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Private Health Cover gap payments

Julia

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I had occasion to be at Accident and Emergency of my local hospital today and amongst the conversation with a nurse, she said that if a patient elects to be admitted as a private patient, the public hospital will pick up the tab for all the gap fees. This is apparently an incentive to get people to use their private cover rather than be treated as private patients.

I don't know whether this is just Qld Health or whether it applies to other States.
It would make a difference to many, I think, in deciding whether to invoke their private cover.

Has anyone else come across this?
 
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I am assuming you meant public patient.
The only incident I know of was. Two workmates had very similar accidents on the same weekend, both recieved a severe cut to one of their hands.
Anyway one went in as a public patient, the other as private(both had health cover).
The one who went in as public payed nothing, the other payed over $500.:D
 

Julia

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I am assuming you meant public patient.
No. I meant exactly what I said, i.e. that it's possible to elect to be admitted as a private patient but not pay any of the gap payments for e.g. anaesthetist, surgeon, et al.
If you have an excess on your private health policy, obviously you'd still have to pay that.
 

ghotib

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Never heard of anything like that, and it seems weird. Does it mean that public hospitals, which are notoriously short of money, actually pay for patients?

More importantly, are you OK?
 

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Has anyone else come across this?
Can't say I have, Julia;
and given the state of WA's public hospital system, I'm not keen to experiment either.
In the 1990's I had the dubious pleasure to experience the system first hand - mainly because St John's lacked the facilities I was told I needed. Not only did the Neurologist fail to see me in 4 weeks, I was also ferried between hospitals to have a non-existing blockage of a carotid ballooned; during which procedure the balloon burst. Much to my amusement, because I had also been given a double dose of valium...

A number of my Pensioners Group, whom I assist in matters Internet, Centrelink, etc, can tell even more hair-raising tales.
no thanks - I'm not keen to have a repeat performance...

PS for fish: No, the bill is picked up by your Private Insurance; the public hospital would probably benefit by not having to worry about payment because often, public patients will be unable to meet their obligations in time.
 
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This is apparently an incentive to get people to use their private cover rather than be treated as private patients.
Sorry i thought you meant public in that statement, I must have misunderstood.:rolleyes:
 
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Probably cash flow issues.

Public hospitals cannot charge for patients who elect to be admitted under the Medicare arrangements (Commonwealth/State Medicare Agreements). And it is the patients choice health insurance or no health insurance.

Note that the determined daily bed-day rate (say $1,900 per day) plus other fees (X/Ray at Say $200 a pop) for compensible patients (Workers comp, MVA patients who are litigating.)

So, rather than getting no cash for a public patient, to assist with cash flow get them to use their health insurance and do not charge then for the bed-day cost.

It is called cost shifting.

Now whether that "deal" also includes the medical/other health professional practitioners private fees is another matter altogether.

Another nice little shooftie is instead of issuing pharmaceutical starter packs (as the hospitals are supposed to do on discharge) is write a prescription for the patient to get filled shifting the cost to the PBS.

Nothing changes much does it?
 

ghotib

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But but but... Julia's original post says that the public hospital is actually paying the gap. Are you saying the "health" fund pays the hospital the set rate, and out of that the hospital pays the gap amounts? Still seems weird to me, but then I think our entire system for funding medical care is nuts.
 
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But but but... Julia's original post says that the public hospital is actually paying the gap. Are you saying the "health" fund pays the hospital the set rate, and out of that the hospital pays the gap amounts? Still seems weird to me, but then I think our entire system for funding medical care is nuts.
Health funds negotiate with private hospitals on the rates.

For public hospitals it is the minimum rate as determined by the Commonwealth Minister under the Private Health Insurance Act. Trying to find that rate is an exercise in itself but you can bet that it is less than the daily bed-day rate determined by State Governments for workers compensation, etc. However, with case-mix..........

Mind you nobody actually tells you any of the details of this sh&t. You have to dig for it. And if you get it wrong the response will be "Well, it is publicly available."
 
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Health funds negotiate with private hospitals on the rates.

For public hospitals it is the minimum rate as determined by the Commonwealth Minister under the Private Health Insurance Act. Trying to find that rate is an exercise in itself but you can bet that it is less than the daily bed-day rate determined by State Governments for workers compensation, etc. However, with case-mix..........

Mind you nobody actually tells you any of the details of this sh&t. You have to dig for it. And if you get it wrong the response will be "Well, it is publicly available."
Ok, I found one (Vic). http://health.vic.gov.au/feesman/fees1.htm#private

Example: Private admitted patient
Surgical 1-14 days $692 per day. 15+ days $542

Now, if you were a hospital administrator and the budget is tight, which would you prefer? Nothing as a public patient or $692 per day if they agreed to use their health insurance and no gap to apply?
 
