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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Values in Workplace Culture
Professor Sabe Sabesan, is the Clinical Dean of the Townsville Regional Medical Training network incorporating the Townsville Hospital and Health Services and the Townsville Clinical School of the James Cook University and the director of the department of Medical oncology at the Townsville Cancer Centre, Townsville Hospital.
The Professor recently wrote, “Workforce wellness and engagement have become buzzwords in healthcare settings since there is an intimate relationship between staff wellbeing and performance of the healthcare system. Wellness initiatives such as wellness champions and wellness committees have been set up in response to emerging workforce mental health issues. These are largely reactive rather than being proactive in addressing or preventing the root cause of mental health issues.”
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Improved access to technology needed for people with Type 2 Diabetes needing insulin
The National Diabetes Services Scheme (NDSS) provides subsidised products for diabetes management; however, disparities exist in access to technology between those with Type 1 and Type 2 diabetes. While continuous glucose monitoring (CGM) devices are subsidised for Type 1, they are not available for Type 2 diabetes. ADEA advocates for equitable access to these essential tools, emphasising that all individuals with diabetes deserve the resources necessary for optimal management and reduced risk of complications. Without such technologies, many are forced to rely on finger pricking, which can be inconvenient and unsafe in settings such as the workplace and in higher education.
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Launch of Australian Centre for Value-Based Health Care
The movement to value based healthcare across the industry in Australia, gained pace last month, with the Australian Healthcare & Hospitals Association launch of the Australian Centre for Value-Based Health Care.
