Make insurers fund home care, says Catholic Health Australia

Australia’s largest non-government provider of health and aged care services is calling for an overhaul to the private health insurance model to force funds to pay for home health services.

Catholic Health Australia says patients who may have preferred to receive care at home were being forced into more expensive hospital care simply ­because that was what was funded by their health insurer.

Australia’s largest non-government provider of health and aged care services is calling for an overhaul to the private health insurance model to force funds to pay for home health services in a bid to reduce pressures on the ­nation’s hospitals.

Catholic Health Australia – which represents about 15 per cent of hospital-based healthcare in Australia – is also advocating for Labor to introduce a hybrid workforce model to allow undergraduate nurses into the workforce before they have finished studying to alleviate staffing shortages.

In a submission to the federal government ahead of the May budget, the peak body said regulatory arrangements for private health insurance were out of touch with care models in the ­public system which now allowed numerous treatments that previously took place within hospitals to be administered in other settings.

This included treatments such as dialysis, chemotherapy, rehabilitation and palliative care.

CHA said patients who may have preferred to receive care at home were being forced into more expensive hospital care simply ­because that was what was funded by their health insurer.

It has also called for the Productivity Commission to conduct a whole of system review of the private health sector amid concern it is experiencing “immense financial hardship, with its long-term viability threatened”.

The peak body argued that reforms to the private health sector would benefit the taxpayer, with more than two out of every five hospital admissions in Australia being to a private hospital.

Two out of three elective surgeries ­between 2019 and 2021 were ­performed in private hospitals.

“In instances in which patients would prefer to receive care at home, these programs should be available to them, not constrained by the whims of their health insurer,” the submission said.

“Default benefits are a key instrument in the private health ­insurance regulatory landscape, ­incentivising private health insurers and hospitals to agree to productive contracting arrangements to deliver care to insured patients.

“Currently, default benefits only apply if members receive treatment in a bricks-and-mortar hospital.

“Out-of-hospital care has the potential to fundamentally improve the capability and efficiency of the private health system.

“Out-of-hospital care can often be more effective with lower readmission rates, length of stay, morality and increased patient satisfaction.”

However, the nation’s peak body representing private health insurers shut down proposals to overhaul its funding model, arguing the changes would be inflationary and unsustainable.

Private Healthcare Australia chief executive Rachel David – who represents major providers including Bupa, HCF, Medibank, Nib, AIA and CBHS – said an ­expansion to default benefits could lead to lower quality care and see consumers’ health premiums rise.

“Health funds are already funding out-of-hospital care to support affordability and convenience for members, and we agree greater penetration of new models of care in the community will be required,” Ms David told The Australian.

“An inflationary default benefit which is payable regardless of the quality, the type, or the requirement for the service is not however the answer.

“Out-of-hospital care can mean anything from wound management, to drug and alcohol detox, to complex palliative care with home nursing. There is no ‘one-size-fits-all’ funding model that is sustainable.”