Case study: SA perfects patient 'harvesting'

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South Australia is engaged in one of the most gratuitous examples of cost-shifting based on evidence obtained by HealthDispatch.

As health minister Greg Hunt calls on state and territory governments to end the practice of 'harvesting' privately insured patients, correspondence from a senior public hospital administrator in South Australia reveals the extent to which it is happening systematically, and the motivation.

The correspondence describes the tactics hospitals should deploy to encourage patients to elect to use their private health insurance, including the use of 'Patient Liaison Officers' (PLOs), and the service model that can be provided.

It is even very open in describing the motivation for seeking to encourage people to elect to be admitted as privately insured patients - revenue.

The correspondence clearly shows that, in addition to the hospital's 'revenue manager' working with admission areas to include patient election choice in the hospital admission process, the stated benefit is 'income'.

It describes the benefit as, "The opportunity to assist the hospital through the income received from the patient's health fund. Income received contributes to providing improved hospital facilities, updated equipment and staff education and training."

In terms of the benefits to patients, which is included below the stated income benefit to hospitals, it lists no co-payments and access to 'free to air' television at no cost, in addition to access to a single room if one is available. It says choice of doctor is 'generally' available.

Yet possibly the most shocking aspect of the letter, and gratuitous example of 'harvesting', is where it describes admitting patients as 'private for accommodation only'.

"This election is provided to a patient when a doctor is not available to accept the patient in a private capacity. The PLOs provide the information during their discussion with parents/patients. The PLOs advise parents/patients they will not have a private doctor and their medical services will be provided in a public capacity. They advise the parents/patient their care will be the same as if they were a public patient and that the money the hospital receives from the patient's health fund helps the hospital."

In other words, the patient has no choice of doctor, is treated as a public patient, and the only purpose - stated - of electing to use their private health insurance is to raise money for the hospital.

The new report from the Australian Institute of Health and Welfare, Private health insurance patients in Australian hospitals, 2006–07 to 2015–16: Australian hospital statistics, shows the proportion of public hospital admissions in South Australia funded by private health insurers increased from 9.9 per cent in 2011–12 to 11.6 per cent in 2015–16.