Station: 5AA
Program: Mornings
Date: 12/12/2019
Time: 11:07 AM
Compere: Leon Byner
Interviewee: Dr Rachel David, CEO, Private Healthcare Australia


LEON BYNER: Health funds are calling- these are private health funds, they’re calling on the Federal Health Minister Greg Hunt – we might try and get him on the show tomorrow – to use the Government’s new data matching powers to stop public hospitals from rorting patients with private health insurance by allowing inexperienced doctors to treat them instead of their chosen specialist.

Let’s talk to the CEO of Private Healthcare Australia, Dr Rachel David. Rachel, good morning. Explain how…

RACHEL DAVID: [Talks over] Good morning, Leon.
LEON BYNER: …this is working and going on.
RACHEL DAVID: Look, we’ve been noticing for some years that there’s been increasing pressure from state governments on private patients to use their private health insurance when they come through a public emergency department. We’ve known this has been going on for some time and we’ve been trying to work with the Federal Government to address this because of course people presenting to an emergency department with shortness of breath and chest pains and other medical conditions can actually use their Medicare. They don’t need to use their private health insurance in that environment. And that does put significant upward pressure on premiums.

A related problem is that part of the contract we have with our members is that they get their doctor of choice or a fully trained specialist to look after them when they present the care. Now, that is- not only do they get someone who’s poorly trained but they take full responsibility for their care and provide continuity. So when someone buys private health insurance, not only are they getting surgery on time, in a private room and all of those things, but perhaps more importantly, part of what they’re buying is that one person who’s responsible, not a shift worker, a junior doctor or someone who might just be passing through.

So what we’ve noticed is that, in some cases, people have been asked to use their private health insurance in a public hospital and if there’s no compulsion, then that’s their choice. But instead of saying their fully trained specialists on call or their private specialist, that they’re being shunted around to some of the more junior staff, and in some cases, using the more senior doctors’ Medicare details, to bill Medicare and the health funds. Now that latter point: using the private doctors’ Medicare details for a more junior doctor or another staff member, that is not on, that’s against the law.

LEON BYNER: [Talks over] Isn’t that fraud?
RACHEL DAVID: Well, it’s certainly against the law, and it’s something whereby we’ve had a number of anecdotal complaints come through actually from doctors themselves in a couple of areas, where they claim that they had complaints from patients who they’d never seen because they’d come through the public system when they were on call and they were never called. And so- and in addition to that, we’ve had actually doctors who’ve been contacted and said: look, your Medicare details have been used 50 times in an afternoon, and they had no idea it was happening.

So, it’s really- we’re not- we need to be clear. We’re not blaming doctors here but this is a system that’s been geared to maximising its cash flow. It’s hurting health funds and it’s hurting our members as well as being a very poor recipe for confidence in the system. So it’s something that we can fix and we think that we should.

LEON BYNER: Do you know which hospitals have done this?
RACHEL DAVID: Look, I’m reluctant to say. There is a hospital-
LEON BYNER: [Interrupts] But you do know? I’m not going to…
RACHEL DAVID: [Talks over] Yeah. I do know.
LEON BYNER: …I’m just going to ask you- so you do.
LEON BYNER: So, the question is this: if you are a private patient in a public hospital and you say to the public hospital: well, this is what my insurance gives me. Could I have the fully-trained person I need or my choice of doctor? What, do they turn around and say: no you can’t?
RACHEL DAVID: Well, look, I think that patients aren’t asserting their rights in these cases and they’re just in distress and they’ve been pushed…
LEON BYNER: [Talks over] Sure.
RACHEL DAVID: …on a particular path, asked for their details and often even admitted to hospital without a fully-trained doctor seeing them.

So what we’re saying is that firstly, the law states that if a private specialist in a public hospital, if their Medicare details are used, they must be physically present. That’s indisputable and it’s part of the law.

The second point is we really don’t think people should be admitted to hospital as a private patient unless the fully-trained specialist on call has seen them, not an ED doctor or a junior doctor. It needs to be their doctor. That’s part of the fundamental value proposition of private health: that your specialist takes full responsibility for your care, not a random person, who you happen to be you know shunted down that particular pathway on that day.

LEON BYNER: Alright. Dr Rachel David, thank you.

Now, here we go again. So we’ve got some private hospitals – and she won’t say which ones – whose administration are using a doctor’s identification, who might be a specialist, when he or she hasn’t seen the patient.

Now, does that sound familiar? Does it? Haven’t we had a discussion about this? Haven’t we? Nothing to see here, right, Mr Premier? No.

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