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Now, if you were a hospital administrator and the budget is tight, which would you prefer? Nothing as a public patient or $692 per day if they agreed to use their health insurance and no gap to apply?
Mystery solved. Common sense wins.
 
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But but but... Julia's original post says that the public hospital is actually paying the gap. Are you saying the "health" fund pays the hospital the set rate, and out of that the hospital pays the gap amounts? Still seems weird to me, but then I think our entire system for funding medical care is nuts.
Judd has answered your question. The public system pays 100% for public patients, so they are $692 better off per day if they waive the gap and the patient agrees to be a private patient in the public system.

Sounds like good management to me and a win for the patients who can use their health fund entitlement without fear of sky rocketing gap payments.

12 year old granddaughter had a pre-auricular sinus removed (in front of her ear) in mid December and I have to say the day surgery team were proficient and caring. They let me walk with her into theatre and stay with her until she went to sleep. A sizeable sinus was removed and the ear cartiledge was scraped in an effort to to ensure full removal, and yet she has a tiny, barely visible scar. The paediatric surgeon was competent and very switched on and this is not an operation they do often. And this was the Gold Coast public hospital - I was pleasantly surprised.
 

Julia

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Sorry i thought you meant public in that statement, I must have misunderstood.:rolleyes:
This is apparently an incentive to get people to use their private cover rather than be treated as private patients.
Joe, my apologies. I did make a mistake in that later sentence. Thanks for pointing it out.

Probably cash flow issues.

Public hospitals cannot charge for patients who elect to be admitted under the Medicare arrangements (Commonwealth/State Medicare Agreements). And it is the patients choice health insurance or no health insurance.

Note that the determined daily bed-day rate (say $1,900 per day) plus other fees (X/Ray at Say $200 a pop) for compensible patients (Workers comp, MVA patients who are litigating.)

So, rather than getting no cash for a public patient, to assist with cash flow get them to use their health insurance and do not charge then for the bed-day cost.

It is called cost shifting.

Now whether that "deal" also includes the medical/other health professional practitioners private fees is another matter altogether.

Another nice little shooftie is instead of issuing pharmaceutical starter packs (as the hospitals are supposed to do on discharge) is write a prescription for the patient to get filled shifting the cost to the PBS.

Nothing changes much does it?
Thanks for explaining, Judd. I didn't get the chance to ask the details.

More importantly, are you OK?
Thanks for asking, ghoti. Yes, other than a bit sore after Lucy somehow entangled her foot between mine and I fell on packed sand. Main impact in knee so needed to check it wasn't fractured. Four hours from triage to admin to junior doctor to senior doctor to Xray to junior doctor. All pleasantly competent, however, which was good.
 

Julia

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I phoned the hospital today to try to find out if I understood correctly what was said yesterday. Spoke with the Patient Liaison Officer.

She confirmed that such an arrangement is definitely in place and further corrected my assumption that the patient would still have to pay the excess on the private policy, e.g. usually $250 or $500. She said the hospital will usually pick this up also unless it's just a one night stay when it was unlikely.

Then she went on to say that your choice of excess also makes a difference to the choices you have in a major centre of treating doctor, i.e. that the lower excess will often entitle you to more choice of hospital and doctor.
I don't quite get how this works. She's sending me some written info which I'll continue to follow up if it's still not clear.

Seems like quite a minefield which is not something you're going to want to try to negotiate if acutely injured, in pain, shock etc.

Judd, you seem well informed about all this. Can you shed any further light on the above?
 
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I had occasion to be at Accident and Emergency of my local hospital today and amongst the conversation with a nurse, she said that if a patient elects to be admitted as a private patient, the public hospital will pick up the tab for all the gap fees. This is apparently an incentive to get people to use their private cover rather than be treated as private patients.

I don't know whether this is just Qld Health or whether it applies to other States.
It would make a difference to many, I think, in deciding whether to invoke their private cover.

Has anyone else come across this?
Until the public system is taken over by the federal government, there will be cost shifting from state to federal, which decreases efficiency.

The flip side is that sometimes a doctor is forced out of the public system to make a decent living (reflecting their committment to their profession and the decades of training required to get where they are).

In all, I don't agree with the process only because certain things are cheaper for the taxpayer (eg medicines) when purchased by the government as opposed to being purchased privately.
 
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Until the public system is taken over by the federal government, there will be cost shifting from state to federal, which decreases efficiency.

