Bupa backs crackdown on cost shifting

Figures showing a jump in private patients being treated in public hospital emergency rooms prompt the Federal Government to demand change.

The Federal Health Minister Greg Hunt says the practice of cost shifting by public hospitals onto the private system is adding hundreds of dollars a year to health insurance premiums.

Independent Hospital Pricing Authority figures show the number of private patients being treated in public hospital emergency rooms has jumped 74.9 per cent from 2012-13 to 2015-16.

The figures show Queensland and Western Australia have the highest number of public hospital patients being shifted onto private cover.

Mr Hunt says while all Australians were entitled to access public hospitals free of charge, things must change.

“The practice of public hospitals billing private health insurance is driving up the cost of insurance premiums and pushing out waiting lists for public patients,” Mr Hunt told media.

Greg Hunt, Federal Minister for Health
“The latest data shows that private health insurance premiums would be 2.5 per cent lower if this practice wasn’t running rampant."
Greg Hunt, Federal Minister for Health

Bupa backs crackdown

The report echoes Bupa’s call for a crackdown on the practice.

“We believe there should be much greater scrutiny of, and transparency regarding, the information provided to members to help them make decisions to either elect to be a private patient or exercise their right to be a public patient,” Bupa said in its recent submission to a Senate Inquiry into the value and affordability of private health insurance.

“Current behaviour by many public hospitals sees many Bupa members receiving a bedside visit after a procedure or letters two or three months after an event pressuring them to declare their private cover and we believe this is unquestionably inappropriate and contrary to the intent of private patient declaration.”

Bupa says Public hospitals should only be able to charge private patients in the case of;

  • pre-booked admissions (e.g. not emergency);
  • if they have contracts with health insurers, with the contract to allow compliance, monitoring and audits, as per arrangements with private hospitals; and
  • if the patient signs a statement prior to admission, submitted to insurer at least 24 hours prior to hospitalisation, with the statement clearly spelling out the additional benefits that will be received as a private patient e.g. choice of doctor.

A bigger issue

An investigation by The Daily Telegraph found public hospitals have been hiring workers whose sole job is to persuade patients to get their health fund to pay for their hospital care, adding $330 a year to premiums.

In a submission to a Senate Inquiry the peak health insurance group Private Healthcare Australia, published research which found cost shifting has been growing at 12% a year since 2009.

It called for the removal of state government quotas for non-source revenue, with increased monitoring of private patient flows through public hospitals.

PHA also called for enhance informed consent processes to protect customers, and greater transparency on care being provided.