Long waits push surg­eries onto pri­vate list


The long wait for hip and knee re­place­ments and cataract surgery in the pub­lic hospi­tal sys­tem is be­ing used to jus­tify those pro­ce­dures be­ing avail­able only in toplevel in­sur­ance poli­cies, given pa­tients al­ready have a strong in­cen­tive to go pri­vate.

Un­der planned gold, sil­ver, bronze and ba­sic cat­e­gories of in­sur­ance, to be in­tro­duced from April, tens of thou­sands of poli­cies will be re­or­gan­ised into com­pa­ra­ble tiers, promis­ing mem­bers greater trans­parency and the abil­ity to shop around.

How­ever, as­sign­ing clin­i­cal ser­vices to cat­e­gories proved dif­fi­cult and took longer than the fed­eral gov­ern­ment ex­pected. With hospi­tal cov­er­age fall­ing, and con­cerns over ris­ing pre­mi­ums, stake- hold­ers have also had to pre­dict how mem­bers and prospec­tive mem­bers will re­act to the changes.

Doc­u­ments ob­tained by The Aus­tralian un­der free­dom-of-in­for­ma­tion laws show wait­ing times for elec­tive surgery in pub­lic hos­pi­tals have been fac­tored into cat­e­gory de­sign.

The Aus­tralian In­sti­tute of Health and Wel­fare this week re­vealed the av­er­age over­all me­dian wait­ing time for ad­mis­sion for elec­tive surgery in 2017-18 was 40 days and in­creas­ing at a rate of two days a year.

Con­sul­tants en­gaged to model var­i­ous cat­e­gory op­tions told the De­part­ment of Health they had fac­tored in “de­mand shift­ing from the pub­lic to pri­vate set­ting” but may have un­der­es­ti­mated the po­ten­tial in elec­tive surgery.

Where peo­ple faced wait­ing more than a year in the pub­lic sys­tem, or an unin­sured bill that would be higher than pre­mi­ums over the same pe­riod, there was greater in­cen­tive to take out in­sur­ance.

“Such con­sumers may warm to the op­tion of pur­chas­ing a prod­uct for a par­tic­u­lar ser­vice to avoid the pub­lic hospi­tal wait­ing list,” the con­sul­tants said, giv­ing as ex­am­ples hip and knee re­place­ments and cataract surgery, which will be man­dated only for gold-cat­e­gory poli­cies.

With an age­ing pop­u­la­tion, de­mand for cataract surgery is in­creas­ing and it is the most com- mon elec­tive pro­ce­dure in the pub­lic sys­tem. So, too, is de­mand for hip and joint re­place­ments.

Ac­cord­ing to the in­sti­tute data, 1.9 per cent of peo­ple on the pub­lic list for cataract surgery wait more than 365 days, with 6 per cent of those on the list for hip re­place­ments and 8.4 per cent of those on the list for knee re­place­ments, also a con­se­quence of ris­ing obe­sity rates.

The con­sul­tants said that in 2016-17 the av­er­age charge for a hip re­place­ment was $27,070 and for a knee re­place­ment $24,599.

“Both hip and knee re­place­ments are good ex­am­ples of treat­ments which have both long pub­lic wait­ing lists and treat­ment charges that are mul­ti­ple times the typ­i­cal cost of a sin­gle year’s pre­mium,” the con­sul­tants said.

“Both of these ef­fects will make pri­vate health in­sur­ance par­tic­u­larly ap­peal­ing, and there may even be peo­ple who ad­versely select against the in­dus­try by drop­ping their cover again once they have re­ceived their treat­ment. The fi­nan­cial sus­tain­abil­ity of the pri­vate health in­sur­ance sys­tem is best man­aged by min­imis­ing such op­por­tu­ni­ties for gam­ing the sys­tem.”

Health Min­is­ter Greg Hunt said the big­gest driver of wait­ing times in the pub­lic sec­tor was gov­ern­ments pur­su­ing in­sured pa­tients for the rev­enue, forc­ing those who can­not af­ford in­sur­ance and are “gen­er­ally do­ing a lot tougher” to wait longer.

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