all this is a culture of overweening entitlement.
If you need elective surgery, the surgeon can put you on one of two waiting lists. One is for private patients; the other is for everyone else. The private list is short and the public list is very long indeed.
These doctors believe they are entitled to this because, in private hospitals, they can earn so much. Senior doctors in the private system in Hobart earn as much as $3 million a year or more because they bill the patient, who has no market power. Patients just pay the bill. How has all this been allowed to happen?
Why are we permitting our public hospital system to be so profoundly debauched?
There are several answers to this. The first, and simplest, is that most people don’t know what is going on and have no
idea of the damage it inflicts on hospital finances. The nurses who, in good faith, ask for patients to bill their private insurers have never been told.
Ministers in successive governments have either not understood or have not been prepared to confront those doctors. Bureaucrats have tried and failed to bring the system under control. A situation that ought to be a serious public issue, that ought to create outrage among people who believe you shouldn’t be able to buy your way into a public hospital ahead of someone sicker than you. But no.
Who cares?