The flip side is that sometimes a doctor is forced out of the public system to make a decent living (reflecting their committment to their profession and the decades of training required to get where they are).

In all, I don't agree with the process only because certain things are cheaper for the taxpayer (eg medicines) when purchased by the government as opposed to being purchased privately.
Despite not being involved in the health industry, or any other industry (apart from stacking grocery shelves) for that matter, I can appreciate the arguments here.

I start to wonder whether the Feds would be prepare to take over public hospital as opposed to "funding" them to a large extent.

Two reasons for my line of thought (a) the Feds would probably not like to be held responsible for medical misadventures or the so called waiting list issue - could be other matters as well and, (b) probably don't want the staffing/funding problem as I understand about 70% of the cost of running hospitals is salaries, etc; let the States deal with the matter of wage demands patient ratios blah blah, ie shift blame. Might as well if the States are shifting costs - the Feds would have to be aware of this.

And there is the murky waters of the Australian Constitution. State/Commonwealth relationships and all that stuff.

PS: There was an amendment in 1946 to enable the Commonwealth to fund dental treatment but like any other thing it is a "may" which means exactly that according to a High Court decision of many years ago (no I am not legally qualified. I just happen to take an interest in various matters.)
 

Julia

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Until the public system is taken over by the federal government, there will be cost shifting from state to federal, which decreases efficiency.
MW, could you explain how this relates to the issue I raised? i.e. if the public hospital picks up the tab for what the patient would otherwise pay when electing to be treated as a private patient, how does this cause cost shifting between state and federal governments? I'm obviously missing how any cost shifting occurs other than removing what would usually be gap payments for the patient.

It seems to be reasonable strategy all round in that the patient is going to be more likely to invoke their private cover and what the hospital pays in such an instance is going to be less than if that same patient were to be admitted as a public patient.
 

Logique

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If the patient invokes their private health cover, isn't the cost shifting actually from the govt to the business sector? Or if you like, private health funds propping up the public system. An arrangement the Labor-Greens govt now seeks to undermine.

Why means test the private health insurance rebate? How does it actually increase the amount of money in the overall system, especially given that ~10% of policy holders (on current estimates) will drop their private cover, giving the health funds a great excuse to increase contributions for the rest.

That is, the govt saves some money on insurance rebates to the 'rich', but they then have to plough this straight back into the public system. Or worse, maybe only some of it will come back - the public system then even more under siege. It's just bloody minded political dogma, 'rich' folks are on the luvvies hit list.

Labor-Greens either can't or don't want to see the symbiosis between the public and private systems.

As for hospitals saying '..invoke your insurance cover, and we'll cover i) gap payments, and ii) your policy excess..' ..Well that would be fine by me, but I think I'd like that promise in writing beforehand.
 
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If the patient invokes their private health cover, isn't the cost shifting actually from the govt to the business sector? Or if you like, private health funds propping up the public system. An arrangement the Labor-Greens govt now seeks to undermine.

Why means test the private health insurance rebate? How does it actually increase the amount of money in the overall system, especially given that ~10% of policy holders (on current estimates) will drop their private cover, giving the health funds a great excuse to increase contributions for the rest.

That is, the govt saves some money on insurance rebates to the 'rich', but they then have to plough this straight back into the public system. Or worse, maybe only some of it will come back - the public system then even more under siege. It's just bloody minded political dogma, 'rich' folks are on the luvvies hit list.

Labor-Greens either can't or don't want to see the symbiosis between the public and private systems.

As for hospitals saying '..invoke your insurance cover, and we'll cover i) gap payments, and ii) your policy excess..' ..Well that would be fine by me, but I think I'd like that promise in writing beforehand.
Yep and probably introduces distortions on health fund payments, eg $692 per day would not be incurred as a benefit payment if the public hospital did not shift that to the health fund. Does it also distort the level of funds from State/Fed required to operate public hospitals? "Oh look at the numbers who elected to be admitted a private patients in public hospital" type of thing.

One small issue is the choice of doctor. Not entirely true if your favorite specialist in whom you may have complete trust does not have access rights to a particular hospital.

It all jarred with what I thought happened in the public system when I was rushing around for arrangements for my wife who died in the early part of last year. What I was told or being asked to do simply didn't seem to "fit." No "So you wish to be admitted as a public or private patient?" The question first asked was "Do you have health insurance?" Like, what did that have to do with an election to be admitted as public or private?

Maybe it's just me but I simply felt there were some deceptive practices going on. Not blaming the hospital staff because that is basically how they have been trained. A bit of "This is the process to follow when admitting patients" sort of thing.
 

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