Patients 'should be alarmed' by insurers' tactics

Health insurers' restrictions on home-care funding are against patients' best interests, Australian Private Hospitals Association (APHA) CEO Brett Heffernan says.

Mr Heffernan criticised a recent report by Medibank Private that highlighted how insurers could make savings by providing care outside of hospitals.

Such services are almost exclusively delivered by the insurers themselves, who seldom recognise or pay for any other providers.

"Insurance companies determining clinical needs based on what they're prepared to pay ... that's not why anyone takes out private health insurance," Mr Heffernan said.

"Australians' bulldust barometers are well-tuned. Care outside of a hospital is something private hospitals are perfectly positioned to provide, complementing the high-quality care patients expect inside the hospital setting.

"The two go hand-in-hand and can be complementary depending on patient needs. This continuum of care can be critical to patient well-being.

"But when insurance companies refuse to pay for the same services other than the ones they run, you'd be excused for being a tad dubious about the standard of care you're getting."

Mr Heffernan said patients "should be alarmed" when insurance companies seek to justify their forays into clinical service provision based on cost-savings.

"The growth of vertical integration by health insurers is a threat to clinician autonomy. The only people who should be making decisions about what care a patient receives and where that care is delivered is the doctor and their patient," he said.

"Private health insurers have embraced 'hospital in the home' as a model that allows them to monopolise patient care and take the decision making away from clinicians. Often they will only fund a hospital in the home or other innovative program if, lo and behold, they are also delivering it."

Mr Heffernan said APHA was seeking alternative funding options in private psychiatric and private rehabilitation hospitals.

"A default benefit in those settings would give patients more options for their care and access to innovative programs developed by the hospital for their patients in their own homes," he said.

Mr Heffernan cited the Australian Medical Association's 2023 report warning that the country could be headed towards a US-style managed care health system if insurance companies continued their push for vertical integration. 

"It said about 40 percent of patients are missing out on access to out of hospital services, in large part because the funding models don't support the innovation we know exists in the private hospital sector," he said.

"It also highlighted the danger that vertical integration is leading to outcomes that are not in patients' best interests.

"In the end, this is about large health insurers adding to their ever-expanding coffers by effectively paying themselves to provide cut-cost care. Health funds are sitting on billions of dollars of skyrocketing profits. This pitch for even more cash serves only benefit them and stands to fail patients completely."

Read more: Health insurers 'restrict patient care options'

Read more: Do we want US-style managed care in Australia?

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