The (non)sense of having private insurance


Successive governments have placed more and more pressure on those of us working hard for our money to have private health insurance. This had gradually moved from being given an incentive to do it, to now getting a stiff tax penalty if you do not. In return we at least had some control on who operated on us and having our operations sooner than people waiting for surgery in a public hospital and there was nothing wrong with this – after all we pay a fair bit of money for this so it is not a matter of a favor being granted, it is a product being purchased.

Enter the ACT Government – over the last few years they have every now and then cleaned up the waiting lists of Specialities such as Orthopaedics and ENT by taking the public cases to a private hospital where the surgery is performed by the Consultant Surgeons in their private capacity. The Chief Minister refers to the arrangements as being “commercial in confidence” but the rumours in the corridors are that the Surgeons are earning as much as 30% above AMA rates – not a bad little racket if you can run parallel theatres and do ten or more major joint replacements in a day. Contrast this with a similar list in the public hospital system where you would be lucky to get two done. The reasons for this slow process in the Public System are legion and could be the subject of a separate lengthy post.

This brings us back to people who are paying a lot of money for their private health insurance – they get referred to a specific specialist who will book them in to a private hospital to operate on them. They will also be hit with a substantial out of pocket gap payment. Imagine their surprise when the punter in the bed next to them has the exact surgery, by the same surgeon yet has no out of pocket expenses or insurance and is not shy to boast about this to all those “so & so’s with insurance” who share their ward – anecdotal reports from patients confirm this has been happening.

Up to now this has been ad hoc and infrequent but yesterday we received notice that things have changed a lot – The majority of the Orthopaedic surgeons at The Canberra Hospital (all from one private group) will in future perform ALL of the public joint replacements referred to them at a specific private hospital in Canberra. This includes all pre and post op issues.

Not only is this incredibly unfair to people who pay huge amounts of money for private insurance and gap fees, it is also an incredibly short sighted and expensive way of artificially reducing surgical waitinglists without addressing the issues within the Public System that has resulted in the waiting lists being this long in the first place.

As things stand GPs in Canberra cannot even send patients to an Orthopaedic Surgeon in a public hospital – all referrals are vetted by a Physiotherapist and if this Allied Health worker overrules the GP’s clinical assessment the patient will never see a Surgeon.  Even if the Physiotherapist does graciously allow the patient to proceed past them the wait is enormous given that the Surgeons will all be working elsewhere in the private facility operating on public patients.

Clearly some of us live in the Lucky Country – others just keep paying !

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