CHOICE membership

"I gambled on Australia's public health system and lost"


#1

Hi all,

I’ve had an interesting couple of years trying to navigate the public/private health conundrum while sitting on waiting lists for surgery.

I’ve written my story up for CHOICE.com.au: https://www.choice.com.au/money/insurance/health/articles/i-gambled-on-public-health-system-and-lost

I’m contemplating my options with health insurance, and wondering if anyone else has had a similar experience?

-JB


#2

This Choice article is possibly pertinent in Queensland at the moment as…

The waiting game for those in Queensland may have just got longer.

This is possibly the main reason why we choose to take out (expensive) private health insurance for our family as one can’t rely on the public (government) health system being fit for purpose all the time or meeting our needs in a time we expect. While the public system is often championed as having the best specialists/practitioners and often leads in many forms of treatment, waiting can be stressful and very worrying for those involved.

Combining this to a fractionalised state health systems, it doesn’t give one a high level of confidence in the public system being available when one needs it.

We have also experienced the fractionalisation of the adoption processes…if one moves from one state to another, the process also restarts just like Jonathan Brown’s experience with the public healthcare system.

The fractionalisation (and possibly duplication) of health and other public services is unacceptable in today’s day and age. We are all Australians and should be able to have the same level of healthcare and continue with the same processes should one move interstate.

Unfortunately, with the multiple layers of government tending to do their own thing, this will not be resolved unless we have a different mindset in relation to how the nation’s government function.


#4

Considering @jonathan story relates to long delays and failures in the NSW system!

Likely to be repeated across every state, as more Australians abandon private health cover in favour of the lower cost public option!

Private health options are only worthwhile if they can deliver value for money?

However for the investors in the providers of private healthy insurance and services, they are only worthwhile if they deliver profit and growth?

The public interest vs vested interests?
Very much a Federal Govt concern and debatably the only level of government able to influence or control the balance in the sector. Otherwise every state government needs to have a crystal ball. Commitments to build new facilities and train staff based on a guess of the effects in 5-10 years time of federal govt policy on personal wealth, health insurance affordability, and personal medical demands.

Unlikely to deliver the best outcome given partisan and decisive political culture?

At least Choice is still providing independent advice on how to assess private cover vs needs.


#5

It’s been fascinating leading CHOICE’s public comment on the April 1 changes - we all seem to have very different perspectives on what private health insurance is meant to be and what it’s for.

The two sides of the coin seem to be

  1. People who want to be able to pick and choose what health needs they can be covered for and see it more like a phone plan (pick and choose whether calls are more important, or data etc).

Complexity, but choice (but more risk of turning up at hospital and finding condition x is not covered under your policy)

  1. People who just want their health insurance to cover them no matter what (including people who’ve been caught out and thought they were covered but then got stung with huge fees).

Simplicity and no surprises, but less choice (You show up at the hospital and 99% sure you’ll be covered no matter what)


#6

There is a third side, the edge, that we do not have a choice about. (no pun intended).

If one goes to a GP or surgeon and is referred for X-rays, ultra-sounds, blood work or pathology tests, private health insurance does not exist unless you are admitted to hospital, and medicare usually pays a small pittance. It almost seems like the medico’s whim of the day whether they tick ‘BB’ or not (eg out of pocket), and we don’t always have the presence to ask in the circumstances of being unwell.

All referrals and medical services should be bulk billed and properly funded so there would be no need for the private system and what we are sold as ‘health insurance’. But as it is, hospital or extras cover should be allowed to cover such referrals but is not.

As coalition governments are elected it has been their policy to prefer the American system where provider and corporate income can be stratospheric, insurance companies have substantial profits, dividends flow, and personal economic resources and insurance is the key to treatment. As for the rest, few worries about them except when soliciting votes. It might not be all that different from the (current) opposition as our political options seem to be ‘right’ and ‘centre right’ minded.


#7

Excellent point, I have been thousands of dollars out of pocket from specialist appointments, temporary medical devices, getting scans (multiple times) - and I had to start all that over again in New South Wales too after already having all that done in Victoria.


#8

That is truly ridiculous. I can see where the final diagnosis might be required to be repeated under the different state management, but the tests?

One has to wonder if all of the information, if uploaded into MyHealthRecord, might have circumvented that or would just have been seen as chaff regardless, further reinforcing how poorly thought out so much of it has been.


#9

Is it a surprise given medical professionals are registered separately in each state?

We remain a loose alliance of 6 independent nation states and sundry others with lesser rights of autonomy. :upside_down_face:


#10

The same goes in the US where a medical professional moving interstate often has to retake their licensing exams! However the results of inter-state tests being rejected remains curious to me as that does not happen in the US, but then in the US it is all private so the rules are different.

I have always called us 6 cities that agreed to ‘play country’.


#11

… not sure they agreed - they just said they did because they had nothing better to do :rofl:

The way the situation in this topic has been handled by the powers that be is a disgrace. I wonder how many people get this kind of treatment, and what is the cost, both financial and more importantly to health and life …


#12

Most health professionals have been registered on a NATIONAL level since 2010 when The Australian Health Practitioner Regulation Agency (AHPRA) started.

https://www.ahpra.gov.au/About-AHPRA.aspx

Prior to this there was state by state registration.

