Health funds to pay for you to get hospital treatment at home

Say goodbye to bad food and uncomfortable beds because health funds will soon be paying for you to get hospital treatment at home. But there’s one big concern about the new program.

• Australia’s surgery wait times explode
• Costly ‘deception’ behind health fund premium rise

Private health funds will pay for patients to be treated at home rather than in hospital under a new scheme that could save fund holders hundreds of dollars in premium fees.

Patients recovering from surgery could avoid hospital food, sleep without being disturbed by other patients or nurses doing hospital rounds, save on parking fees and be near family and pets in familiar surroundings.

But hospital care providers want the government to impose strict quality controls on the new model so health funds don’t try to save money by cutting corners on the standard of care.

While no-one will undergo surgery in their home, the scheme – announced in last week’s Federal Budget – will cover rehabilitation services after knee and hip replacements, as well as other procedures provided by physiotherapists and nurses.

Mental health care from specialist nurses and psychologists will also be funded in the home.

Eventually the care revolution could extend to chemotherapy, palliative care and even dialysis.

Nurses will visit your home to deliver care under a new model. Picture supplied.

The switch will initially save health funds $315 million a year and could cut health fund premium rises by around one per cent, the private health insurance industry estimates.

Currently the law states health funds can only pay for care that is delivered in a hospital with a few minor exceptions.

Health funds have accused private hospitals of driving up health fund premiums by gaming this system and referring one in two patients to in hospital rehabilitation to make higher profits.

There has been a 45 per cent jump in the number of private patients receiving in hospital rehabilitation since 2009 with one in two private patients receiving the service compared to as few as 15 per cent in public hospitals.

“Evidence shows the sooner a patient is up and moving after surgery the better and they are more likely to do this in a home environment they feel confident in,” Private Healthcare Australia CEO Dr Rachel David told News Corp Australia.

Many patients were hospitalised for mental health conditions even though it cost a lot more to treat them in a hospital because it was the only way they could get gap free care, Dr David said.

It costs health funds $9000 per patient for in hospital rehabilitation compared to $2500 per patient in the home.

Funds pay $1000 a day for group psychological therapy in a mental hospital but just $220 when the service is supplied in the community or $100 when a GP delivers it.

But health funds are prevented from covering the fees charged by psychologists and mental health nurses when they provide care outside hospital.

Health funds spent more than $800 million in the last financial year on in hospital mental health services – many of which could have been delivered in the community.

Catholic Health Care Australia (CHA) which already provides hospital in the home services said research showed people treated at home were less likely to be re-admitted to hospital and were less likely to die than those treated in hospital.

CHA Health Policy Director James Kemp said expanding out of Hospital Care is good for patients because it provides flexibility and more care options.

But he said it must not be used as a chance for health funds to cut corners and funnel patients into substandard models of care,

“Thousands of people are walking away from health insurance every month. If insurers try to use this as another way to cut costs then thousands more are going to cancel their plans,” Mr Kemp said.

He said it’s vital for the government to introduce strong national standards to ensure patients get the right outcome.

Phoebe O'Connell benefited from hospital in the home care. Picture: Richard Walker

Phoebe O’Connell managed to cut short a recent three week stay in hospital when her health fund paid for the Mater Hospital’s hospital in the home program to have a nurse deliver intravenous treatment in her own home.

The 19-year-old contracted meningococcal Y disease in 2018 and suffered significant health issues including losing both kidneys and her spleen. She also came close to having her finger, toes and nose amputated.

She was able to get off dialysis and resume her university studies when her mum Katy donated her kidney.

The anti- rejection medication she needs after the transplant means Ms O’Connell is immunosuppressed and she recently caught a virus that required antiviral medication.

She was able to be surrounded by friends and family and her cats Hugo and Lou and dog Stella while being treated at home.

“I’m a 19 year old girl, and I wasn’t gravely ill and it was so depressing to sit in a hospital room where you can’t do much and can’t have visitors because of COVID,” she said.

“I wasn’t worried about being treated at home, the nurses did all my observations like blood pressure, I had blood tests every day, all the nurses were experienced,” she said.

Originally published as Health funds to pay for you to get hospital treatment at home