INDUSTRY PERSPECTIVE
State of private healthcare in Australia
Australia’s healthcare system is often described as a mixed system, with a combination of public and private providers. While public healthcare through Medicare provides universal coverage for essential services, private healthcare offers additional options and amenities for those who can afford them.
Private Healthcare Australia (PHA) is the Australian private health insurance industry’s peak representative body that currently has 21registered health funds throughout Australia and collectively represents 98% of people covered by private health insurance. PHA member funds today provide healthcare benefits for over 14 million Australians.
Dr. Rachel David is the CEO of Private Healthcare Australia, which is a policy, advocacy and research organisation that represents Australian health insurance funds and their members.
Australian Health Journal spoke with Dr David on the trends seen in private healthcare in Australia, including the impact to private specialist consultations from workforce issues in primary health. In rising costs of living pressures to household budgets, she comments on how the industry is showing the value of private healthcare.
According to Dr. David, the services that private health insurance policyholders use are related to their age and the availability of particular services in the public hospital system.
In recent years, some procedures that were once performed in the public sector have been almost entirely shifted to private healthcare. For people under the age of 50, the predominant claim for private health insurance is mental health, followed by reproductive health and obstetrics. For men, another group claims for sporting injuries and other accidents that cannot be fixed quickly. For people aged 55-65 and 70, most claims are in the orthopaedic space, including hip replacements, knee replacements, and procedures for back pain. These are the big drivers for people to have private health insurance due to the long wait times in the public sector. As people get older, into the frail aged group, claims are related to heart disease and vascular disease, such as stents in the heart for coronary artery disease, or more major procedures like valve replacements for heart failure.
Private health insurance also covers services provided by allied health under extras cover for people seeking care in the community. The biggest claims under extras cover are for dental care, with people seeking low-cost or free dental care for things like scale and clean basic dental services and checkups.
Dr. David notes that there are a number of trends in private health insurance that have been enhanced as a result of the pandemic and the impact on the Australian economy. There have been a number of quarters of growth in private health insurance since March 2020, which is when the pandemic kicked off in Australia. This growth is due to skilled migration, more women entering the workforce, and younger people remaining on family policies until the age of 31.
On the provider side, Dr. David notes that there is a rapid return of procedural medicine into the private hospital system after the lockdowns. However, in some particular health areas, particularly mental health and rehabilitation, doctors are preferring to manage patients out of the hospital and in the community. Private health insurance providers are hoping to move with this disruption and encourage regulators to permit them to fund more care in the community and shorter stays in hospitals for people with mental health conditions and short-stay surgeries.
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25 years of non-indexation of nuclear medicine impeding access & affordability
The President of the Australasian Association of Nuclear Medicine Specialists (AANMS), Associate Professor Sze Ting Lee spoke with Australian Health Journal about the following:
Usual levels of nuclear medicine services in Australia each year
Current levels of nuclear medicine services in Australia
How changing demographics in people moving to regional areas has impacted access to nuclear medicine services
The nuclear medicine workforce including trainees
The key recommendations from the pre-budget submissionIn the lead up to the Australian Federal Budget in May 2023, Australian Health Journal reached out to peak health industry bodies to hear about their priorities, either noted in pre-budget submissions lodged with Federal Government in January 2023 or in recent forums such as the Strengthening Medicare Taskforce.
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Lived experience & human-centred design in healthcare
Recognised as one of the Top 100 Women of Influence by The Australian Financial Review, Melanie Tran is a visionary leader whose work lies at the intersection of design, technology, health, disability, and education. With a focus on human-centred design, digital strategy, and service design, she leads transformative initiatives as a Manager in Design, Digital and Data at Nous Group, a global consulting firm. Her work is driven by a deep passion for using creativity and technology to solve complex social challenges.
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The Case for Embedded Pharmacy in Residential Aged Care
Embedded pharmacy in residential aged care has been successful in South Australia at the Tanunda Lutheran Home in the Barossa Valley. Julian Soriano talks about his pharmacy role in medication management and medication safety to deliver the best clinical care for residents.
In this segment, Julian talks about the traditional pharmacy model serving residential aged care and the limitations of the imprest process for dispensing medication. Soon into the project he saw the collaboration required with GPs and onsite nurses in dispensing medication for residents in end-of-life or palliative care. Julian sees the imprest process unable to support end-of-life residents, even being able to check the availability of medication.
But what most may not be aware of, is his rapid growth since starting the business in 2013 having just been in health care a few years earlier. Being part of a 2nd generation health care family, Shawn learnt from his father on site and at trade show visits overseas. Prior to HPA, he spent 2 years working in fit-outs of operating theatres, neo-natal and general population ICU, throughout being more fascinated with what he saw.