There are some exceptions, e.g. for WA and certain jobs (such as ambulance/paramedics who are in the process of adding to AHPRA).


#13

There seem to be several threads:

Public Hospitals are full / almost full / over full -
Hospitals run at near capacity most of the time, hence the waiting lists for inpatient treatment, especially for “less urgent” conditions.

Would be a waste of resources (money, staff, infrastructure) to have an excess proportion of staff and facilities to not be doing anything - how much should be left for peak demand is a complex matter.
How much is too much?

Private hospitals also run close to capacity, which allows more patients to be cared for and to maximise hospital revenue (they are businesses after all, some are not-for-profit while some are listed on the ASX)
Private hospitals do not always have a bed vacancy for every condition, and some waiting is required, although likely to be less than in the public system for NON-emergency conditions.

Australia’s public health system is among the best in the world (yes, really - and no, I don’t work for any).

The value (or not) of private health insurance, legislated limitations, price, etc
Huge topic, see various government enquiries:

https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/completed_inquiries

Information about prior health conditions, tests and treatments is not readily available across the country, may need repeated, etc.

Each state runs that state’s public hospitals. They tend to develop their own electronic health record, each of which is poorly compatible with those of other states, the private hospitals, and the rest of the health system outside the hospitals (GP, private specialists, pathology and other testing places, physio, etc).

The non-hospital lot have developed ways to communicate and access information as needs and options have arisen. This has been developed and paid for by these companies. State governments do not believe they have any responsibility to/for anything not within the public hospital system (references available if desired).

The Federal government has had minimal role in improving information transfer within the entire health systems, despite the billions spent on the PCEHR / My Health Record (huge topic, see threads elsewhere on this site)

State and Federal governments, varying roles and responsibilities across the decades in a geographically very large country.

So: anybody got any useful suggestions to address these complex matters?


#14

Interesting reading. I’m sorry you are going through this!

I’ve had a different experience. I was diagnosed with a serious health condition in Dec 2018 that required surgery. It was scheduled 2 months later in Sydney. I now see a specialist doctor every 3 months and cannot fault a single experience. My care was the best, the nurses amazing. I did have to go to Sydney for surgery, but my specialist doctor travels to Canberra weekly.

I feel like I’m in the best hands and am so thankful that I was able to have this experience as a public patient.


#15

I understand that there is a difference between serious health conditions requiring treatnent and less urgent or non-critical (elective type) surgeries.

Priority is given to the treatemeht of serious conditions potentially at the expense of non-critical surgeries, whereby non-critical will be delayed until there are time and resources to allow the surgery to occur. Such is less likely with seriour hewlth conditions.


#16

I think that’s why I was so confident second time around - my first experience was great, it was only a couple of months and I was in.

And that was before my condition worsened - I just had mild issues at that point.

This time around, my condition was awful and I spent about 3 months getting no more than 1-3 hours sleep a night, before I found a stop-gap measure.


#17

Absolutely, I think for me there’s a disparity between the perception and reality of “elective”.

“Elective” makes it sound like I’m waiting for a nose job or face lift of my own choice, but actually not having this resolved has had a significant life impact in the last two years. I have some temporary things in place, but I’m definitely not operating at 100%.

Waiting has had flow on health effects too.


#18

The rub with that truth is that many so-called elective surgeries can have dramatic negative impacts on the quality of life if not timely treated, and if left long enough can become terminal. ‘Elective’ means its is not an immediate emergency and can be scheduled ‘at convenience’ (of the hospital system), not that it might not be quite serious to the patient’s well being.

If one is on an elective list one can be pushed back by emergencies, and that is reasonable, excepting when one’s place in the queue ages without adjustment and the system does not have the capacity to ever catch up or at least materially and sustainably reduce the average backlog. It appears in many areas of most states that latter problem is the real issue.


#19

When I was at death’s door & had quad by-pass surgery, the guy who shared my room at the [private] hospital where I was to be operated on had come from the country, by St John’s Ambulance, in an emergency dash to save his life. FOUR public hospitals, as he entered the city, told the ambulance they couldn’t take him. Although my hospital was private, when in desperation the ambulance turned up at the door, they admitted him and operated the same day I had my by-pass.

So ever since that rather chilling experience, I am a fervent believer in private health cover.


split this topic #20

A post was merged into an existing topic: CPAP Machines and Sleep Apnoea - Making sense of the plethora of devices


#21

Apart from gaps in general one charge that grinds my gears is the often (if you are not careful) huge fee to Anaesthetist. A simple day procedure for my son some time ago cost well over $1k to the Anny.
BUT a reliable source told me many moons ago - if you are private - the person with the skills is holding the scalpel; if you are public it may not be the case* & you don’t have a say. *a student can be holding the scalpel & the person with the experience is “supervising”! NTYVM