Health insurance for home care a money grab

29 October 2019

Health insurance for home care a money grab
Private health insurers are making another play for Australians money, wanting to fund services in
the home.

In response to today's Australian article, Australian Private Hospitals Association (APHA) Acting
CEO Lucy Cheetham raised a warning.

"While the intent is not stated, several references to healthcare provided in the home quote
insurer-provided services.

"Is this increased interest related to the fact that several health insurers have explicitly stated that
they want to diversify their business models and move into the delivery of health services
themselves?

"This has been an enormous frustration for private hospital providers. Time and again they have
approached private health insurers with innovative and effective out-of-hospital programs only to
have funding knocked back.

"While it sounds great to have chemotherapy in the comfort of your home, it's a furphy that it is a
cheaper option. If not managed well, it raises safety concerns. Having an insurer determining care
options rather than a medical professional is a dangerous business.

"Rehabilitation, mental health, chemotherapy, dialysis and palliative care can all be provided in the
home when clinically appropriate and patient circumstances permit. There is currently nothing to
prevent insurers from contracting with hospitals to provide these services. Aside from the bar on
covering services already funded by Medicare, there is also nothing to prevent them from paying
for community-based services offered by other providers," Ms Cheetham said.

There are a number of excellent examples where this is already happening.

Toowong Private Hospital, a private mental health hospital in Brisbane recently won a global
award for their Mobile Recovery Support Service.

Toowong Private Hospital CEO Christine Gee said the service offers individually tailored, one-toone, time limited support that enables the patient to enhance their quality of life.

"The service is for eligible Bupa members with a mental illness who have had an in-patient
admission, or who are at risk of an in-patient admission – sometimes we are able to catch people
before they need to be admitted to inpatient care.

"This partnership with Bupa has enabled us to offer a more comprehensive approach to the
delivery of mental health care and services. The service provides a multi disciplinary team to
Level 3 /11 National Circ, Barton ACT 2600. PO Box 4502, Kingston ACT 2604. [T] 02 6273 9000 [F] 02 6273 7000
[E] [W] www.apha.org.au [FB] ValuingPrivateHospitals [Twitter] @priv8hospitals
ABN 82 008 623 809

assist our patients in the community. This is contemporary care for the treatment of mental health
conditions that enables us to deliver the right care in the right place at the right time. It's a shame
we can't provide this service to all of our patients, hopefully other health insurers will come on
board at some point
"For people with severe depression and anxiety , these are socially isolating illnesses, allowing
this community model of care enables a smoother transition to home and in a number of cases
has also enabled us to support patients in their home and avoid a period of hospitalisation" Ms
Gee said.

"People might feel well in the hospital, but then when they are back in their homes, they can
sometimes feel overwhelmed and when that takes hold they may deteriorate quickly which
unfortunately often results in re-admission to hospital and another cycle of disruption to their
quality of life.

"This service enables us to follow them into the community and provide a stepped care approach
to supporting them in a recovery based approach to treatment of their mental health illness.

"This service has been especially helpful for the patients' treating psychiatrist as well as the patient
and their families and carers.

"Depending on the needs of the patient, nurses and allied health staff visit the patient at home,
providing specialist mental health treatment and support as well as assisting the psychiatrist with
case management services. Toowong Private Hospital is trusted by the psychiatrists and patients
and there is already an existing therapeutic relationship there. Patients find that very reassuring
which in turn increases the effectiveness of the treatment, it's a seamless and coordinated
approach to comprehensive mental health care." she said.

Ms Cheetham said the private hospital sector is highly regulated to ensure the safety and quality
of the services it provides. The mental health services provided by the private hospital sector are
for people at the high end of the acuity scale. Patients are referred hospital rehabilitation services
because they need a structured rehabilitation plan and interdisciplinary care - more than can be
provided through their GP.

"If health insurers want further reform we need to ensure that this is in consumers' interests. We
need to ensure that irrespective of where the service is provided or by whom, consistent standards
apply. We need to ensure that consumers are in the driver's seat able to access the options that
are right for them," she said.

-ENDSMedia contact: Frith Rayner, Director Communications and Marketing, 0413 971 999

The Australian Private Hospitals Association (APHA) is the peak industry body representing the private hospital and day surgery
sector. The private hospital sector treats 4.5 million patients a year, including treatment of a third of chemotherapy, 60 percent of all
surgery, 74 percent of all elective musculoskeletal surgery and 80 percent of rehabilitation.

Level 3 /11 National Circ, Barton ACT 2600. PO Box 4502, Kingston ACT 2604. [T] 02 6273 9000 [F] 02 6273 7000
[E] [W] www.apha.org.au [FB] ValuingPrivateHospitals [Twitter] @priv8hospitals
ABN 82 008 623 809

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31/10/2019 Small change could make huge difference to mental health care access

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4/10/2019 Facts get in the way of a bad story