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Robust private health system holds the key

Robust private health system holds the key

For Tasmania’s health system, the federal election is looming as another missed opportunity.

Much needed structural reforms to our health sector simply haven’t been talked about. The few announcements that do concern health are based purely on providing additional funding sugar hits to try and help a system perpetually struggling to meet demand.

It is an unfortunate fact that election campaigns tend to focus on splashes of cash and bricks and mortar. A contest of ideas and policy around long-term reform of health systems simply doesn’t get a look in.

Parties of all colours seem only look at electorates, not outcomes. We need to shift our political narrative from short-term measures tied to election cycles to measures achieving long-term, sustainable outcomes where all Tasmanians can access the health care they need, when and where they need it so they can live healthier lives.

The importance of the private health system in the overall achievement of such goals is often, unfortunately, underplayed or altogether not recognised.

But it is a hard cold fact that more Tasmanians have some level of private health insurance than those who don’t. All up, more than 275,000 Tasmanians are members of private health funds. The logical outcome of this is that two out of every three elective surgeries performed throughout the country are done in the private system.

So, despite only performing one-third of the elective surgery load, the public system continues to groan under pressure of growing public hospital elective surgery waiting lists. People stuck on these waiting lists often develop more complex medical conditions and complications simply because they cannot be seen anywhere near clinically recommended timeframes. It then falls entirely on the taxpayer to provide even more resources to deal with a person who is much sicker than what they were when first diagnosed as needing surgery. Health systems should be geared to make people better, not contribute to a decline in their health.

At a time when cost of living pressures are crunching family budgets, people who are putting their hand in their own pocket to help fund their health care and take pressure off the public health system, on top of contributing to the funding of the public system, need to have every incentive possible to keep their private insurance and not become 100 per cent reliant on the public system for their health care.

As a not for profit private health insurer, St.LukesHealth would like nothing better than to be able to help as many people as possible to reach outside the acute public hospital system to access their care more quickly and in a more affordable fashion. We firmly believe it is better for people to stay out of hospital wherever possible and deliver care with the aim of keeping them out.

Unfortunately, government policy settings enshrine hospitals and hospital admission as the only gateway to care pathways.

Under current outdated regulations, private health insurers are only able to fund procedures when they are performed in an admitted hospital setting.

Private health insurance should be able to provide cover for procedures done outside of a traditional hospital, where clinically appropriate, by non-hospital health providers which are currently undertaken in a hospital.  Services like wound care, intravenous infusions, rehabilitation and other post-operative procedures could be undertaken under the supervision of a general practitioner, or other health care providers in a community setting.
This would have the immediate effect of reducing inpatient demand at our public hospitals.
Importantly, such a reform would allow fit-for-purpose patient care to be offered at a lower cost, with increased accessibility, and a focus on early intervention that addresses health issues before they become serious.

We need to ensure that private health insurance regulation provides insurers with the flexibility required to keep pace with modern care delivery settings, the changing health needs of our community and actually make it easier for people to access the care they need when they need it outside of hospital, which would in practice keep them healthier or reduce the length of a hospital stay.

Private health insurance reform is a critical piece of the health picture. Without a robust private health system, the public hospital system will continue to buckle and lurch from crisis to crisis.

Tasmania badly needs health reforms which will drive fundamental change in our health system.

Policymakers need to start seeing the health system in its entirety and allow people to use private health insurance to stay out of hospital wherever possible, not just for the good of themselves but for the good of the entire State.
Paul Lupo, CEO, St.LukesHealth.