This week the Australian Medical Association called for reforms to encourage greater uptake of out-of-hospital care in the private sector, with a focus on patient choice and clinical autonomy.
AMA President Dr Danielle McMullen said the lack of rules on the provision of private out-of-hospital care in Australia limited patient access to innovative models of care, like home rehab or hospital-in-the-home, while allowing private health insurers to design their own models on their own terms to cut costs and limit patient choice.
“Due to a lack of policy and legislation, private health insurers currently control virtually every aspect of private out-of-hospital care – including what services are available to patients and what they can charge – through vertical integration,” Dr McMullen said.
The AMA’s proposal for a legislated framework has been outlined in a new position statement on principles for private health insurance to cover out-of-hospital care released on 9 December.
Catholic Health Australia (CHA) has backed the AMA’s call for greater access to out-of-hospital care for patients.
“We have been calling for reform to out-of-hospital care for the past year and are pleased to see the sector unite around this issue,” said Catholic Health Australia CEO, Jason Kara.
“Treatments like chemotherapy, dialysis, wound care, palliative care and post-surgical rehab can be conducted safely at home with better outcomes – but millions of patients are missing out. We urgently need reforms that allow patients and their doctors to choose where they receive their care, rather than having that choice dictated by insurers.“
Meeting of the Private Health CEO Forum
Improving access to ‘hospital in the home’ care was a key option for reform presented to the Private Health CEO Forum (CEO Forum) today by the Minister for Health and Aged Care, Mark Butler MP.
The changes presented to the CEO Forum would require insurers to cover clinically appropriate and safe hospital-run models of hospital in the home care.
According to a statement by Minister Butler, patients will benefit from getting hospital-quality care from the comfort of their home, while hospitals will be supported to grow and innovate, with an important new funding stream.
The CEO Forum was formed in response to the Private Hospital Sector Financial Health Check to discuss a range of short and long-term reform options to ensure the availability and viability of private health services, while making the private hospital system fairer and more sustainable for patients.
Other key reform proposals presented to the CEO Forum today for consideration included:
- Changes to make maternity care more accessible and affordable, by including maternity cover as a standard inclusion across a greater number of policies instead of only ‘gold’ level policies, expanding access to new models of care, and making it easier for insurers to cover this critical service.
- Changes to improve access to mental health care, by increasing the supply of internationally educated psychiatrists, which will also have flow-on benefits for the public hospital system.
- Changes to make contract negotiations fairer between hospitals and insurers, by improving the “default benefits” system that guarantees the funding that hospitals receive when they don’t have a contract with an insurer.
- Other reforms to reduce red tape and improve productivity, to support the long-term health of the private health sector.
For more information
AMA media release: Give patients choice for out-of-hospital care
CHA backs AMA push for greater access to out-of-hospital care
Minister for Health and Aged Care, Working Collaboratively to Underpin Private Hospital Viability