Privately insured patients get VIP treatment in public hospitals

Public hospital admission is meant to be based on need. But it turns out private patients are jumping the queue.

Exclusive: Health fund members are being allowed to queue jump avoiding lengthy waiting times for elective surgery by cash strapped public hospitals in breach of Medicare rules.

New data reveals on average health fund members are waiting just 22 days for elective surgery in a public hospital compared to the 44 days public patients wait.

For some procedures the difference in surgery wait times is even larger.

Half of all public patients waiting for a hysterectomy waited 275 days compared to just 87 days for private health insurance-funded patients in 2017-18, Australian Institute of Health and Welfare (AIHW) data shows.

Privately insured patients using public hospitals got hip and knee replacements within just 29 days while publicly funded patients waited 88 days.

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Patients with private health insurance are getting through the public hospital queue faster. Picture: istock

The (AIHW) reports that in public hospitals “the time within which 50 per cent of public patients were admitted for their awaited procedure was longer for all of the 25 most common intended procedures compared with private health insurance funded patients”.

State and federal hospital agreements enshrine the principle that public hospital admission is meant to be based on clinical need not health insurance status but this data shows cash-strapped public hospitals are breaking the rules to get their hands on health fund dollars.

It makes a mockery of the $6 billion government private health insurance subsidy meant to encourage health fund members to use private hospitals to relieve the pressure on public hospitals.

In 2017 research by health consultant Martin Goddard found NSW is the worst offender with hospitals like Sutherland charging 41 per cent of the care it provides to private insurers, at Royal North Shore 34 per cent of patients have the health fund charged.

Westmead Hospital boasted in its patient information brochure that people who elect to use their private insurance have the “choice to have elective surgery earlier”.

Health Minister Greg Hunt described the practice as “unacceptable” in 2017 and demanded State Ministers explain the longer waiting times faced by public patients.

But the latest AIHW shows the problem is getting worse with 8.4 per cent of elective surgery in public hospitals now funded by health insurance compared to 7.7 per cent in 2015-16.

There were 57,647 health insurance funded elective surgery admissions to public hospitals in 2017-18 compared to 47,033 in 2015-16.

Public hospital admission is meant to be based on clinical need not health insurance status. Picture: istock

In some cases privately insured patients living in the bush have no option but to use public hospitals for elective surgery.

News Corp Australia last week revealed how cash strapped hospitals were pursuing people beyond the grave to get their families to bill their health fund for their care.

Hospital staff who refuse to get people to use their health cover in public hospitals are disciplined and threatened with the sack.

Public hospitals raked in over $1.6 billion from billing health funds every year and funds have estimated it is adding $92 to the average health fund premium.

Nearly 30,000 Australians dumped their health cover in the three months to June because they can no longer afford premiums above the inflation rate.

Every Australian is entitled to be treated for free in a public hospital even if they have private health cover.

The Australian Medical Association (AMA) has accused health funds of hypocrisy for complaining about public hospitals charging their members when many of them sell public hospital only products.

She said it was time for state and federal government to properly fund private hospitals.

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The AMA has accused private health funds of hypocrisy for complaining about public hospitals.

“Accusing the public hospitals of being greedy, when years of failure between State and Federal Governments to agree to suitable funding, obscures the real issues,” AMA (NSW) Vice President, Dr Danielle McMullen said.

Opposition health spokesman Chris Bowen said “of course you should be allowed the choice of being a private patient, but it should be your Medicare card that determines your access of care, not your credit card.

“This is a symptom of a struggling health system where out of pocket costs and wait times are rising while the Morrison Government sits on its hands. Greg Hunt must show some leadership to reduce these record highs, and to address the private health system issues with a root and branch inquiry.”

Private Hospitals Association chief Michael Roff said: “There is no informed choice when public hospitals chase patients to use their insurance well after they are discharged, and their greed for revenue has blinded them to the immorality of allowing insured patients to jump the queue ahead of public patients. It’s time for a full inquiry into the extent of these practices.”

Originally published as Privately insured patients get VIP treatment in public hospitals