PHA: Now is the time to revisit private health reforms

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Private Healthcare Australia chief executive Dr Rachel David says now Australians are relying on the private sector to clear the backlog of elective surgery, it is time for the government to revisit key private health reforms to improve affordability and keep Australians in health cover.

Making sure private health insurance is affordable for Australians is suddenly more important than ever before.

We all understand Australia’s economic recovery is a high priority but the experience of the COVID-19 pandemic has reminded us our health is something we should never take for granted.

The many Australians impacted directly by COVID-19 and the tens of thousands who had their essential non-emergency surgery postponed as a result of the pandemic need no reminding.

Keeping private health insurance affordable will make it possible for these people to access timely surgery, it will take pressure off the public hospital system and it will ensure we maintain balance in our mixed Australian health system as our environment continues to change.

One of the reasons Australia has done so well in its response to the pandemic compared with other countries, is the flexibility, expertise and capacity offered by our mixed private and public health system.  The pure ‘private’ system in the USA, and the UK’s mostly public National Health Service have floundered by comparison.

This pandemic has however rocked our health systems across the country, and it will take them years to recover. The private sector has a critical role to play and we need to work with stakeholders to provide affordable, safe and timely care for all Australians.

We have to make the changes necessary to win back young Australians, bring down wasteful costs and provide the services people need and want.

Elective (essential non-emergency) surgery waiting lists in the public sector have blown out across the country.  Governments are announcing cash injections to boost public hospital capacity, but research shows that even with the investment public hospital waiting lists for elective surgery will not get back to previous levels until at least June 2022.

The private system, however, can increase capacity by 20 per cent this year and next, and private health insurers have provisioned for the necessary expenditure to catch up in elective surgery.

The private sector will inevitably play the leading role in clearing the backlog of elective surgery but for most Australians it all comes back to affordability. Women and families have been hit hard by the economic impact of COVID-19 and are reviewing their expenditure, including private health insurance.

When COVID-19 hit Australia health funds stepped up to the challenge, postponing the April 1 premium increase and providing financial relief for thousands of Australians. Health funds gave a commitment no fund would seek to profit from the suspension of elective surgery.

As the government’s COVID-19 strategy proved to be highly effective, elective surgery and allied health consultations resumed well ahead of the expected time frame. The so-called windfall gains predicted by a few never eventuated.

Health funds have continued to introduce new initiatives to support their members, including but not limited to rebates, short term premium reductions, extension of benefits and rollover of extras benefits until next calendar year.

They have invested millions of dollars in COVID-19 support programs, focussing on members’ mental health and wellbeing. In addition to funding psychology telehealth and in-hospital mental health treatment, many funds have online mental health and wellbeing services their members can access.

However more must be done to make private health insurance sustainable in the long run and it will involve making some tough decisions.

The baby boomers understand the value of private health and are accessing surgery at record levels.  The economic crisis however putting the cost of private health insurance further out of reach for younger Australians who have been hardest hit.

By necessity COVID- 19 refocused the government and the entire healthcare sector on addressing the immediate crisis. Many reform projects, including improving the affordability of private health insurance, were parked.

The Federal Government must now focus on:

  • Immediately recommencing regulatory reform to bring down medical implant costs escalating way out of proportion to the rest of the world, and the number of surgeries actually performed; and
  • Implementing measures to retain and attract young Australians and families into private health insurance, critical to addressing affordability for all Australians Reforming decades-old regulation constraining the ability of health funds to fund services provided outside of hospital.

Health funds will continue to do their part on the road to recovery.

  • This includes maintaining access to telehealth and hospital in the home programs Working with providers to ensure as many services as possible are provided with no or known out-of-pocket costs; and,
  • Tailoring products and services, which are both affordable and relevant to a new generation of members who need and want a focus on mental health, wellness and prevention as we emerge from the pandemic crisis.